[Eye and cat scratch disease: A case series]. / Œil et maladie des griffes du chat : à propos de 7 cas.

INTRODUCTION: Cat scratch disease is a pleiomorphic condition, sometimes with isolated ophthalmic involvement. We report the clinical observations of seven cases with ophthalmologic manifestations of cat scratch disease. OBSERVATIONS: There were seven patients, with a median age of 52 years, of whom five were women and three had unilateral involvement. Six exhibited Leber's stellate neuroretinitis, an incomplete syndrome in two cases, and one associated with chorioretinal foci. One patient had isolated retinal infiltrates. The diagnosis of cat scratch disease was confirmed by Bartonella henselae serology, positive in all cases. All patients received treatment with doxycycline. Ocular complications (with optic atrophy and macular retinal pigment epithelial changes) were noted in five cases. DISCUSSION: Ocular bartonellosis is an atypical clinical form. It requires a directed ancillary work-up with serology or PCR, which has the peculiarity of being highly specific if not very sensitive. Treatment is above all preventive. Antibiotics may be initiated. CONCLUSION: Cat scratch disease must be excluded in the work-up of posterior uveitis.

[An iris metastasis revealed a bronchopulmonary cancer]. / Métastase irienne révélatrice d'un cancer bronchopulmonaire.

We report the case of a 53-year-old patient referred by his ophthalmologist for a red, painful eye. On exam, he demonstrated findings of granulomatous uveitis with ocular hypertension (38 mm Hg) and a whitish, vascularized iris tumor with invasion of the irido-corneal angle. As our first hypothesis was an iris metastasis, a systemic work-up was carried out, which revealed moderately differentiated broncho-pulmonary carcinoma with multiple metastases (brain, cerebellum and adrenal). Emergency radio-chemotherapy was initiated, and the outcome was good, with rapid regression of the iris metastasis and good efficacy against the primary cancer. After one year of follow-up, the patient developed a metastasis at a new site, and his general condition deteriorated.

[Activity-based financing: is ambulatory care profitable for the institution]. / T2A et chirurgie orbitopalpébrale : l'ambulatoire est-il vraiment rentable pour l'établissement ?

INTRODUCTION: The aim of this study was to evaluate the impact of the 11th version of the National Health System's Activity-Based Financing on the income of a University Hospital department for palpebral, lacrimal, and orbital surgeries. PATIENTS AND METHODS: The number of such surgeries in 2008 was based on the Medicalization Program of the Information System. Using the 11th version of the Activity-Based Financing for Diagnosis-Related Groups, we compared the income in both inpatient and outpatient settings. RESULTS: Two hundred and forty-eight patients undergoing palpebral, lacrimal, or orbital surgery between January and December 2008 were included, with 87% treated on an outpatient basis. The lower reimbursement for outpatient surgery resulted in a loss of 184,500 euros (79%) for our department compared to the inpatient procedure. DISCUSSION: With rigorous organization, ambulatory surgery is feasible for palpebral, lacrimal, and orbital surgery. Nonetheless, with department incomes related to activity, ambulatory care seems financially disadvantageous. Many departments are trying to develop an ambulatory structure, but the need to balance their budget requires improved coherence.

[Impact of the Activity-Based Financing (11th Version) on glaucoma surgery payment in hospital resources]. / Retentissement de la version 11 de la T2A sur le financement de la chirurgie des glaucomes.

AIM: In this study, the potential impact of 11(th) version of the National Health System's Activity-Based Financing on the income of a University Hospital department was evaluated for glaucoma surgeries. PATIENTS AND METHODS: The number of glaucoma surgeries in 2008 was analyzed based on the Medicalization Program of Information Systems. Using the 11(th) version of the Activity-Based Financing for Diagnosis-Related Groups (DRG), we compared the income of these surgical procedures on both an inpatient and an outpatient setting. RESULTS: One hundred and forty-nine patients undergoing glaucoma surgery between January and December 2008 were included, 94% of whom were treated on an outpatient basis. The lower reimbursement for outpatient surgery resulted in a loss of euro 100,000 or 64% of revenues compared to an inpatient procedure. DISCUSSION: Ambulatory glaucoma surgery is feasible but requires rigorous organization. Nonetheless, while department incomes are related to activity, ambulatory care seems financially disadvantageous. Many departments are trying to develop an ambulatory structure, but the apparent contradiction between the objectives of public health insurance and the hospital's need to balance its budget requires further clarification.

[Central corneal thickness and retinal nerve fiber layer thickness in ocular hypertensive patients and healthy subjects]. / Pachymétrie cornéenne centrale et épaisseur de la couche des fibres optiques chez les sujets normotones et hypertones.

OBJECTIVE: To evaluate the retinal nerve fiber layer thickness and the central corneal thickness in ocular hypertensive patients and healthy subjects. PATIENTS AND METHODS: We prospectively included 55 ocular hypertensive patients (126 eyes) and 63 healthy subjects (110 eyes). In each individual we measured standard automatic perimetry, frequency doubling technique visual field, and central corneal thickness with an ultrasonic pachymeter and optical coherence tomography (OCT). Retinal nerve fiber layer thickness was evaluated with GDx-VCC and OCT. RESULTS: Central corneal thickness was significantly thicker in ocular hypertensive patients (p<0.009 and p<0.033 respectively). We found a significant correlation between ultrasonic pachymeter and OCT central corneal thickness in both groups (p<0.0001). Retinal nerve fiber layer thickness was not statistically different between healthy and ocular hypertensive subjects, but was significantly thinner in ocular hypertensive patients with thin central corneal thickness only with GDx-VCC. In the control group, no statistically significant linear correlation was noted between central corneal thickness and retinal nerve fiber layer thickness. In the ocular hypertensive group, we found a linear correlation between ultrasonic pachymeter and OCT central corneal thickness and the average retinal nerve fiber layer thickness with the GDx-VCC. DISCUSSION: Retinal nerve fiber layer thickness was globally similar in both healthy and ocular hypertensive subjects. CONCLUSION: Although some statistically significant differences in the retinal nerve fiber layer thickness were observed between these two groups, they were not clinically relevant.

[Improving medical information for patients with a customized website]. / Amélioration de l'information médicale des patients: intérêt pour un service d'ophtalmologie de disposer d'un site Internet.

INTRODUCTION: In order to improve medical information for the patients consulting at the Department of Ophthalmology, an Internet website was set up. We wanted to estimate the rate of patients connecting to this website. Then we evaluated how the patients could draw a benefit from visiting this Internet site. PATIENTS AND METHODS: Prospective study of the patients seen in the department of ophthalmology over 4 consecutive days in May 2007. The first questionnaire was distributed to all patients and completed in the department. The second one was given only to the patients equipped with a broadband Internet connection and was to be completed at home after having visited the website. RESULTS: Six hundred twenty-one patients were admitted to the department during the period; 510 (82%) were included in the study. Among them, 382 (74.9%) responded to the first questionnaire. The broadband connection rate was 42.5%, 74.5% of these patients took an interest in our site, and 64.6% thought of visiting it. Forty-two (29%) responded to the second questionnaire. After having visited the site, 61.2% of the patients felt that their medical information was improved, 71.8% rated the quality of the site as good, and 87.9% would recommend this site to their relatives. CONCLUSION: This type of website is liable to efficiently supplement the information provided by the Ophthalmology Department doctors. It justifies the time and staff investment necessary for its operation.

Changes in meibomian fatty acids and clinical signs in patients with meibomian gland dysfunction after minocycline treatment.

AIMS: To assess the changes in ocular surface abnormalities and meibomian fatty acid composition in patients suffering from meibomian gland dysfunction (MGD) after treatment with oral minocycline associated with lid hygiene versus lid hygiene only. METHODS: We evaluated the break-up time, corneal staining and quality of meibomian excreta, and collected meibomian oil in 20 individuals suffering from MGD before and after 8 weeks of minocycline associated with lid hygiene (n = 10) or lid hygiene only (n = 10). Meibomian fatty acids were directly transmethylated and analysed by gas chromatography (GC) and GC mass spectrometry. RESULTS: The meibomian fatty acid composition was slightly modified after 8 weeks in both groups. The decrease in a branched-chain fatty acid (isoC20) was greater after minocycline treatment than after lid hygiene only (-65% and -25%, respectively; p<0.05). Other fatty acids were unchanged. A significant improvement in the BUT was observed after minocycline treatment (p = 0.03). CONCLUSION: This study showed better tear film stability after minocycline treatment and a biological effect on meibomian fatty acid composition in MGD patients. Minocycline was more effective than lid hygiene alone. Both interventions partly corrected fatty acid composition abnormalities. Among the fatty acids, isoC20 could be a biological marker of MGD.