Assuntos
Blefarofimose , Diabetes Mellitus , Ceratocone , Anormalidades da Pele , Blefarofimose/complicações , Blefarofimose/diagnóstico , Blefarofimose/genética , Feminino , Humanos , Ceratocone/complicações , Ceratocone/diagnóstico , Ceratocone/genética , Masculino , Anormalidades da Pele/complicações , Anormalidades UrogenitaisRESUMO
INTRODUCTION: Cataract surgery is the most commonly performed surgery in the world, and its success depends in part on the quality of mydriasis. PURPOSE: To compare, for the same eye, the pupillary dilation obtained with Mydrane® (standardized intracameral solution of 0.02% tropicamide, combined with 0.31% phenylephrine and 1% lidocaine) intraoperatively versus Mydriasert® (0.28mg tropicamide insert and 5.4mg phenylephrine) with a contact time between 45 and 60 minutes in the preoperative period. METHODS: Single center prospective study from November 2016 to January 2018 at the Laveran Army Instructional Hospital in Marseille. Patients referred for surgery were dilated at the preoperative consultation with Mydriasert®. The pupillary diameter after 45-60 minutes of contact with the insert was manually measured, by two different examiners, through the "iris image" tab of the Pentacam® elevation topography. Patients were dilated on the day of their cataract surgery with 0.2cc of Mydrane® injected in the anterior chamber through a paracentesis. Thirty seconds later, prior to injection of viscoelastic, an eye photograph was taken by screen capture. The pupillary diameter was evaluated by two different examiners with to the Piximeter 5.9 metrology software. The difference in pupil dilation between Mydriasert® and Mydrane® was tested with the paired series Student t-test. RESULTS: In total, 111 eyes of 82 patients were included. Mydriasert® achieved a mean pupillary dilation of 7.21±0.79mm. The mydriasis obtained with Mydrane® averaged 6.35±0.8mm. This difference of 0.86mm was statistically significant (P<0.001) with a confidence interval of 95% [-0.97; -0.74]. CONCLUSION: On average, Mydrane® dilates the pupil less than Mydriasert®. However, the mydriasis obtained with Mydrane® remains comfortable for the performance of the capsulorhexis. It helps save preoperative time and affords additional anesthetic to the cataract surgery. Nevertheless, the use of Mydriasert® is beneficial when extra mydriasis is required.
Assuntos
Extração de Catarata/métodos , Implantes de Medicamento/administração & dosagem , Lidocaína/administração & dosagem , Midriáticos/administração & dosagem , Fenilefrina/administração & dosagem , Pupila/efeitos dos fármacos , Tropicamida/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Variação Biológica Individual , Dilatação/métodos , Esquema de Medicação , Combinação de Medicamentos , Implantes de Medicamento/efeitos adversos , Feminino , França , Humanos , Cuidados Intraoperatórios/métodos , Lidocaína/efeitos adversos , Masculino , Pessoa de Meia-Idade , Midriáticos/efeitos adversos , Soluções Oftálmicas , Fenilefrina/efeitos adversos , Cuidados Pré-Operatórios/métodos , Pupila/fisiologia , Padrão de Cuidado , Tropicamida/efeitos adversosRESUMO
INTRODUCTION: Cataract surgery is the most commonly performed surgery in the world, and its success depends in part on the quality of mydriasis. PURPOSE: To compare, for the same eye, the pupillary dilation obtained with Mydrane® (standardized intracameral solution of 0.02% tropicamide, combined with 0.31% phenylephrine and 1% lidocaine) intraoperatively versus Mydriasert® (0.28mg tropicamide insert and 5.4mg phenylephrine) with a contact time between 45 and 60 minutes in the preoperative period. METHODS: Single center prospective study from November 2016 to January 2018 at the Laveran Army Instructional Hospital in Marseille. Patients referred for surgery were dilated at the preoperative consultation with Mydriasert®. The pupillary diameter after 45-60 minutes of contact with the insert was manually measured, by two different examiners, through the "iris image" tab of the Pentacam® elevation topography. Patients were dilated on the day of their cataract surgery with 0.2cc of Mydrane® injected in the anterior chamber through a paracentesis. Thirty seconds later, prior to injection of viscoelastic, an eye photograph was taken by screen capture. The pupillary diameter was evaluated by two different examiners with to the Piximeter 5.9 metrology software. The difference in pupil dilation between Mydriasert® and Mydrane® was tested with the paired series Student t-test. RESULTS: A hundred and eleven eyes of 82 patients were included. Mydriasert® achieved a mean pupillary dilation of 7.21±0.79mm. The mydriasis obtained with Mydrane® averaged 6.35±0.8mm. This difference of 0.86mm was statistically significant (P<0.001) with a confidence interval of 95% [-0.97; -0.74]. CONCLUSION: On average, Mydrane® dilates the pupil less than Mydriasert®. However, the mydriasis obtained with Mydrane® remains comfortable for the performance of the capsulorhexis. It helps save preoperative time and affords additional anesthetic to the cataract surgery. Nevertheless, the use of Mydriasert® is beneficial when extra mydriasis is required.
Assuntos
Extração de Catarata/métodos , Midriáticos/administração & dosagem , Pupila/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Extração de Catarata/normas , Dilatação , Esquema de Medicação , Combinação de Medicamentos , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Período Pré-Operatório , Pupila/fisiologia , Padrão de CuidadoRESUMO
INTRODUCTION: Retraction of the lower eyelids has multiple etiologies. Its surgical treatment is a vertical elongation of the tarsus. This can be obtained by using a graft. We describe a sampling and grafting technique using palatal fibromucosa intratarsal graft. TECHNICAL NOTE: The procedure is performed in two steps under general anesthesia. The graft is harvested on the lateral sides of the palatine vault to avoid neurovascular bundles. This area corresponds to the maxillary fibromucosa according to Delaire's classification. The graft is then inserted in the lower eyelid tarsus. DISCUSSION: Many "spacers" are available to extend the posterior lamella vertically; the palatal fibromucosa graft may be used directly and is easy to harvest. It has a similar stiffness to that of the tarsus and there is no need to harvest periosteum. Sparing the periosteum allows for a better healing of the donor site and decreases postoperative pain. The lateral harvesting area, away from the anterior palatine artery, seems more accessible than the median area, especially in ogival palates.
Assuntos
Doenças Palpebrais/cirurgia , Mucosa Bucal/transplante , Palato Duro/transplante , Procedimentos de Cirurgia Plástica/métodos , Anestesia Geral , Pálpebras/cirurgia , Humanos , Palato Duro/cirurgia , Cuidados Pós-Operatórios/métodosRESUMO
We report the cases of two patients presenting with unilateral Kyrieleis arteritis complicating severe posterior uveitis, one secondary to toxoplasmosis and the other in the context of Behçet's disease. The treatment response was favorable with complete visual recovery in both cases. Kyrieleis arteritis has been described since 1933, but its pathogenesis is still unknown. However, it appears to be more of a periarteritis than an actual arteritis. It is classically associated with posterior uveitis without a direct correlation with disease severity.
Assuntos
Arterite/etiologia , Artéria Retiniana/patologia , Uveíte Posterior/complicações , Corticosteroides/uso terapêutico , Adulto , Anti-Infecciosos/uso terapêutico , Arterite/diagnóstico , Arterite/tratamento farmacológico , Síndrome de Behçet/complicações , Síndrome de Behçet/tratamento farmacológico , Colchicina/uso terapêutico , Angiofluoresceinografia , Humanos , Masculino , Pan-Uveíte/complicações , Recuperação de Função Fisiológica , Retina/patologia , Toxoplasmose Ocular/complicações , Toxoplasmose Ocular/tratamento farmacológico , Uveíte Posterior/tratamento farmacológicoRESUMO
We report a case of fibrous dysplasia revealed by acute ptosis in a 38-year-old patient. Ophthalmologic examination disclosed a moderate right ptosis. The rest of the results were strictly normal except for a known facial asymmetry. Visual acuity was 20/20 in both eyes, there was no extrinsic or intrinsic oculomotor disorder, and funduscopy was normal. Given this acute presentation, emergency cerebral imagery was carried out, providing a diagnosis of fibrous dysplasia with orbital and cavernous repercussions, with no sign of cerebral disorder or obvious vascular lesion. Progression was marked by a regression of the ptosis. Fibrous dysplasia is a rare pathology but presents varied clinical presentations. The authors present the broad characteristics of this pathology and the management of an acquired ptosis. They discuss the possible mechanisms involved in the drop of the right upper eyelid of this patient and the therapeutic solutions.
Assuntos
Blefaroptose/etiologia , Displasia Fibrosa Poliostótica/complicações , Osso Frontal/patologia , Doenças Orbitárias/complicações , Osso Esfenoide/patologia , Doença Aguda , Adulto , Blefaroptose/fisiopatologia , Diagnóstico Diferencial , Emergências , Assimetria Facial/etiologia , Displasia Fibrosa Poliostótica/diagnóstico , Displasia Fibrosa Poliostótica/diagnóstico por imagem , Displasia Fibrosa Poliostótica/patologia , Osso Frontal/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Modelos Biológicos , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/fisiopatologia , Oftalmoplegia/etiologia , Oftalmoplegia/fisiopatologia , Doenças Orbitárias/diagnóstico por imagem , Doenças Orbitárias/patologia , Radiografia , Osso Esfenoide/diagnóstico por imagemAssuntos
Conjuntivite/microbiologia , Lúpus Vulgar/complicações , Mycobacterium tuberculosis , Tuberculose Ocular/diagnóstico , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Cicatriz/tratamento farmacológico , Cicatriz/microbiologia , Túnica Conjuntiva/microbiologia , Conjuntivite/tratamento farmacológico , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/microbiologia , Feminino , Humanos , Lúpus Vulgar/tratamento farmacológico , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/microbiologia , Tuberculose Ocular/tratamento farmacológicoRESUMO
Optic neuritis (ON) is an inflammatory disease whose etiology remains obscure. We report a case of ON attributable to Mycoplasma pneumoniae (MP). A 26-year-old man presented a sudden onset bilateral loss of visual acuity, without any history of pulmonary or ear-nose-throat infection. Diagnosis of optic neuritis was made on the basis of visual field loss, though optic disks and visual evoked potentials were normal. Color vision could not be assessed due to a congenital dyschromatopsia. The neurological examination was normal. On magnetic resonance imaging, there was no enhancement or enlargement of optic nerves, but a demyelinating lesion of the cervical spinal cord. Lumbar puncture revealed lymphocytic meningitis with 60 white blood cells, all of them being lymphocytes. Oligoclonal bands were presents in the CSF. With no evidence of any other infection or auto-immune disease, the diagnosis of Mycoplasma pneumoniae infection was established due to the presence of Mycoplasma pneumoniae specific IgM antibodies. Outcome was quite favorable within three months without treatment. Neurological symptoms--encephalitis, meningitis, polyradiculitis, or more rarely ON or cerebella ataxia--are the main extra pulmonary manifestations of Mycoplasma pneumoniae infection. Search for anti-Mycoplasma pneumoniae IgM antibodies should be performed routinely when On is diagnosed.
Assuntos
Mycoplasma pneumoniae , Neurite Óptica/etiologia , Pneumonia por Mycoplasma/complicações , Adulto , Anticorpos Antibacterianos/líquido cefalorraquidiano , Potenciais Evocados Visuais , Humanos , Imageamento por Ressonância Magnética , Masculino , Neurite Óptica/líquido cefalorraquidiano , Pneumonia por Mycoplasma/líquido cefalorraquidiano , Pneumonia por Mycoplasma/microbiologia , Medula Espinal/patologia , Punção Espinal , Transtornos da Visão/etiologia , Campos VisuaisRESUMO
Although cataracts cause 47% of global blindness, their epidemiologic impact in different countries is notoriously uneven and the world can be divided into two zones according to economic conditions. In advanced countries where care is good, cataracts account for only 5% of blindness while cataracts still account for 50% of blindness in developing countries. After a brief overview of historical, clinical and therapeutic aspects, this article updates epidemiological data on cataracts in the world. It also provides insight into political, socio-economic, and cultural factors adversely affecting care availability in developing countries thus making cataracts a major public health problem and an obstacle for development. Finally this article offers a few recommendations for reducing the backlog of cataracts in the world and for consolidating advances made over the last two decades thanks to experience gained in various National Blindness Prevention Programs (NBPP).