[Cost of cataract surgery in a public hospital]. / Évaluation du coût de la chirurgie de la cataracte dans un établissement public de santé

With more than 500,000 operations per year, cataract surgery is currently the most frequently performed surgical operation in France. Several procedural techniques are described, but phacoemulsification after micro-incision is the most common. The cost and reimbursement by the French social security depend on whether the procedure is conducted on an inpatient or outpatient basis. The objectives of this prospective study were to evaluate the cost of cataract surgery in a public hospital setting and to correlate differences in surgical practice with financial impact. One hundred twenty-five operations were observed in the operating room and many data points were recorded for analysis. Topical anesthesia was administered in 87.2% of cases; the mean duration of the surgery was 42minutes. The mean direct cost was 366 € (drugs, sterilization of reused equipment, medical devices, etc). The extended cost of the surgery (infrastructure, hospitalization, food and laundry, etc.) was computed to be 1130 € for outpatients and 1335 € for inpatients assuming a one-night stay in the hospital. In view of the reimbursement provided by social security, this innovative study in a public hospital demonstrates that cataract surgery is a profitable activity, reinforcing our strategic plans.

[Direct cost of cataract surgery in public hospital]. / Approche du coût direct de la chirurgie de la cataracte dans un établissement de santé public.

INTRODUCTION: With more than 500,000 operations per year, cataract surgery is the most performed act nowadays in France. Several techniques can be used but the phacoemulsification after micro-incision is the most common and the purpose is to put an intraocular lens into the eye. AIM: To approach the direct cost of the cataract surgery and to compare it to the amounts of reimbursements, and to get some epidemiological and statistical data about this surgery. MATERIAL AND METHODS: This study is prospective; many operations were followed up in the operating room and every following data were recorded: age of the patient, type of anaesthesia, type of intraocular lens, adverse events, name of surgeon, duration of the intervention, single use material and medications used during operation and their quantity for each operation. RESULTS: One hundred and twenty-five cataract surgeries were followed. Patients mean age was 74,1 years and the anaesthesia was topical in 87,2% of cases; only two patients had general anaesthesia. The mean duration was 42 minutes. The mean direct cost was 366 € but reached 630 € in case of capsular tear. The cost greatly varied depending on the surgeon. Two references of lens (foldable monofocal, that cost between 100 and 150 €) represented 80% of the implanted lenses. CONCLUSION: This type of study may lead to a standardisation of surgical techniques and evaluate the proportion of supply and medications in that type of surgery.

[Hypereosinophilic syndrome and orbital inflammatory pseudotumor]. / Syndrome hyperéosinophilique associé à une pseudo-tumeur inflammatoire orbitaire.

INTRODUCTION: Idiopathic hypereosinophilic syndrome is defined by the combination of persistent eosinophilia and evidence of tissue damage. It is a diagnosis of exclusion. CASE: We report the case of a 53-year-old man with idiopathic hypereosinophilic syndrome associated with an orbital inflammatory pseudotumor. Therapy with corticosteroids rapidly decreased the number of circulating eosinophiles; the orbital inflammatory pseudotumor regressed at the same time. DISCUSSION: This is the first report of idiopathic hypereosinophilic syndrome associated with an orbital inflammatory pseudotumor.

[Tuberculous dacryocystitis]. / Dacryocystite tuberculeuse.

BACKGROUND: Acute infection and inflammation of the nasolacrimal sac may complicate congenital obstruction of the nasolacrimal duct. Acute dacryocystitis is uncommon later and tuberculosis is exceptionally responsible for it. CASE REPORT: A 4 1/2 year-old boy was admitted because he suffered from acute left dacryocystitis with fever and cervical adenitis. Involvement of both lacrymal gland and lymph node persisted despite antibiotic and corticosteroid therapy. Needle biopsy of the lymph node showed presence of Mycobacterium tuberculosis and excision revealed caseating granulomas. The tuberculin skin test was positive while pulmonary tuberculosis was discovered in the patient's father. The patient was successfully given izoniazid, rifampin for 9 months and pyrazinamide for 2. Drainage of the sac area was necessary after 1 month of treatment followed by dacryocystorhinostomy. CONCLUSION: This rare case of tuberculous dacryocystitis permits to delineate the difficulties of ophthalmologic therapy.

[Exophthalmos in children caused by vascular orbital neoformation]. / Exophtalmie de l'enfant par néoformation vasculaire orbitaire.

BACKGROUND--Exophthalmos or proptosis may be a result of several causes; when unilateral, it leads to search a variety of orbital tumors. CASE 1--A 2 month-old baby presented with a right exophthalmos which developed within a few days. Computed tomography showed infiltration of the orbit by a mass. Surgical biopsy showed capillary hemangioma. The patient was given prednisone 2 mg/kg/day for 2 months; exophthalmos disappeared within 10 days and the child was normal 7 years later. CASE 2--A 13 year-old boy was examined because he had developed left exophthalmos within 2-3 weeks. Ultrasonography and computed tomography showed an orbital tumor compressing the eye and the optic nerve. This tumor was excised and histological examination showed that it was a thrombotic arterial aneurysm. CONCLUSIONS--Vascular lesions can be responsible for a rapidly developing orbital tumor. Their diagnosis can be difficult and must be made in order to avoid aggressive surgery.

[Primary empty sella turcica syndrome]. / Syndrome de la selle turcique vide primaire.

Authors relate a typical case of primary empty sella turcica. Its physiopathogenesis is not yet well known, ophthalmological manifestations are non specific and variable, and authors point out difficulties in treatment.

[Tilted disk syndrome. Symptomatologic aspects and diagnostic problems. Apropos of a case]. / Inversions papillaires. Aspect sémiologique et problèmes diagnostiques. A propos d'un cas.

The tilted disk syndrome is a frequent congenital abnormality. The case reported here associates tilt of the disk crescent hypopigmentation of inferonasal quadrant and macula ectopy. We study the visual field defects which are attributed to a localized ectatic inferonasal area. We discuss then the opportunity to perform neurological examination.