[Quality of life survey of 3,738 patients treated with intravitreal injections for age-related macular degeneration]. / Enquête de qualité de vie auprès de 3738 patients traités par injections intravitréennes pour leur dégénérescence maculaire liée à l'âge.

PURPOSE: To evaluate the peri- and post-intravitreal injection (IVI) symptoms reported by patients who have been repeatedly injected for age-related macular degeneration (AMD) and to analyze these according to the protocols of the injector. MATERIALS AND METHODS: Multi-center, cross-sectional, consecutive, analytical survey. RESULTS: The IVI protocols of 106 injectors differed in terms of the number of instillations of povidone-iodine, its contact time, and rinsing of the ocular surface post-injection. In total, 3,738 patients responded to the survey, 60.1% of whom were women; 36.4% had received more than 20 IVIs; 50.7% of patients reported irritation upon application of povidone-iodine. Post-IVI, depending on the symptom in question, between 44.8% and 57.4% of patients reported symptoms of ocular surface change. The number of instillations of povidone-iodine, its contact time with the ocular surface, and abundant rinsing post-IVI increased the immediate symptoms. Patients who received more IVIs were more prone to experiencing gritty eyes, and the incidence of acute pain increased in patients who had previously received over 20 IVIs. Women and patients previously treated for dry eye or glaucoma were at greater risk of worse symptoms. CONCLUSION: Comparing injecting centers' practices with patients' self-assessments showed an aggravation of symptoms of ocular surface changes related to povidone-iodine. This survey contributes to providing data for the implementation of a protocol to improve the quality of life of patients injected repeatedly for AMD.

[Quality of life after corneal transplantation: a retrospective study]. / Qualité de vie après greffe de cornée: étude rétrospective.

PURPOSE: To assess how clinical and social characteristics influence health-related quality of life among patients who have undergone corneal transplantation. METHODS: Sixty-eight patients followed up for at least 1 year after corneal transplantation participated in this study. Data were collected on social status, systemic co-morbidities, ocular history, best corrected visual acuity, and a detailed ocular examination. Questionnaires that allowed calculation of VF14 and the SF36 scores were filled out for each participant interview. The associations between questionnaire outcomes and social status, ophthalmic status, and general health were evaluated using one-way analysis of variance and multiple stepwise linear regression. RESULTS: The mean best-corrected visual acuity (BCVA) was significantly better in the operated eye for keratoconus and dystrophies than for bullous keratopathy. There is a strong relationship between BCVA in the operated eye and the VF14 score (beta=8.45, p=0.005) and also between BCVA of the contralateral eye and the VF14 score (beta=19.91, p<0.0001). Correlations between VF14 and SF36 were all positive (range r=0.29-0.49, p<0.01). CONCLUSION: This retrospective analysis provided strong evidence for the validity and reliability of the VF14 as an instrument for testing visual disabilities or satisfaction in patients who had corneal transplantation. Astigmatism or anisometropia did not affect VF14 and SF36 scores. The most important factors associated with the VF14 score and SF36 measures were the visual acuity of the operated eye as well as the contralateral one, including their physical function, vitality, and the patient's perception of mental and general health.

[Comparison of PKR and LASIK for the treatment of low myopia: statistic study of refractive and optic results]. / Comparaison de la photo-kératectomie réfractive et du LASIK pour le traitement des myopies faibles.

PATIENTS AND METHODS: We present a study which compares the refractive and optical results obtained after PKR and LASIK for the correction of low myopia without astigmatism. This retrospective study involved 729 patients. All operations performed by the same surgeon, and with the same excimer laser (a Technolas Keracor 117 C). Before operation, all patients had a spherical equivalent between -0.5 and -6.0 D and a cylinder less than -0.5 D. Two groups were formed according to the treatment used. Three postoperative examinations were done (the first between 3 and 7 days, the second between 1 and 3 months, and the third between 10 and 14 months). Refractive results: Our statisticaly study found no difference in the results obtained with the two techniques. COMPLICATIONS: The incidence of complications was similar for the two procedures, but those observed after LASIK are generally more serious. DISCUSSION: In this indication, the efficacy of PKR and LASIK is similar. CONCLUSION: PKR and LASIK are safe and efficacy for the treatment of low myopia. For these patients, the use of PKR of LASIK currently depends on the habit and preference of the surgeon.

Cancer transmission through corneal transplantation.

PURPOSE: A retrospective study to demonstrate the safety of corneas from donors affected by systemic malignancies in a view of keratoplasty. METHODS: Using the data of the cancer registry department in a district of 500,000 residents, we analyzed retrospectively 143 patients followed up in the same region and transplanted between 1987 and 1995. We compared the incidence of cancer in recipients of cornea coming from donors with malignancies with recipients of cornea from donors without malignancies. The rate of cancer in this population was also compared with the incidence of cancer in the general population at the same age. RESULTS: Eleven patients (7%) were excluded from the study, eight of them for the presence of cancer in their medical history before surgery and the three others because of lack of information about their follow-up after surgery. Forty patients received corneas from cancerous donors and 103 from donors without cancer. Six patients developed malignancies between 1 and 4 years after transplantation, and only one of them received a cornea from a donor with a systemic malignancy. This recipient developed a different type of cancer from that of the donor. The five other patients received corneas from donors without systemic malignancies. By comparing theses results, there was no relationship between the occurrence of malignancies and transplantation of corneas from cancerous donors (relative risk = 0.49, 95% confidence interval = 0.01-13.62). CONCLUSION: There was no increased incidence of cancer in our patient population compared with reference population. Based on this study, there is no statistical or clinical evidence to suggest the transmission of cancer from donors with malignancies via corneal transplantation, according to the accepted criteria of donor selection.

[Secondary intraocular lens implantation: methods and complications]. / Implantation secondaire. Techniques et complications.

PURPOSE: We report a review of the literature on complications of secondary lens implantation without capsular support. METHODS: We assessed results and complications after trans-sulcus sclera l fixation (SSIOL), open-loop anterior chamber intraocular lens (ACIOL) and iris-claw lens (ICIOL). RESULTS: Series published in the literature showed variable results. The rate of increased visual acuity ranged from 71% to 92% for SSIOL, 77% to 92% for ACIOL, 83% to 100% for ICIOL. Complications included: decentration and tilt of th IOL in 0-15.3% for SSIOL, 0-8.6% for ACIOL, 1.8-4.8 % for ICIOL; retinal detachment in 1.1-6% for SSIOL, 0-3.3% for ACIOL; cystoid macular edema in 5.8-23% for ACIOL, 4.8%-5.2% for ICIOL; bullous keratopathy in 0-26.3% for SSIOL, 0-14.2% for ACIOL, 4.8% for ICIOL. Vitreous hemorrhage and suture erosion were specific complications report ed for SSIOL in 1.1-25% and 15-20% of cases respectively. CONCLUSION: Secondary IOL implication is a good alternative for correction of aphakia eyes without a posterior capsule. This analysis shows no one procedures offers more safety than the others. The decisive facto r for choosing among the different types of IOL appears to be surgical experience.

[Procurement of corneas: analysis of inventory of hospital coordination. Prospective study at the Besançon Hospital University during the course of one year]. / Prélèvements de cornée: analyse du recensement par la coordination hospitalière. Etude prospective au CHU de Besançon sur une durée d'une année.

PURPOSE: To identify the obstacles contributing to the deficiency in supply of corneal donation. Quantitative and qualitative analysis of the collection and the distribution of corneas was performed by the staff of organ and tissue transplantation in the University Hospital of Besançon. METHODS: Medical records of all the deceased patients between the 8(th) of February 1998 and 28(th) of February 1999 were reviewed. In these medical records, we distinguished 2 groups RESULTS: During the study period, 1044 patients died at Besançon University Hospital. 616 medical records were checked and 428 were not. Out of 616 checked medical records, we found 337 (54%) medical contraindications, 112 (18%) denied requests, 105 (17%) logistic problems and 62 (10%) procurements after consent. Out of 428 medical records unchecked, we found 215 (50%) medical contraindications, 199 (46%) potential donors and 14 (3,2%) logistic problems. The most important factor of non cornea procurement was medical contraindication. The unavailability of the transplant coordination ophthalmologists and logistic problems represented 30% of non procurement corneas. Relatives opposition was found only in 18% of cases. CONCLUSION: This survey was an overview of the real condition of corneal donation in our institution. Caution regarding medical selecting donor corneal material should be used even if it represents the most important factor of non cornea procurement. To increase the supply of donor material, logistic and audibility of transplant coordination and surgeons should be improved.

[Intrathoracic retrotracheal goiter: excision through a cervical approach]. / Goitre endothoracique rétrotrachéal: exérèse par voie cervicale.

A case of retrotracheal goiter in the posterior mediastinum in a 53 year-old woman revealed by dyspnea is here described. A computed tomographic scan and magnetic resonance imaging specified the his extension from the lower flap of the thyroid, and its relationships in the mediastinum. It was removed through a cervicotomy only.

[Use of the computer in teaching rheumatology. Trial application in the diagnosis of an adult polyarthritis]. / Utilisation de l'ordinateur pour l'enseignement en rhumatologie. Essai d'application au diagnostic d'une polyarthrite de l'adulte.

The immense possibilities offered by the computer can be utilized in medical education, through a free dialogue between the student and the machine thanks to a terminal. A diagnostic simulation program has been carried out in diagnosing adult polyarthritis. This program neccesitates an analysis of diagnostic behavior and, on this basis, the preparing of a diagnostic tree or graph. The reasons leading to the plan adopted in constructing the graph, are discussed. Cases of increasing difficulty are proposed to the student, who must follow the course plan in order to arrive at a diagnosis. This teaching method, applied for thing pedagogical advantages both for the teacher and the student. The operating cost seems reasonable.