Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 30
Filtrar
1.
J Fr Ophtalmol ; 47(2): 103994, 2024 Feb.
Artigo em Francês | MEDLINE | ID: mdl-37903682

RESUMO

INTRODUCTION: The goal of this study was to estimate the prevalence of workplace violence in a population of young ophthalmologists in France and to characterize these situations. METHODS: We conducted an epidemiological descriptive, cross-sectional, multi-center study based on an anonymous questionnaire. We submitted a questionnaire to all ophthalmology residents and fellows (n=157) in the Grand Est and Bourgogne-Franche-Comté regions between December 2020 and March 2021. RESULTS: The overall response rate was 76.4% (n=120, 55% female and 45% male) of whom 81.6% reported having faced aggression at least once. For 50.9% of participants, aggression had occurred several times per year. These situations occurred during the first year of residency in 64.3% of cases. They mainly consisted of verbal aggression (98.8%) by a patient or their relatives (43.7% and 29.8%). The main complaints voiced by these individuals concerned the wait time (40%) and the feeling of lack of competence or improper medical care (26.8%). Fifty-seven percent of people who faced these situations thought about it for at least a week, and 20.4% of those exposed felt anxiety at work after the incident. CONCLUSION: We found high prevalence of verbal aggression in professional ophthalmology practice. Although these situations were mainly verbal aggression without significant consequences, they sometimes lead to anxiety in the aftermath. We should prepare medical students to manage them, through appropriate theoretical and practical training, such as medical simulation described in this article.


Assuntos
Agressão , Oftalmologia , Humanos , Masculino , Feminino , Estudos Transversais , Violência , Inquéritos e Questionários
2.
J Fr Ophtalmol ; 44(9): 1349-1357, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34544594

RESUMO

PURPOSE: To compare the expression profiles of various cytokines and chemokines in vitreous samples from patients with retinal detachment (RD) to those from controls and to analyze their association with various clinical features. METHODS: In this prospective study, undiluted vitreous fluid was obtained from 41 patients with primary RD and 33 controls with macular hole or vitreomacular traction. A multiplex bead immunoassay was performed to determine the expression of 27 inflammatory mediators. RESULTS: Eleven mediators were significantly upregulated in the vitreous of RD patients compared with controls, including the following: cytokines IL-1ra, IL-6, IL-7, IL-8, IFN-γ; chemokines CCL2, CCL3, CCL4, CXCL10 and CCL11 and growth factor G-CSF. Correlation analyses showed that levels of IL-1ra, CXCL10, CCL11 and G-CSF were positively correlated to the extent of detachment, while those of IL-1ra and CXCL10 were associated with the duration of detachment. There was also a positive association between the concentrations of CXCL10 and CCL11 and preoperative flare values. Additional analysis revealed that flare values and both CXCL10 and CCL11 levels were significantly higher in eyes with grade B or C proliferative vitreoretinopathy (PVR). CONCLUSION: Our results confirm that RD induces a marked inflammatory response with a complex cytokine network. We identified proteins specifically linked to several clinical features that might contribute to photoreceptor degeneration and PVR-related redetachment. These proteins may represent potential therapeutic targets for improving the anatomical and functional outcomes of RD surgery.


Assuntos
Descolamento Retiniano , Vitreorretinopatia Proliferativa , Citocinas , Humanos , Estudos Prospectivos , Vitreorretinopatia Proliferativa/diagnóstico , Corpo Vítreo
3.
J Fr Ophtalmol ; 44(7): 937-946, 2021 Sep.
Artigo em Francês | MEDLINE | ID: mdl-34147276

RESUMO

Choosing a first-line treatment to optimize long-term outcomes is a major challenge for treating patients with neovascular age-related macular degeneration (AMD). The development of several new molecules makes it critical to identify the relevant factors to consider so as to provide an optimal risk-benefit ratio when initiating a treatment in naïve patients with neovascular AMD. This paper proposes a consensus established with the Delphi method (which includes a gradation in a consensus based on an analysis of the convergence rate of answers) to provide criteria that guide the ophthalmologist's decision for treatment initiation and follow-up in neovascular AMD patients. Fourteen questions were submitted to 93 French retina experts. Thirteen (93%) of the questions reached a consensus (≥50% of answers consensual). The criteria recommended to take into account were both efficacy and onset of action of the molecules, their safety, and the ability to decrease injection frequency. The primary criterion of expected efficacy of a molecule is a combination of the gain in visual acuity and resorption of retinal fluid. With regard to safety, experts recommend tighter follow-up for molecules currently in development, and at every scheduled visit, patients should be screened to identify early any potential adverse effects such as intraocular inflammation, retinal vasculitis or vascular occlusion. Experts also emphasize the importance of the packaging of the biological, with a preference toward prefilled syringes. Injection frequency is a key factor, and the authors recommended aiming for a maximal injection interval of 12 to 16 weeks. The stability of that maximum interval is also an important factor to consider in treatment selection.


Assuntos
Inibidores da Angiogênese , Degeneração Macular Exsudativa , Inibidores da Angiogênese/uso terapêutico , Consenso , Humanos , Injeções Intravítreas , Medição de Risco , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual , Degeneração Macular Exsudativa/diagnóstico , Degeneração Macular Exsudativa/tratamento farmacológico , Degeneração Macular Exsudativa/epidemiologia
4.
J Fr Ophtalmol ; 44(7): 962-967, 2021 Sep.
Artigo em Francês | MEDLINE | ID: mdl-34083066

RESUMO

PURPOSE: To evaluate and to compare functional outcomes and complication rates of the same-day versus delayed pars plana vitrectomy (PPV) for intravitreal retained lens fragments after cataract surgery. METHODS: Retrospective comparative series of 135 eyes with retained lens fragments that underwent PPV between August 2014 and July 2016. Sixty-two eyes received same-day PPV (group 1) and seventy-three eyes underwent delayed PPV (group 2). Outcome measures included best-corrected visual acuity (BCVA) at 6 months and postoperative complications. RESULTS: The mean time to PPV in group 2 was 4.3±5.3 days. Mean axial length, lens fragment size and surgical technique were comparable in both groups. At 6 months, BCVA was 0.27±0.40 logMAR in group 1, and 0.35±0.30 logMAR in group 2, with no significant difference (P=0.205). Fifty-one (82.2%) eyes in group 1 and 53 (72.6%) eyes in group 2 achieved BCVA of+0.30 logMAR (20/40) or better (P=0.183). The most common complications were macular edema, elevated intraocular pressure>25mmHg, and retinal detachment occurring respectively in 10 (16.1%) eyes, 4 (6.4%) eyes and one eye (1.6%) in group 1 and 11 (15.0%) eyes, 5 (6.8%) eyes and 2 (2.7%) eyes in group 2. Overall, the complication rate was similar in both groups (P=1). CONCLUSION: Our study shows that visual acuity outcomes and complication rates were similar regardless of timing of the PPV. The optimal timing of surgery remains a multifactorial decision involving patient preferences, transportation, surgeon availability and severity of the initial presentation.


Assuntos
Extração de Catarata , Catarata , Subluxação do Cristalino , Humanos , Subluxação do Cristalino/diagnóstico , Subluxação do Cristalino/epidemiologia , Subluxação do Cristalino/etiologia , Estudos Retrospectivos , Vitrectomia
5.
J Fr Ophtalmol ; 44(4): 523-530, 2021 Apr.
Artigo em Francês | MEDLINE | ID: mdl-33622547

RESUMO

INTRODUCTION: To study the functional and anatomical effects of internal limiting membrane (ILM) peeling in macular hole surgery with a minimum follow-up of 10 years. METHODS: Retrospective study of patients who underwent successful macular hole surgery prior to 2010. All patients underwent vitrectomy and ILM peeling after staining. Functional assessment included measurement of visual acuity and retinal sensitivity using microperimetry (NIDEK MP-3) as well as a subjective visual function questionnaire. Anatomical assessment was based on evaluation of the macular region and optic nerve using spectral domain optical coherence tomography (SD-OCT) with comparison to the fellow eye. RESULTS: Fourteen women and five men were included. Visual acuity of operated eyes (0.07±0.08logMar) was not significantly different from that of fellow eyes (0.04±0.08logMar) (P=0.10). The mean retinal sensitivity of the operated eyes was 25.1±1.9dB with no difference from the fellow eyes 25.2±1.6dB (P=0.82). However, 2 patients exhibited 2 relative scotomas >10dB. On questioning, 3/19 patients (16%) described a disturbing scotoma in monocular vision, while 11/19 (58%) described metamorphopsia, and 3 subjectively assessed their visual loss at more than 60%. The external limiting membrane was present and intact in all patients, and the ellipsoid zone was restored in 16/19 patients (84%). The cone interdigitation zone was intact in 9 patients, altered in one patient and not interpretable in 9 patients. Retinal optic nerve fiber layer thickness showed a moderate loss of fibers in the operated group 95.9±9.5 versus 101.5±10.9 (P=0.001) in the fellow eyes. The ganglionic complex thickness in the operated eyes (90.1±8.3) was not significantly different from that of fellow eyes (91.9±8.8) (P=0.37). CONCLUSION: ILM peeling in macular hole surgery induces anatomical changes in the inner layers of the retina, still visible on SD-OCT 10 years after the procedure. However, this remodeling of the inner layers does not appear to have significant deleterious effects on patients' retinal sensitivity or vision.


Assuntos
Membrana Epirretiniana , Perfurações Retinianas , Membrana Basal/cirurgia , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/cirurgia , Feminino , Humanos , Masculino , Retina/diagnóstico por imagem , Retina/cirurgia , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/cirurgia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual , Vitrectomia
6.
J Fr Ophtalmol ; 43(7): 586-597, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32631695

RESUMO

Major depressive disorder, bipolar disorder and schizophrenia are currently among the most common psychiatric disorders, known to constitute a serious public health issue in terms of morbidity, mortality and functional handicap. Their pathophysiology is still unclear, but there is now increasing evidence supporting the existence of abnormalities of neurotransmission. As the retina is an extension of the central nervous system, it may be an interesting site of study which might provide a better understanding of the pathophysiology of psychiatric disorders. Several studies have demonstrated retinal abnormalities, with abnormal cone and rod responses on electroretinography (ERG), suggesting a process of functional neuronal loss, structurally supported by a decrease in the retinal nerve fiber layer thickness (RNFL) on optical coherence tomography (OCT), which suggests involvement of the molecular signal pathways of neurotransmission. These tests could be useful tools for diagnosing and monitoring psychiatric disorders. This article is an overview of the literature on retinal abnormalities observed in patients with major depressive disorder, bipolar disorder or schizophrenia, and discusses how they could be pathophysiologic markers.


Assuntos
Transtorno Bipolar/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Retina/diagnóstico por imagem , Retina/fisiologia , Esquizofrenia/fisiopatologia , Acuidade Visual/fisiologia , Transtorno Bipolar/complicações , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/patologia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/patologia , Eletrorretinografia , Humanos , Fibras Nervosas/patologia , Fibras Nervosas/fisiologia , Retina/patologia , Células Fotorreceptoras Retinianas Cones/patologia , Células Fotorreceptoras Retinianas Cones/fisiologia , Células Ganglionares da Retina/patologia , Células Ganglionares da Retina/fisiologia , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Esquizofrenia/patologia , Tomografia de Coerência Óptica
7.
J Fr Ophtalmol ; 43(5): e157-e166, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32381369

RESUMO

Major depressive disorder, bipolar disorder and schizophrenia are currently among the most common psychiatric disorders, known to constitute a serious public health issue in terms of morbidity, mortality and functional handicap. Their pathophysiology is still unclear, but there is now increasing evidence supporting the existence of abnormalities of neurotransmission. As the retina is an extension of the central nervous system, it may be an interesting site of study which might provide a better understanding of the pathophysiology of psychiatric disorders. Several studies have demonstrated retinal abnormalities, with abnormal cone and rod responses on electroretinography (ERG), suggesting a process of functional neuronal loss, structurally supported by a decrease in the retinal nerve fiber layer thickness (RNFL) on optical coherence tomography (OCT), which suggests involvement of the molecular signal pathways of neurotransmission. These tests could be useful tools for diagnosing and monitoring psychiatric disorders. This article is an overview of the literature on retinal abnormalities observed in patients with major depressive disorder, bipolar disorder or schizophrenia, and discusses how they could be pathophysiologic markers.


Assuntos
Transtorno Bipolar/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Retina/diagnóstico por imagem , Retina/patologia , Retina/fisiopatologia , Esquizofrenia/fisiopatologia , Transtorno Bipolar/complicações , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Eletrorretinografia , Humanos , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Transmissão Sináptica/fisiologia , Tomografia de Coerência Óptica
8.
J Fr Ophtalmol ; 43(5): 404-410, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-32312595

RESUMO

PURPOSE: To report the causes, clinical features and surgical outcomes of retinal detachment (RD) in young adults. METHODS: Retrospective study of 111 eyes of 99 patients aged between 18 and 40 years, who underwent primary RD surgery between January 2011 and January 2019. All patients underwent either scleral buckling or pars plana vitrectomy. We analyzed the demographic data, characteristics of the RD, primary and final anatomic success rate and best-corrected visual acuity (BCVA) at the conclusion of follow-up. RESULTS: The mean age of the patients was 30.3±6.5 years. RD was more frequent in males, with a gender ratio of 1.8. The breaks were atrophic round holes or retinal dialysis in 49 (44.2%) cases and were associated with posterior vitreous detachment in 62 (55.8%) cases. The main etiologies were high myopia (45.0%) and trauma (9.0%). Retinal reattachment was achieved in 74 (66.5%) eyes overall with a single procedure and in 108 (97.2%) eyes with two or more procedures. The primary success rates were 69.6% (46/66 eyes) with scleral buckling and 62.2% (28/45 eyes) with vitrectomy. High myopia was a risk factor for surgical failure (P<0.01). The mean BCVA improved from 0.71±0.64 logMAR to 0.41±0.35 logMAR (P<0.01) CONCLUSION: RD in young adults differs from that in older adults in clinical features and etiology. The main causes are trauma and high myopia. The anatomic outcomes appear less favorable, with a primary reattachment rate of 66.5%. However, the functional prognosis remains satisfactory with an improvement of 3 lines of visual acuity.


Assuntos
Descolamento Retiniano/diagnóstico , Descolamento Retiniano/epidemiologia , Descolamento Retiniano/cirurgia , Adolescente , Adulto , Idade de Início , Feminino , Humanos , Masculino , Descolamento Retiniano/etiologia , Estudos Retrospectivos , Fatores de Risco , Recurvamento da Esclera/métodos , Recurvamento da Esclera/estatística & dados numéricos , Resultado do Tratamento , Acuidade Visual , Vitrectomia/métodos , Vitrectomia/estatística & dados numéricos , Descolamento do Vítreo/complicações , Descolamento do Vítreo/epidemiologia , Descolamento do Vítreo/cirurgia , Adulto Jovem
9.
J Fr Ophtalmol ; 43(1): 43-50, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31870667

RESUMO

PURPOSE: To evaluate anatomical and functional outcomes of surgical displacement of macular hemorrhages complicating exsudative age-related macular degeneration (AMD) after vitrectomy, subretinal rtPA (recombinant tissue plasminogen activator) injection, intravitreal bevacizumab injection and gaz tamponade. METHODS: Retrospective case series, including 26 patients with submacular hemorrhage, who underwent a surgical displacement within 15 days after the onset of symptoms. Optical coherence tomography (OCT) was carried out to measure the diameter of the hemorrhage and to specify the relation with retinal pigment epithelium. Anatomical success was defined as a total displacement of the hemorrhage away from the fovea at first postoperative visit. Visual acuity improvement was measured at 1 and 6 months and at final postoperative visit. RESULTS: The procedure resulted in hemorrhage displacement away from the fovea in 20 eyes (81%). Visual acuity significantly improved by 5,8 (±7,2) lines (P=0.0003) at 1 month postoperatively, 7,4 (±6,7) lines (P=0.0004) at 6 months and 7,4 (±7,4) lines (P=0.0002) at final postoperative visit (16,5±19,8 months). There was an inverse correlation between hemorrhage diameter and final acuity improvement (Pearson correlation coefficient P=-0.60 (IC 95% [-0.81; -0.26]; P=0.002)). CONCLUSION: Vitrectomy with subretinal rtPA injection was found to be effective for the displacement of AMD hemorrhage in 81 % of the patients. Mean final visual acuity improved by more than 7 lines.


Assuntos
Hematoma/terapia , Degeneração Macular/terapia , Hemorragia Retiniana/terapia , Ativador de Plasminogênio Tecidual/administração & dosagem , Vitrectomia , Idoso , Idoso de 80 Anos ou mais , Bevacizumab/administração & dosagem , Bevacizumab/efeitos adversos , Terapia Combinada , Feminino , Hematoma/complicações , Hematoma/tratamento farmacológico , Hematoma/cirurgia , Humanos , Injeções Intraoculares , Degeneração Macular/complicações , Degeneração Macular/tratamento farmacológico , Degeneração Macular/cirurgia , Masculino , Dados Preliminares , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Hemorragia Retiniana/complicações , Hemorragia Retiniana/tratamento farmacológico , Hemorragia Retiniana/cirurgia , Estudos Retrospectivos , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento , Vitrectomia/efeitos adversos , Vitrectomia/métodos
10.
J Fr Ophtalmol ; 42(9): e391-e397, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31471124

RESUMO

INTRODUCTION: Macular subretinal hematoma is a complication of age related macular degeneration (AMD) responsible for a severe change in vision. We evaluated anatomic and functional results of surgical treatment of hematoma by vitrectomy, subretinal injection of r-tPA (recombinant tissue plasminogen activator), intravitreal bevacizumab injection and air tamponade. METHODS: Retrospective case series including 26 patients with submacular hemorrhage who underwent vitrectomy within 15 days after the onset of symptoms. Optical coherence tomography (OCT) was performed to measure the diameter of the hemorrhage and specify the location in relation to the retinal pigment epithelium. Anatomical success was defined as a total displacement of the hemorrhage out of the fovea at the first postoperative visit. Visual acuity improvement was measured at 1 and 6 months and at final postoperative visit. RESULTS: The procedure resulted in hemorrhage displacement away from the fovea in 20 eyes (81%). Visual acuity significantly improved by 5.8 (±7.2) lines (P=0.0003) at 1 month postoperatively, 7.4 (±6.7) lines (P=0.0004) at 6 months and 7.4 (±7.4) lines (P=0.0002) at the final postoperative visit (16.5±19.8 months). There was an inverse correlation between hemorrhage diameter and final acuity improvement (Pearson correlation coefficient ρ=-0.60 (IC 95% [-0.81; -0.26]; P=0.002)). CONCLUSION: Vitrectomy with subretinal r-tPA injection was found to be effective for the displacement of AMD hemorrhage in 81% of the patients. Mean final visual acuity improved by more than 7 lines, confirming the efficacy and functional benefit of surgical displacement.


Assuntos
Hematoma/etiologia , Hematoma/terapia , Degeneração Macular/complicações , Hemorragia Retiniana/etiologia , Hemorragia Retiniana/terapia , Ativador de Plasminogênio Tecidual/administração & dosagem , Vitrectomia , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Injeções Intralesionais , Degeneração Macular/fisiopatologia , Masculino , Proteínas Recombinantes/administração & dosagem , Recuperação de Função Fisiológica , Retina , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
11.
J Fr Ophtalmol ; 42(8): 844-851, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31164299

RESUMO

INTRODUCTION: The purpose of this study was to describe the epidemiologic characteristics of adult uveitis evaluated at the regional center of excellence specializing in systemic and autoimmune disease in the Nancy university medical center. The secondary objectives were to describe the progression over time of the various etiologies and to identify local specificities. MATERIALS AND METHODS: We performed a retrospective epidemiological study of patients diagnosed with uveitis. All patients were referred to the regional center of excellence of the Nancy university medical center between January 1, 2005 and December 31, 2016. Patients under 18 years of age, patients with a first episode of acute anterior uveitis, as well as patients for whom the etiological diagnosis was made by the ophthalmologist with no need of internal medicine referral, were excluded. Age, gender, laterality, site of inflammation, clinical signs, etiology (infectious, non-infectious or idiopathic, as well as diagnosis), and date of first consultation were recorded. RESULTS: Six hundred and ninetypatients were included, with 59 % women and a mean age of 49 years. The uveitis was unilateral in 53 % of cases. Panuveitis was the most common form (52 %, N=358), followed by recurrent anterior uveitis (30 %, N=205), posterior uveitis (16 %, N=107), and intermediate uveitis (3 %, N=20). Non-infectious etiologies accounted for 35 % of all uveitis (the most common being HLA-B27 uveitis, sarcoidosis, ankylosing spondylitis and Behçet's disease) and infectious etiologies for 13 % (tuberculosis, toxoplasmosis and Lyme disease were the most frequent). The uveitis was idiopathic in 52 %. A trend toward improvement in diagnostic yield was observed : 53 % of uveitides were considered idiopathic prior to 2011 compared to 50 % after 2011 (P<0,01). CONCLUSION: We identified a majority of panuveitis, which is explained by our inclusion criteria. Fifty-two percent of our series remained idiopathic, with an improvement in the diagnostic yield over time. This could be related to both repeated etiological assessments and better diagnostic performance. The study of this large cohort of patients improved our knowledge of the characteristics of uveitis in our center.


Assuntos
Uveíte/epidemiologia , Uveíte/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , França/epidemiologia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Uveíte/diagnóstico , Adulto Jovem
12.
J Fr Ophtalmol ; 42(6): 618-625, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31084938

RESUMO

PURPOSE: To determine the diagnostic and functional yield of vitrectomy in patients with uveitis of unknown origin. METHODS: A single-centered retrospective study was performed on patients who underwent a diagnostic vitrectomy for uveitis in the Department of Ophthalmology of the Nancy University Hospital from January 2011 to December 2016. Vitreous samples were analyzed in the cytology laboratory by cytological and immunohistochemical techniques, and in the microbiological laboratory by culture and bacterial, fungal and viral PCR, depending on clinical findings. Preoperative and one- and six-month postoperative visual acuity were collected and compared. RESULTS: Thirty-four patients (39 vitrectomies) were included. Vitreous testing led to a diagnosis in 14 out of 39 cases (36 %): 10 intraocular lymphoma, 2 amyloidosis, 1 CMV retinitis, and 1 choroidal metastasis of cutaneous melanoma with vitreous dissemination. Vitrectomy was negative in 20 patients. Visual acuity improved from 1.2±0.7 logMAR preoperatively to 0.8±0.7 logMAR at 1 month (p<0.001) and 0.9±0.8 logMAR at 6 months (p=0.054). CONCLUSION: In our study, diagnostic vitrectomy and vitreous fluid analysis were useful to diagnose uveitis of unknown origin, most of which were found to be intraocular lymphomas. Visual acuity improved for the majority of patients. Diagnostic vitrectomy with appropriate vitreous analysis related to clinical examination must be considered in the evaluation of uveitis of unknown origin.


Assuntos
Uveíte/diagnóstico , Vitrectomia , Idoso , Amiloidose/complicações , Amiloidose/diagnóstico , Neoplasias Oculares/complicações , Neoplasias Oculares/diagnóstico , Feminino , Humanos , Linfoma/complicações , Linfoma/diagnóstico , Masculino , Melanoma/diagnóstico , Melanoma/secundário , Retinite/diagnóstico , Retinite/virologia , Estudos Retrospectivos , Uveíte/etiologia , Acuidade Visual , Vitrectomia/estatística & dados numéricos , Corpo Vítreo/microbiologia
13.
J Fr Ophtalmol ; 42(1): 49-56, 2019 Jan.
Artigo em Francês | MEDLINE | ID: mdl-30611541

RESUMO

PURPOSE: To compare performance on the EyeSi surgical simulator in 3 training modules by users with different levels of experience in ophthalmology. METHODS: We included 18 surgeons (6 residents with no cataract experience, 6 residents with little experience (1 to 10 cases) and 6 experienced cataract surgeons (over 500 cases). Three modules were selected (capsulorhexis, phacoemulsification-cracking and irrigation and aspiration). All subjects completed 12 levels of increasing difficulty twice, and the results of the second trial were analyzed according to the surgeon's experience. RESULTS: For the capsulorhexis module, experienced surgeons achieved higher total scores than the other 2 groups in exercise 1 (P=0.0102). For the phaco-cracking module, experienced surgeons achieved higher total scores in exercise 8 (P=0.0495) and a tendency toward significance in exercises 3 (P=0.0934) and 5 (P=0.0938). Participants with greater experience had lower total task time in exercises 1 (P=0.0444), 4 (P=0.06) and 5 (P=0.0189). CONCLUSION: Experienced surgeons outperformed residents with regard to overall score in 4 exercises of the capsulorhexis and phaco-cracking modules. Our results confirm previously demonstrated construct validity for these modules on the EyeSi simulator. These findings will help in the development of relevant training programs that could potentially be applied to the standard ophthalmological curriculum.


Assuntos
Capsulorrexe , Paracentese , Facoemulsificação , Treinamento por Simulação/métodos , Cirurgia Assistida por Computador , Irrigação Terapêutica , Capsulorrexe/instrumentação , Capsulorrexe/métodos , Competência Clínica , Simulação por Computador , Avaliação Educacional , Humanos , Internato e Residência , Curva de Aprendizado , Procedimentos Cirúrgicos Oftalmológicos/instrumentação , Procedimentos Cirúrgicos Oftalmológicos/métodos , Oftalmologia/educação , Oftalmologia/instrumentação , Oftalmologia/métodos , Paracentese/instrumentação , Paracentese/métodos , Facoemulsificação/instrumentação , Facoemulsificação/métodos , Reprodutibilidade dos Testes , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Irrigação Terapêutica/instrumentação , Irrigação Terapêutica/métodos , Interface Usuário-Computador
14.
J Fr Ophtalmol ; 41(10): 939-944, 2018 Dec.
Artigo em Francês | MEDLINE | ID: mdl-30442489

RESUMO

PURPOSE: To evaluate the anatomical and functional outcomes of macular hole (MH) surgery with a temporal inverted internal limiting membrane (ILM) flap technique. METHODS: Monocentric retrospective study of 24 patients who were operated on for macular hole between March 2014 and April 2017 at Nancy University Hospital. All patients underwent pars plana vitrectomy with the inverted ILM flap technique. ILM peeling was restricted to the temporal side of the fovea, and the macular hole was then covered with the ILM flap, followed by SF6 tamponnade and first day face-down positioning. The main outcome measures included macular hole closure rate and visual acuity at 1 month postoperatively. RESULTS: Eight men and 16 women of mean age 67.0±5.4 years were included. The mean axial length was 23.5±1.2mm. The mean diameter of the MH was 362±123µm. Closure of the MH was achieved in 23 of 24 eyes (95.8%) after one surgery. The mean BVCA improved significantly from 0.71±0.20 logMar to 0.29±0.22 logMar (P<0.001) at 1 month postoperatively, for a gain of 0.42±0.24 logMar. CONCLUSION: Macular hole surgery with the inverted ILM flap technique results in good anatomical and functional outcomes, comparable to those obtained with the classic technique with complete ILM peeling.


Assuntos
Perfurações Retinianas/patologia , Perfurações Retinianas/cirurgia , Retalhos Cirúrgicos/transplante , Vitrectomia/métodos , Vitrectomia/reabilitação , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Perfurações Retinianas/fisiopatologia , Estudos Retrospectivos , Vitrectomia/efeitos adversos
15.
J Fr Ophtalmol ; 41(9): 814-822, 2018 Nov.
Artigo em Francês | MEDLINE | ID: mdl-30217613

RESUMO

PURPOSE: To evaluate the improvement in quality of life of patients operated within 6 months for strabismus in Graves' disease using a questionnaire. MATERIALS AND METHODS: A retrospective study was based on a cohort of patients undergoing strabismus surgery for Graves' disease at the Nancy university medical center between June 2015 and January 2017. A quality-of-life questionnaire composed of the functional GO QOL questionnaire plus 10 additional questions was given to patients. The questionnaires were completed by patients in consultation before surgery and then at six months postoperatively. A subgroup analysis was conducted to identify potential risk factors such as smoking, orbital decompression, duration of disease progression, number of surgeries, previous treatments or gender influences on the progression of the postoperative score. RESULTS: Thirty-three patients (15 men/18 women) underwent surgery, with mean age 56 years; 16 (48 %) were smokers, 24 (70 %) were operated for the first time for strabismus. 8 patients (24 %) had a history of surgical orbital decompression. The mean preoperative GO QOLf was 30 (±23.8), which increased to 72 (±29.6) postoperatively (P=0.004). All the answers to the questions proposed were improved by surgery. The most improved items were difficulty in extreme gaze+6.82 points (P=0.001) and going down stairs +6.81 (P=0.002). Smokers had a lower preoperative GO QOLf than non-smokers (25±22.84 vs. 34±24.55); the same was true for their postoperative improvement (35±34.5 points vs. 50±18.8, P=0.002). History of orbital decompression did not appear to influence quality of life (21±25.39 vs. 65±33.98); the same was true for previous corticosteroid or immunosuppressant treatment (28±23.52 vs. 67±28.24), respectively P=0.42; P=0.73. Gender did not appear to influence the results P=0.17. First-time strabismus surgery patients showed a tendency which was not significant toward better improvement after 2 or 3 surgeries (respectively 45 vs. 39 vs. 33) P=0.056. There was no correlation between the duration of the disease and the change in the GO QOLf (R=0.04). CONCLUSION: This study confirms that strabismus surgery significantly improves the quality of life of patients with Graves' ophthalmopathy. The GO QOLf demonstrates its effectiveness in highlighting this progression. Our ten additional questions proved to be very good tools for assessing this condition.


Assuntos
Oftalmopatia de Graves/cirurgia , Qualidade de Vida , Estrabismo/cirurgia , Inquéritos e Questionários , Descompressão Cirúrgica , Feminino , Doença de Graves/complicações , Doença de Graves/cirurgia , Oftalmopatia de Graves/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Estrabismo/complicações
16.
J Fr Ophtalmol ; 41(6): 546-553, 2018 Jun.
Artigo em Francês | MEDLINE | ID: mdl-29887407

RESUMO

PURPOSE: To describe epidemiological characteristics of outpatients examined by university medical center ophthalmologists in emergency rooms (ER), and to determine factors associated with true emergencies. METHODS: A monocentric cross-sectional study including all patients examined by an ophthalmologist in the ER of in the university hospital of Nancy over a two-month period was conducted. Demographics and medical characteristics were assessed. The visits were categorized by ophthalmologists as true emergencies or not. RESULTS: Among the 1,308 patients included, the median (IQR) age was 49 (32-64) years, and 56 % were males. The main reasons for seeking care were eye redness (32.6 %), eye pain (30.0 %), eye trauma (26.1 %), and visual loss (23.3 %). Nearly 40 % of the consultations were judged as not truly emergent. Factors significantly associated with true emergencies were: age under 60, male gender, some reasons for seeking care (visual loss, eye redness, eye pain), and a period of less than 3 days between symptom occurrence and the ER visit. CONCLUSION: The proportion of non-emergent ER visits was relatively high, and factors associated with true emergencies have been identified in our study. Standardized protocols may be useful to help emergency physicians and nurses to determine when to refer a patient to an ophthalmologist.


Assuntos
Emergências/epidemiologia , Traumatismos Oculares/epidemiologia , Traumatismos Oculares/terapia , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Estudos Transversais , Serviços Médicos de Emergência , Feminino , França/epidemiologia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Oftalmologistas , Oftalmologia/estatística & dados numéricos , Fatores de Risco
18.
J Fr Ophtalmol ; 40(10): 853-859, 2017 Dec.
Artigo em Francês | MEDLINE | ID: mdl-29100608

RESUMO

INTRODUCTION: Although the general increase in ambulatory surgery allows for a 20% reduction in costs of hospitalization, the necessity of a day 1 postoperative visit remains the main problem for elderly patients or those who reside at considerable distance. For these reasons, in 2014, we decided to only see patients with uncomplicated filtering surgery at D5 and D21 and to replace the D1 visit with a telephone call. The primary goal of our study was to analyze a population of patients undergoing uncomplicated filtering surgery who were not seen at D1 and to describe the frequency of postoperative complications, intraocular pressure results and therapeutic management at D5 and D21. PATIENTS AND METHODS: This was a retrospective monocentric study in the department of ophthalmology. All patients (naïve of surgical treatment for glaucoma) underwent surgery for primary open-angle glaucoma in an ambulatory surgery unit between May 2014 and July 2016. A nurse made a phone call to the patients at day 1 and they responded to a standardized questionnaire. Depending upon their responses, the patients were seen quickly (<24hr) or on the systematic schedule at day 5 and day 21. RESULTS: One hundred and forty-four eyes (126 patients) were included in our study. The mean preoperative IOP was 20.4±6.4mmHg. After the phone call, only five patients were examined before the first planned follow-up at day 5. For 3 of them, the examination revealed the presence of a hyphema, and their topical medication was changed. The other two patients had no treatment modifications. At day 5, the mean IOP was 10.6±5.9mmHg. Thirty-two eyes (22.2%) required a change in their medication at day 5. The mean IOP at day 21 was 12.9±4.6mmHg. Our success rate (IOP<21mmHg with no topical medication) at day 21 was 95.6%. DISCUSSION: The guidelines for filtering glaucoma surgery recommend examining the patient at day 1 (or at least before day 3), day 8, day 15 and day 30 or more frequently according to the case. We replaced the day 1 visit with a telephone call. We did not note a substantial rate of complications due to the elimination of the D1 visit. The criteria of success of filtering glaucoma surgery vary in the literature, but our success rate at D21 seems to be similar that in the literature and may suggest that the day 1 visit is not necessary if the surgery for primary open angle glaucoma is uncomplicated.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Cirurgia Filtrante/métodos , Glaucoma de Ângulo Aberto/cirurgia , Cuidados Pós-Operatórios/métodos , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/métodos , Feminino , Seguimentos , França/epidemiologia , Glaucoma de Ângulo Aberto/epidemiologia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Pacientes Ambulatoriais , Complicações Pós-Operatórias/epidemiologia , Consulta Remota , Estudos Retrospectivos
20.
J Fr Ophtalmol ; 39(7): 636-40, 2016 Sep.
Artigo em Francês | MEDLINE | ID: mdl-27591131

RESUMO

PURPOSE: To evaluate the anatomical and functional results of macular hole surgery with internal limiting membrane (ILM) peeling after 10 years follow-up. METHODS: Monocentric retrospective study of patients who had undergone macular hole surgery between 2003 and 2005 in the Nancy University Medical Center and still followed in the department in 2014. All patients underwent pars plana vitrectomy and ILM peeling without staining. Clinical examination at ten years including determination of best-corrected visual acuity (BCVA), evaluation of quality of life and spectral domain optical coherence tomography was performed. RESULTS: Four men and six women with mean age of 64±8 years were included. The mean diameter of the MH was 395±133µm. The mean best corrected visual acuity improved significantly from 0.90±0.22 logMAR to 0.14±0.14 logMAR after 10 years with a satisfactory quality of life in 90 % of patients. The integrity of the IS/OS layer was preserved in 9 eyes. Inner retinal dimples located in the temporal quadrant related to ILM peeling initiation were observed in 8 eyes. No significant RNFL or ganglion cell complex changes were found compared to the contralateral eye. CONCLUSION: Macular hole surgery with ILM peeling in this series resulted in a visual acuity gain of 8 ETDRS lines and persistent improvement in quality of life after a 10-year follow-up.


Assuntos
Membrana Epirretiniana/cirurgia , Perfurações Retinianas/cirurgia , Vitrectomia/métodos , Idoso , Membrana Epirretiniana/complicações , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Perfurações Retinianas/complicações , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...