[Outpatient vitreoretinal surgery without next-day examination: Feasibility and acceptability]. / Chirurgie vitréo rétinienne en ambulatoire sans examen du lendemain : faisabilité et acceptabilité.

PURPOSE: To assess the feasibility and acceptability of outpatient care without next-day examination for patients undergoing retinal surgery. METHODS: Patients undergoing ambulatory vitreoretinal surgery between November 2013 and February 2016 at the Vienna medical center were included in this retrospective study. The age, comorbidities, indication, surgical technique and type of anesthesia used, symptoms, intraocular pressure and biomicroscopic examination data at the D0, D7 and M1 visits were recorded. Patient satisfaction with the outpatient treatment was collected by phone call in April 2016. RESULTS: Fifty-three surgeries on 49 patients (24 women, 25 men) with a mean age of 70 years (range, 39-91 years) were analyzed. The surgery was pars plana vitrectomy in all cases, with 26 cases of epiretinal membrane surgery, 7 vitreomacular traction syndrome, 4 vitreous hemorrhage, 6 macular hole, 4 dislocation of lens material, 5 retinal detachment and 1 macular retinoschisis in high myopia. The type of anesthesia was general in 64.1 % of cases (34) and local in 36.9 % of cases (19). Of the D0 examination data, 100 % were compatible with the patient being discharged to home. One patient consulted before the D7 exam for the occurrence of a subconjunctival hemorrhage. There were seven cases (13.2 %) of intraocular pressure elevation and two cases of vitreous hemorrhage (3.8 %) on the D7 examination data. Twenty-seven patients (55.1 %) were reached by phone and all of them were satisfied with their outpatient management. CONCLUSION: Outpatient treatment of patients without next-day examination for vitreoretinal surgery is possible and well accepted.

[Surgical solution to vitreous floaters visual problem]. / Solución quirúrgica al problema visual de los cuerpos vítreos flotantes.

PURPOSE: To evaluate the role of 25 gauge pars-plana vitrectomy (25G-PPV), after a careful patient selection, when we find highly annoying vitreous floaters and to question if this is an ethical therapeutic option. METHODS: A retrospective study of eight eyes (seven patients) aged 58+/-14 years old (range 42-78) high myopes and pseudophakes who underwent 25G-PPV. Clinical data and visual acuity were studied at six to twelve months follow-up. Health-related functioning and quality of life was measured with the 39-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-39). RESULTS: No complications were observed. All patients were satisfied. Safety at third month was 100% and 37.5% improved one or more lines of visual acuity. CONCLUSIONS: Vitreous floaters can be often undervaluated by ophthalmologists, resulting in no intervention. Conventional 20 gauge PPV after a carefully examination can be an effective option for some authors. 25G-PPV incorporates also advantages as the early recovery, with little complications in pseudophakic eyes.

Coping with extended facedown positioning after macular hole surgery: a qualitative diary analysis.

BACKGROUND: Patients undergoing facedown positioning have to overcome physical and psychological challenges; however, their perspective and experience are rarely documented in the research literature. OBJECTIVES: The objective of this study was to examine the content of a self-motivated diary written by a person who underwent 77 days of facedown positioning after macular hole surgery. Her narrative about the obstacles during this postsurgical requirement resulted in an insightful description of several core topics relevant to patient care. METHODS: The diary content was summarized using qualitative description procedures. This document was selected due to its unique rich nature. Thematic analysis was used to summarize and describe main topics of importance within the diary. Additional data sources (i.e., medical file, research literature, patient follow-up, and Web sites) were consulted to provide a more comprehensive understanding of the diary content. RESULTS: On the basis of proximity of coded quotes and richness of content, seven areas of interest emerged, including the patient's emotional state, quality of sleep, nutritional considerations, visual functioning, physical status, social support, and entertainment needs. DISCUSSION: Potential patients and their caregivers can learn from the experiences of an individual who has coped successfully with this treatment. This analysis builds the groundwork for the refinement of guidelines for overcoming prevalent physical and psychological barriers.

Visual experiences during vitreous surgery under regional anesthesia: a multicenter study.

PURPOSE: To investigate patients' subjective intraoperative visual experiences during vitreous surgery performed under regional anesthesia, to ascertain if patients were frightened by their visual experiences, and to determine the risk factors associated with a frightening visual experience. DESIGN: Multicenter, prospective study. METHODS: Sixty-five patients who had vitreous surgery under regional (retrobulbar or peribulbar) anesthesia in five centers in Ireland, Singapore, and Hong Kong were interviewed within 2 hours of their operation using a standardized questionnaire. RESULTS: Thirty patients (46.2%) perceived light perception throughout the entire operation, 19 patients (29.2%) experienced transient loss of light perception, and 16 patients (24.6%) experienced no light perception throughout the entire duration of the surgery. Nine patients (13.8%) were frightened by their intraoperative visual experiences. Patients who were frightened by their visual experiences were more likely to see color (100%) than those who were not frightened (55.4%) (P = .010). The mean age of the patients who were frightened was lower (51.8 years) compared with those who were not frightened (64.6 years) (P = .003). The mean duration of surgery was longer for patients who were frightened (118.9 minutes) compared with those who were not frightened (91.2 minutes) (P = .047). CONCLUSIONS: Most patients undergoing vitreous surgery under regional anesthesia retained at least light perception intraoperatively. Importantly, 13.8% of patients were frightened by their visual experiences. A younger age, longer duration of surgery, and perception of color were risk factors for a frightening visual experience.

[Value of vitrectomy in intermediate uveitis and Behçet's disease with hyalitis. A study of 400 cases]. / Intérêt de la vitrectomie dans les uvéites intermédiaires et la maladie de Behçet avec hyalite. Etude sur 400 cas.

Can vitrectomy help to understand the vitreous role in intermediate uveitis and Behçet's disease with vitritis without retinal detachment? 400 vitrectomies were decided because of vitreous changes but, over all, if macular changes were seen clinically or on the angiogram in 58 Behçet's disease and 342 intermediate uveitis including 59 children cases. Visual acuity, clinical, angiographical and visual field controls, recurrences, reduction of the medical treatment and growth were followed during 1 to 9 years. The vitrectomy products were compared to those of other inflammatory origin vitreous, the both representing 149 cases. Vitrectomy at the early stage of only posterior interface changes prevent the macular edema but this one is irreversible. The preexisting angiographical lesions have not regressed but they are generally quiet. The RD incidence is lower even if it is possible after vitrectomy, in 1.2% of the cases (1% in late vitrectomies). Recurrences and further medical treatment are reduced. This psychological point of view is important. Thus, vitrectomy at alone posterior interface change stage avoid ocular complications. Its pathogenic role in intermediate uveitis is not demonstrated; it seems more a secondary than a primary process.