Perioperative time and economic impact of an intracameral combination of mydriatics and anaesthetics in routine cataract surgery.

PURPOSE: The aim of this study was to compare the perioperative time and economic impact of a licensed intracameral anaesthetic/mydriatic combination (Mydrane) during routine cataract surgery. METHODS: A real-life, prospective, comparative study was performed in 3 clinical centres in France. Preoperative, surgical, and post-operative times were determined for two mydriasis strategies using conventional preoperative mydriatics/anaesthetics eye drops (control regimen) or Mydrane administered at time of surgery. Staff, surgery schedules and drugs utilisation were collected over 12 surgery half-days. The total cost of each strategy was estimated based on treatment cost and nursing costs. RESULTS: The analysis included 112 routine cataract surgeries (57 surgeries using Mydrane and 55 using the topical regimen) without protocol deviations or complicated surgery. Overall, the mean time between administration of the first mydriatic eye drops or Mydrane and the end of the surgery was 27.4 ± 21.1 min in the Mydrane group vs. 90.3 ± 30.4 min in the control group (P < 0.0001). The total time of the procedure (from admission to discharge) was not significantly different between groups (P = 0.1611). On average, the extra cost of drugs per patient in the Mydrane group (€5.81) was almost balanced by the reduced nursing time (€5.57) with some variations between centres, due to different organisation including staff resource and consumable. CONCLUSIONS: The Mydrane strategy produced perioperative nursing time saving and cost reduction provided that adaptation and reorganisation of routine cataract surgery are implemented.

Refractive and topographic stability of Intacs in eyes with progressive keratoconus: five-year follow-up.

PURPOSE: To evaluate the long-term rate of progression of keratoconus in eyes implanted with Intacs (Addition Technology Inc) at 5-year follow-up. METHODS: Data of 105 eyes from 85 patients who had undergone consecutive Intacs implantation between January 2001 and December 2005 were studied retrospectively for progression of keratoconus. Progression of keratoconus was defined as an increase in steep keratometry (K) of ≥ 1.00 diopter (D) over 4 years between 1- and 5-year follow-up. All eyes were categorized into three subgroups: eyes with documented preoperative progression (change in steep K ≥ 1.00 D over 12 months preoperatively), eyes with documented absence of preoperative progression, and eyes with no record of preoperative progression. RESULTS: Ninety-two eyes were available for analysis. Overall, 91.3% (84/92) of eyes demonstrated no progression between 1- and 5-year follow-up. In the sub-group analysis, 92.9% (52/56) of eyes with documented preoperative progression demonstrated no progression. Additionally, no statistically significant differences were noted in mean steep, flat, and average keratometry; manifest refraction spherical equivalent; and uncorrected and corrected distance visual acuity (P>.05) between 1- and 5-year follow-up. CONCLUSIONS: Results of our study demonstrate the long-term stability of refractive and topographic outcomes following Intacs implantation in eyes with keratoconus. The finding that 92.9% of eyes with progressive keratoconus did not progress postoperatively indicates that Intacs implantation may be a potential therapeutic option to halt progressive keratoconus.

Keratoconus associated with Williams-Beuren syndrome: first case reports.

PURPOSE: To report two memorable clinical comorbid cases of Williams-Beuren syndrome (WBS) associated with keratoconus (KC). WBS is known to be an abnormal systemic development caused by a microdeletion of contiguous genes in chromosome 7q11.23, which includes the elastin gene. KC is currently suspected to have a genetic origin but the responsible gene has not been clearly identified. METHODS: KC and WBS is described for two cases. Risk factors for KC were investigated by interviewing parents, and WBS was confirmed by fluorescence in-situ hybridization (FISH). Histological analysis with Orcein (coloring specific to elastin) on the receiver corneal button of patient 1 was carried out. RESULTS: Because of the rarity of both pathologies and the absence of other risk factors for developing keratoconus, we considered a possible genetic link. The association had never been reported in the literature. The first histological investigation could not confirm the presence of abnormal elastin in the cornea, but another gene could be responsible. CONCLUSION: This report highlights the first cases of this association. Further histological and cytogenetic investigation on the deletion should be interesting in order to argue a possible physiopathological or genomic link.