FIL-SSF Carlevale intraocular lens for sutureless scleral fixation: 7 recommendations from a serie of 72 cases. MICA study (Multicentric Study of the Carlevale IOL).

PURPOSE: Lacking a standard technique, the surgical management of aphakia without capsular support remains to be optimized. The goal of this study is to analyze results for the Carlevale FIL-SSF intraocular lens and propose surgical recommendations. PATIENTS AND METHODS: The P1.5 Collective performed a retrospective analysis, with a minimum follow-up of 6 months, of the records of 72 implantations of the Carlevale FIL-SSF intraocular lens, specifically designed for sutureless scleral fixation in the ciliary sulcus. RESULTS: The most common indication was exchange of a posterior chamber intraocular lens (70.8%). The surgery lasted a mean of 53.4minutes due to the creation of scleral flaps. The implant was damaged in 12.5% of cases. Visual acuity was improved in 83.3% of cases. The postoperative spherical equivalent was -0.3 diopters, with no change in corneal astigmatism. The implant was centered and stable in all cases. Two cases (2.8%) of cystoid macular edema were observed and resolved over six months. DISCUSSION: A number of advantages of the Carlevale FIL-SSF intraocular lens make it a safe and effective solution for correction of aphakia in the absence of capsular support. It requires a longer than usual surgical procedure, and the implant must be handled with care. From their experience, the authors propose 7 recommendations to accelerate the learning curve. CONCLUSION: In light of the results of this study, we propose the Carlevale FIL-SSF intraocular lens as the new standard for the correction of aphakia without capsular support, but other studies are necessary to determine its exact place within the heirarchy of other available techniques.

[Phacoemulsification: advantages of a consultation the day after surgery?]. / Phacoémulsification : intérêt de la visite du lendemain ?

INTRODUCTION: Cataract surgery is the most frequent surgery in France. The D1 consultation limits the extension of ambulatory care to patients who can return on their own the day after sugery. We assessed the usefulness of this systematic D1 consultation in terms of therapeutic modifications. MATERIAL AND MéTHODE: Retrospective study of patients who underwent cataract surgery in a teaching hospital from february to july 2006. The major parameter was the modification of postsurgical treatment after the D1 consultation. RESULTS: Of the 380 operated eyes studied, the patients included 145 men and 235 women, the mean age was 73.8 years (range, 43-92), 86% underwent conventional hospitalization, 70% had been operated by a senior surgeon, and 66% had no suture. At the D1 visit, 11 modifications (2.9%) were recorded: one case of athalamia, one Seidel-positive test, four cases of high IOP (>30mmHg), and five severe inflammations of the anterior segment. All the treatment changes were reported in the group of hospitalized patients, none were reported in the ambulatory patients. Of the 380 eyes studied, only one required sutures at D1, the other treatment changes were minor. CONCLUSIONS: The low output of the D1 visit raises the problem of its relevance in terms of public health. In most of the English-speaking and Scandinavian countries, patients have only one postoperative visit at 1 month. Patients could receive written and oral recommendations and a hotline number to contact the surgical team, which could allow the D1 visit to be discontinued for standard patients with uncomplicated surgery.

[Assessment of macular profile using optical coherence tomography after epiretinal membrane surgery]. / Analyse maculaire en tomographie à cohérence optique après chirurgie de membrane épirétinienne.

PURPOSE: The aim of this study was to analyze the quality and functional result of epiretinal membrane (ERM) surgery using optical coherence tomography (OCT). PATIENTS AND METHOD: We conducted a retrospective, non comparative study between January 2004 and June 2006. Thirty-two eyes were included and operated by vitrectomy for ERM. The OCT assessment of the macular profile was evaluated postoperatively on day 8, day 30 and every 3 months thereafter. The first outcome measure was postoperative abnormality of the OCT profile. The secondary outcome measure was analysis of the functional result with macular thickness and best visual acuity. The Student t-test and the paired series comparison were used for the statistical analysis. RESULTS: After surgery, 23 eyes (72%) showed abnormality of the reflectivity signal as assessed by OCT. Only nine eyes (28%) had or showed restored foveal depression and normal macular thickness. Dissociated optic nerve fiber layer appearance was observed in 43.7% (14 eyes). The best visual acuity increased from 0.58+/-0.23 LogMar to 0.25+/-0.24 after ERM surgery (p<0.001). The macular thickness decreased from 374.6+/-78.7 microm to 271+/-44.6 microm postoperatively (p<0.001). CONCLUSION: Epiretinal membrane surgery is safe and effective in terms of the functional result but most cases do not recover normal microanatomy. This feature does not influence the functional result. Mechanical traction due to peeling of the epiretinal membrane associated with peeling of the internal limiting membrane may be the cause of these microanatomical results.