Vision-Related Quality of Life after Cataract Surgery in West Africa.

PURPOSE: To study vision related quality of life (VRQoL) before and after a massive cataract campaign in West Africa and the relationship with visual indicators. METHODS: All the patients who received cataract surgery in Burkina Faso during a blindness prevention campaign were examined. VRQoL was assessed using a modified version of the WHO/PBD VF20. The questionnaire was changed to reflect the socioeconomic and local culture. Patients were interviewed by local interviewers before and three months after surgery. A quality of life related to vision index (QoL-RVI) was calculated. RESULTS: A total of 305 patients underwent cataract extraction in at least one eye, of these, a total of 196 (64%) completed the study. Mean age was 61.97 ± 14.39 years. The majority of eyes had poor visual acuity (VA<20/200, log MAR: 1.0) preoperatively (88.70%) with a mean VA of logMAR 2.17 ± 0.70 (20/2000) which improved to 0.86 ± 0.64 LogMAR (20/150) 3 months after cataract surgery. QoL-RVI improved postoperatively in 90.2% of patients, did not change in 3.1% and was worse in 6.7%. Statistically significant differences were detected (Wilcoxon test p <0.05) for all items tested before and after surgeries. Correlations for the patients after operations showed that there was a statistically significant relation between a global estimated QoL-RVI and the VA previous to the surgery (-0.196 p=0.014), regarding the same index and the VA after the procedures (-0,35 p=0,00018). CONCLUSION: Cataract surgery increases the quality of life of patients living in a developing country such as Burkina Faso and the improvement correlates with the recovery of the visual acuity.

OBJECTIF: Étudier la qualité de vie liée à la vision (VRQoL) avant et après une campagne massive contre la cataracte en Afrique de l'Ouest et la relation avec les indicateurs visuels. MÉTHODES: Tous les patients qui ont été opérés de la cataracte au Burkina Faso pendant une campagne de prévention de la cécité ont été examinés. La VRQoL a été évaluée en utilisant une version modifiée du VF20 de l'OMS/PBD. Le questionnaire a été modifié pour refléter la culture socio-économique et locale. Les patients ont été interrogés par des enquêteurs locaux avant et trois mois après la chirurgie. Un indice de qualité de vie liée à la vision (QoL-RVI) a été calculé. RÉSULTATS: Un total de 305 patients ont subi une extraction de la cataracte dans au moins un œil, parmi ceux-ci, un total de 196 (64%) ont terminé l'étude. L'âge moyen était de 61,97 ± 14,39 ans. La majorité des yeux avaient une mauvaise acuité visuelle (AV<20/200, logMAR : 1,0) en préopératoire (88,70%) avec une VA moyenne de logMAR 2,17 ± 0,70 (20/2000) qui s'est améliorée à 0,86±0,64 LogMAR (20/150) 3 mois après la chirurgie de la cataracte. La QoL-RVI s'est améliorée après l'opération chez 90,2% des patients, n'a pas changé chez 3,1% et s'est aggravée chez 6,7%. Des différences statistiquement significatives ont été détectées (test de Wilcoxon p <0,05) pour tous les éléments testés avant et après les opérations. Les corrélations pour les patients après les opérations ont montré qu'il y avait une relation statistiquement significative entre une estimation globale de la QoL-RVI et l'AV avant l'opération (-0,196 p=0,014), concernant le même indice et l'AV après les procédures (-0,35 p=0,00018). CONCLUSION: La chirurgie de la cataracte augmente la qualité de vie des patients vivant dans un pays en voie de développement comme le Burkina Faso et cette amélioration est corrélée avec la récupération de l'acuité visuelle. Mots clés: Qualité de Vie, Cataracte, Cécité, Afrique de l'Ouest.

[Confocal microscopy of the cornea in photorefractive surgery]. / Microscopía confocal de la córnea en la cirugía fotorrefractiva.

OBJECTIVE: Corneal refractive surgery involves a range of techniques which have assumed a growing importance during the last few years. The advances of very different surgical methods and the early age of the majority of the patients subjected to surgery, limits our knowledge of the histopathologic changes in the operated corneas. For this reason, the development of any diagnostic tool which can permit us to improve our knowledge of the wound healing process would be of significant value. As we describe in our paper, confocal microscopy enables the assessment of the more important advantages for the study of corneal wound healing after refractive surgery: high magnification, harmless, and "in vivo", providing pathogenic information and lateral and axial definition not achievable with other exploration techniques. CONCLUSION: Confocal microscopy appears to be an essential tool for creating a global concept of quality in corneal refractive surgery.

Anticonvulsant effects of nimodipine and two novel dihydropyridines (PCA 50922 and PCA 50941) against seizures elicited by pentylenetetrazole and electroconvulsive shock in mice.

In animal models of epilepsy, calcium entry blockers have shown anticonvulsant properties. We studied the antiepileptic effects of nimodipine and two novel dihydropyridines, a calcium antagonist (PCA 50922) and a calcium agonist (PCA 50941), on pentylenetetrazole seizure and maximal electroshock seizure (MES) in mice. Anticonvulsant profile of nimodipine and PCA 50922 was similar to that of clonazepam, but markedly different from that of phenytoin. None of the doses of the PCA 50941 showed anticonvulsant effect.

Follicular conjunctivitis caused by Chlamydia trachomatis in an infant Saharan population: molecular and clinical diagnosis.

AIMS: To ascertain the prevalence of acute trachoma as a supposed endemic disease among infants in the Saharan refugee camps of Tindouf (Algeria) and to evaluate the efficacy of treatment with a single dose of azithromycin. METHODS: 527 children aged between 3 and 17 were evaluated in the camp schools in October 2001. All the children were clinically and microbiologically examined, including slit lamp checks of anterior segment and two conjunctival swabs, one for the detection of membrane lipopolysaccharide by quick immunoassay test Clearview Chlamydia MF and the other for the detection of specific DNA by chlamydia plasmid specific polymerase chain reaction (PCR) assay. After examination, a single dose of azithromycin was administered to each child. One month later samples from positive children and 12 random negative children by the first PCR were taken to perform a new PCR assay. RESULTS: Chlamydia trachomatis was suspected in 2.47% of the children, papillary hypertrophy being the most frequently seen clinical sign. Scarring changes secondary to trachoma were detected in 11.7% of the children. Only four cases (0.8%) were positive to the immunoassay test and 12 cases (2.27%) were positive by PCR. After treatment a second PCR was performed on positive children and they were negative of chlamydia DNA amplification. However, one child who was negative and received the treatment was positive in the second PCR assay. CONCLUSION: Acute trachoma prevalence is much lower than expected among infants in this Saharan population. The possible reasons could be the recent improvements in hygiene and health care. Cicatricial trachoma is more frequent. The Clearview immunoassay test has very low sensitivity in the detection of this disease. A single dose of azithromycin is sufficient to treat chlamydial conjunctivitis. However, a programme of improvement in hygiene and health care is necessary to prevent re-infection.

Automated superficial lamellar keratectomy augmented by excimer laser masked PTK in the management of severe superficial corneal opacities.

AIM: To assess superficial lamellar keratectomy augmented by excimer laser smoothening with sodium hyaluronate 0.25%, for the management of superficial corneal opacities. METHODS: Consecutive procedure performed in 14 eyes (13 patients) with an automated microkeratome and excimer laser phototherapeutic keratectomy (PTK) smoothening using sodium hyaluronate 0.25%. MAIN OUTCOME MEASURES: UCVA, BCVA, pachymetry, degree of haze, ray tracing analysis, and complications. Mean follow up was 12 (SD 1.6) months. RESULTS: Mean preoperative haze from previous corneal refractive surgeries was 3.5 (SD 0.5) (11/14 cases). In one case, opacity was caused by ocular trauma and in two by infectious keratitis. The mean preoperative UCVA was 0.7 logMAR (0.2 (SD 0.13) decimal value). BCVA was 0.4 logMAR (0.4 (SD 0.17) decimal value). Mean preoperative corneal pachymetry was 508 (SD 62.5) micro m and mean opacity depth measured by corneal confocal microscopy was 115.2 (SD 49.4) micro m. At 6 months, 71.4% of the eyes with previous corneal refractive surgery showed grade I haze or less. Mean postoperative corneal pachymetry at 6 months was 352.36 (SD 49.05) micro m. CONCLUSIONS: Automated superficial lamellar keratectomy combined with excimer laser PTK smoothening assisted by sodium hyaluronate 0.25% induces a significant improvement of corneal transparency and visual acuity in cases of corneal opacity caused by previous refractive surgery, ocular trauma, and keratitis.

Efficacy of mitomycin C associated with direct conjunctival closure and sliding conjunctival graft for pterygium surgery.

AIMS: To evaluate the comparative efficacy of direct conjunctival closure (DCC) and sliding conjunctival graft (SCG), with and without intraoperative mitomycin C 0.02% (MMC) for pterygium surgery. METHODS: A comparative study consisting of a retropective chart review from our private practice was used to compare the outcome of patients who had undergone pterygium surgery. The eyes were classified according to the surgical technique performed. Group 1 was treated by DCC; Group 2 by DCC and intraoperative MMC; Group 3 by SCG; and Group 4 by SCG and intraoperative MMC. Outcome indicators were the appearance of recurrences and the time lapse before recurrences. RESULTS: 482 eyes from 327 European Caucasian patients were included. The average follow-up was 19.7 months (SD 30.6). Group 1 comprised 209 eyes, Group 2 107 eyes, Group 3 101 eyes and Group 4 65 eyes. Recurrences appeared in 7.7% of the eyes in Group 1, 4.7% of the eyes in Group 2, 2% of the eyes in Group 3 and 1.5% of the eyes in Group 4. CONCLUSION: SCG reduces the appearance of recurrences in primary pterygium surgery. MMC seems to improve the results of surgery associated with DCC. SCG and DCC with MMC seem to achieve similar results.