The carbon footprint of cataract surgery in a French University Hospital.

PURPOSE: To assess the carbon footprint of cataract surgery in a French university hospital. SETTING: Operating room of Cochin University Hospital, Paris, France. DESIGN: Single-center component analysis. METHODS: One day of surgery was used as a reference. Greenhouse gases (GHG) related to patient and staff transportation were calculated based on the distance travelled and the means of transportation used. The annual consumption of energy (heating and electricity) of our building was converted in kg equivalent of carbon dioxide (CO2eq), and the principle of proportionality was used to calculate what was used for a single cataract procedure. GHG emissions related to the life cycle assessment (LCA) of the equipment used and the sterilization process were calculated. RESULTS: The LCA of disposable items accounted for 59.49kg (73.32%) of CO2eq for each procedure. A single procedure generated 2.83±0.10kg of waste. The average CO2eq produced by the transportation of the patients to and from our center, adjusted for one procedure, was 7.26±6.90kg (8.95%) of CO2eq. The CO2eq produced by the sterilization of the phacoemulsifier handpiece was 2.12kg (2.61%). The energy consumption of the building and staff transportation accounted for the remaining CO2eq emissions, 0.76kg (0.93%) and 0.08kg (0.10%) respectively. Altogether, the carbon footprint of one cataract procedure in our center was 81.13kg CO2eq - the equivalent of an average car driving 800km. CONCLUSION: Our data provide a basis to quantify cataract surgery as a source of GHG and suggests that reductions in emissions can be achieved.

[Ocular manifestations of primary pulmonary artery hypertension]. / Manifestations oculaires de l'hypertension primitive de l'artère pulmonaire.

INTRODUCTION: To report two patients with primary pulmonary hypertension (PPH) and associated ocular findings. CASE REPORT: Two men, 54 and 50 years old, were referred for primary pulmonary hypertension: one patient had had a double-lung transplantation a month before and noticed pain and decreased vision in the right eye; the other man was waiting for a lung transplant and noticed decreased vision in the left eye. Both patients presented with a dilatation of the conjunctival and episcleral veins, without glaucoma, and with bilateral chronic choroidal ischemia. One patient underwent a fluorescein angiography examination and indocyanine green videoangiography. CONCLUSION: Elevated venous pressure is responsible for the dilatation of the conjunctival and episcleral veins, sometimes associated with glaucoma, and for chronic choroidal ischemia with a decrease in visual acuity. Other clinical pictures are discussed.

[Permanent cosmetics and magnetic resonance imaging]. / Maquillage permanent et imagerie par résonance magnétique.

INTRODUCTION: We report a case illustrating the possible relation between permanent cosmetics (tattoos) and magnetic resonance imaging (MRI). OBSERVATION: A 24-year-old woman underwent a permanent cosmetic tattoo (eyeliner) on the four eyelids 5 months before an MRI was performed for headache. After 1 min, the patient reported a burning sensation associated with an eyelid erythema. The MRI examination was interrupted. The burning sensation resolved by the end of the examination and erythema 2 h later. CONCLUSION: Cosmetic tattoo technicians, patients, and MR technologists should be informed of the minor risk associated with the site of the permanent cosmetic tattoo (eyelid, eyebrow).

[Eyelid necrosis caused by an hymenopteran insect bite]. / Nécrose palpébrale par piqûre d'hyménoptère.

We report a case report of extensive eyelid necrosis caused by an insect bite. A 39-year-old man had suffered ocular trauma from a hymenopteran insect in Tunisia. The patient presented with eyelid necrosis. Eyelid necrosis mechanisms following insect bites are discussed and other causes of eyelid necrosis are presented. Eyelid necrosis, often caused by vasoconstrictive medications or animal venoms, notably hymenopteran insect bites, can result in substantial eyelid injury.

[Adenomatous hyperplasia of the conjunctiva]. / Hyperplasie adénomateuse de la conjonctive.

We report a case of adenomatous hyperplasia of the conjunctiva. A 42-year-old man was referred for a left conjunctival lesion involving the caruncle; the histopathological patterns revealed benign adenomatous hyperplasia, a disease that may originate in the conjunctiva. Adenomatous hyperplasia of the conjunctiva is a benign condition. The absence of cytonuclear anomalies and mitotic activity distinguishes adenomatous hyperplasia from adenocarcinoma and mucoepidermoid carcinoma.

[Relevance of traditional hospitalizations in an ophthalmology department]. / Pertinence de l'hospitalisation traditionnelle dans un service d'ophtalmologie.

INTRODUCTION: Ophthalmological indications for traditional hospitalizations are not clearly established and should be updated with respect to both healthcare quality and economic considerations. We therefore analyzed the data of patients hospitalized in an ophthalmology department. PATIENTS AND METHOD: We prospectively analyzed the medical and socioeconomic charts of all patients hospitalized during a 2-month period (December 2006 and January 2007) in a single ophthalmology department. RESULTS: Over the 2 months, 349 patients were admitted (mean stay, 3 days), 324 of whom were operated. The main causes of admission were retinal detachments (n=103), injuries (n=33), endothelial cell failure (n=27), cataract (n=27), high ocular pressure (n=23), and corneal abscess (n=17). Admission was mainly guided by the surgeon's habits (n=135, 39%) and was not medically relevant but was generally motivated by financial considerations. Other hospital admissions were medically justified (intravenous injections, head positioning) but the hospitalization of patients living far from the hospital (n=46; 13%) could be limited by the development of housing made available to patients. CONCLUSION: Ophthalmological hospitalization is not always medically relevant and often is based on financial or housing constraints. More than half of the classical admissions should be switched to ambulatory patient care by adapting financial compensations to surgical costs or providing outpatient housing.

[Bilateral elastosis of the limbus]. / Elastose bilatérale du limbe.

We report of a case of bilateral limbus involvement by white lesions. A 72-year-old man was referred for bilateral lesions involving the inferior part of the corneal limbus. White excrescences associated with a vascular pannus were observed at biomicroscope examination. Histologic patterns showed degenerative fibroelastosis. Degenerative fibroelastosis can be observed at the inferior corneal limbus.

[Congenital grouped albinotic spots: a case report]. / Taches blanches albinoïdes congénitales groupées de l'épithélium pigmentaire de la rétine.

INTRODUCTION: Case report of congenital grouped albinotic spots. OBSERVATION: A 24-year-old woman was referred for frontal headache related to +1.50 hypermetropia. Visual acuity was 20/20 in both eyes. During routine examination, fundus examination revealed multiple, irregular white spots involving the juxtapapillary and peripheral retina in both eyes. Color vision, visual fields, and electroretinographic findings were normal. Fluorescein angiograms showed hyperfluorescent spots; indocyanine green (ICG) showed hypofluorescence of these lesions. CONCLUSION: These albinotic spots are uncommon benign developmental lesions of the retinal pigment epithelium; they appear to represent focal thickening of the retinal pigment epithelium (RPE) that is filled with white material, possibly an abnormal precursor of melanin.

[Eyelid metastasis from a bladder urothelial carcinoma]. / Métastase conjonctivo-palpébrale d'un cancer de la vessie.

INTRODUCTION: Case report of an eyelid metastasis from a bladder urothelial carcinoma. OBSERVATION: A 71-year-old man presented with an eyelid metastasis. The patient had had a bladder carcinoma (pT1HG-2) resected 3 years before. Histologic patterns of bone and eyelid metastases were consistent with a high-grade urothelial carcinoma (pT1HG-2). In this case, eyelid metastasis was an incidental finding of end-stage disseminated metastatic spread of the tumor. CONCLUSION: Eyelid metastases of the bladder are infrequent and associated with disseminated metastatic spread of the tumor.

[Transitional carcinoma of the conjunctiva]. / Carcinome transitionnel de la conjonctive.

We report a case of transitional carcinoma originating from the conjunctiva. An 86-year-old woman was referred for a right conjunctival swelling lasting 6 months after a first surgical excision. The histopathological pattern revealed a transitional carcinoma, which usually originates from the airways and the lacrimal sac; recurrences are not uncommon. Transitional carcinoma may originate in the conjunctiva.

[Corneal edema and systemic NSAIDs]. / Oedème de cornée et AINS systémiques.

INTRODUCTION: We report a case of a transient corneal edema related to systemic NSAID treatment. OBSERVATION: A 48-year-old woman treated with a systemic NSAID [piroxicam B-cyclodextrin (Brexin) and naproxen (Apranax)] presented with a corneal edema and a transient decrease in visual acuity for a period of 24 h. No ocular etiology was found to explain this corneal edema. Another treatment with Apranax was follow by another corneal edema. CONCLUSION: Corneal edema could be related to systemic NSAID treatment.