[Limitations of outpatient vitreoretinal surgery at the Toulouse University hospital between 2016 and 2020: Causes for traditional hospitalization]. / Les limites de l'ambulatoire en chirurgie vitréo-rétinienne au CHU de Toulouse entre 2016 et 2020 : identification des causes d'hospitalisation traditionnelle.

INTRODUCTION: Currently, the majority of patients undergoing vitreoretinal surgery (VRS) are managed on an outpatient basis; this has been made possible by major surgical and anesthetic advances over the past decades. Nevertheless, the conversion to "all outpatient" surgery still poses some problems that are interesting to identify, and traditional hospitalization remains the solution in many situations. METHODS: All patients undergoing VRS at the Toulouse University Hospital between 2016 and 2020 were included retrospectively. For each patient, we analyzed the entire medical, anesthesia and demographic records. We performed a simple descriptive analysis of all parameters studied, followed by a bi-variate analysis between the "Outpatient/Hospitalization" parameter and all other parameters. RESULTS: Three thousand patients were included over the study period; 79.4% of patients were managed on an outpatient basis compared to 20.6% by traditional hospitalization. Failure of ambulatory care was the cause of 41.9% of the traditional hospitalizations, with the absence of an accompanying person on the evening of the surgery being the main reason (47.8%). DISCUSSION: Social isolation is found to be one of the main causes of failure of ambulatory care; improvements might be made at this level, in order to reduce the burden on the inpatient hospital system.

[Assessment of astigmatism associated with the iris-fixated ARTISAN aphakia implant: Anterior fixation versus posterior fixation, study of postoperative follow-up at one year]. / Évaluation de l'astigmatisme associé à l'implant ARTISAN Aphakia fixé à l'iris en face antérieure versus face postérieure : étude du suivi postopératoire sur un an.

PURPOSE: The goal of our retrospective, single-center study of a case series was to compare the total, corneal, and internal astigmatism, and the visual acuity at one year after combined or stand-alone surgery consisting of iris fixation of an iris-claw intraocular lens (ARTISAN aphakia) in aphakic patients, according to whether the lens was fixated to the anterior (n=21) or posterior (n=51) surface of the iris. RESULTS: We did not find a significant difference between these two types of fixation for any of the studied variables. The surgically induced astigmatism was 1.67 D at 176° in group A versus 1.19 D at 11° in group P. CONCLUSION: Although this surgery creates additional corneal astigmatism, it has not been proven that it differs depending on the type of fixation of the iris-claw. If we adhere to the notion that the posterior fixated iris-claw decreases the risk of endothelial decompensation in case the implant becomes disenclavated, then reverse iris fixation of the iris-claw makes sense.

[Evaluation of the nurse triage at the ophtalmology emergency department of Pierre-Paul-Riquet Hospital]. / Évaluation du questionnaire de tri infirmier aux urgences ophtalmologiques de l'hôpital Pierre-Paul-Riquet au CHU de Toulouse.

INTRODUCTION: The steady increase in the number of visits to the various emergency services combined with the decrease in medical demographics, make it necessary to optimize triage of patients to improve their care. The purpose of this study was to evaluate the pertinence of our triage questionnaire in the classification of ophthalmologic emergencies by severity. METHODS: We used a monocentric cross-sectional study. From September 5 through September 25 2017, 858 patients who had all been seen in the ophthalmology emergency department of Pierre Paul Riquet Hospital of Toulouse university medical center and had responded to the triage nurse questionnaire were included. According to the symptoms presented or not by the patient, a color code was attributed (GREEN, ORANGE or RED) in order of increasing level of emergency. For each patient, we compared the severity of the final diagnosis by Base Score with the level of emergency established by our questionnaire. RESULTS: There were 118 "GREEN" patients, 606 "ORANGE" patients and 134 "RED." We were able to analyze 822 patients. 21.65% of patients were correctly classified, 73.36% were overestimated (of which 87.06% by one level and 12.94% by two levels of severity), and 4.99% were underestimated (of which 90.24% by one level and 9.76% by two levels). CONCLUSION: Our current triage questionnaire is not sufficiently discriminating for effective triage of ophthalmologic emergencies. It often overestimates minor emergencies, causing a delay in treating other emergencies. We propose a new questionnaire modified according to the results obtained during our study.

[A series of 20 cases of endogenous endophthalmitis]. / Description et devenir d'une série de 20 endophtalmies endogènes.

BACKGROUND: The purpose of this case series was to evaluate both the visual and systemic prognosis of patients with endogenous endophthalmitis. MATERIAL AND METHODS: We reported a series of 20 cases of endogenous endophthalmitis occurring between 2012 and 2015 at the university medical center in Toulouse. RESULTS: The mean age was 67 (±43.3) years with a male predominance (n=11). The site of entry was found in 14 cases (87.5%). In 11 cases (69%), the causative agent was a bacterium; a fungal infection was found in five cases. Visual acuity after maximal medical and surgical treatment was limited to "no light perception" in 7 cases (35%), "hand motion" in 2 cases (10%), "finger counting" in 3 cases (15%) and 10/10 in 2 cases (10%). One case had no final data. The main site of entry was found to be associated endocarditis (n=7), central venous line or venipuncture (n=6). The main local complications were retinal detachment (n=6), cataract (n=5) and choroidal neovascularization secondary to scarring (n=2). CONCLUSIONS: Endogenous endophthalmitis is associated with poor visual prognosis. It is also often associated with systemic complications that may be life-threatening.

Follow-up after surgery for hemorrhagic AMD.

INTRODUCTION: The long-term functional results of macular hematoma (MH) surgery in exudative AMD are often limited. The goal of this study was to compare visual outcomes of monthly versus bimestrial follow-up in these patients. METHODS: Retrospective, interventional case series. Population : 21 eyes of 21 patients with SMH associated with exudative AMD. INCLUSION CRITERIA: first SMH associated with exudative AMD, with 1-year postoperative follow-up. EXCLUSION CRITERIA: blood located exclusively underneath the retinal pigment epithelium on OCT imaging, SMH due to different etiology, lost to follow-up, ≤5 postoperative visits and a different surgical protocol as described. Patients were divided into two groups according to the number of postoperative visits (number of intravitreal injections [IVT] combined with the number of consultations, only one visit was recorded when IVT and consultation occurred on the same day) during the 1-year postoperative follow-up: group 1 had ≥11 visits (n=8); group 2 had 6 to 10 visits (n=13). All eyes underwent vitrectomy with subretinal injection of recombinant tissue plasminogen activator, fluid-gas exchange and anti-VEGF intravitreal injection. The main outcome was change in best-corrected visual acuity (BCVA). RESULTS: Considering visual acuity (VA) change between 1-month and 1-year postoperative follow-up examinations, group 1 had statistically significant greater VA changes (logMAR -0.29±0.44 vs logMAR 0.42±0.73; P=0.016; P=0.016). In patients that had exudative recurrences (ER), group 1 received more anti-VEGF IVT than group 2 (P=0.045). CONCLUSION: Our results showed that monthly follow-up, between the IVT series, is highly recommended to preserve postoperative VA in patients undergoing surgery for SMH associated with AMD.

[Isolated patchy perivenular whitening: When white edema of the posterior pole may be vascular in origin but not a retinal artery occlusion]. / Blanc périveinulaire isolé : quand un œdème blanc du pôle postérieur d'origine vasculaire ne rime pas avec oblitération artérielle rétinienne.

OBJECTIVE: To identify cases of non-ischemic retinal vein occlusion (RVO) presenting as isolated patchy perivenular retinal whitening and to describe diagnostic considerations and short-term natural history. MATERIAL AND METHODS: Retrospective observational monocentric case series. Patients monitored in one center between January 2013 and January 2015. Among the 151 patients monitored in our center for retinal vein occlusion, we identified patients presenting with isolated patchy perivenular whitening revealing retinal venous occlusion. RESULTS: Eight patients presenting with isolated perivenular whitening revealing RVO were identified (3.9 %). There were five central retinal vein occlusions, three hemi-retinal vein occlusions and no branch retinal vein occlusions. Initial visual acuity was preserved in five out of eight cases. In all cases, patchy perivenular whitening was isolated, without retinal hemorrhage. Blue monochromatic photographs allowed visualization of patchy perivenular whitening in all cases. Optical coherence tomography (OCT) showed a focal and segmental hyper-reflective area in the inner retinal layers, especially in the inner nuclear layer. One month after diagnosis, atrophy was noted in the retinal layers showing initial hyper-reflectivity. Three cases of our series of eight were initially mistakenly diagnosed as central retinal arterial occlusion. CONCLUSION: The main complication of perivenular whitening is the atrophy of inner retinal layers responsible for paracentral scotomas. The differential diagnosis with retinal arterial occlusion, which may be difficult, is based on the angiographic and OCT features, and their progression.

[Treatment delay in patients with first episode of retinal detachment in the studied eye in Midi-Pyrénées]. / Délai de prise en charge des patients atteints d'un premier épisode de décollement de rétine sur l'œil étudié en Midi-Pyrénées.

INTRODUCTION: Retinal detachment (RD) is a potentially blinding condition. Delay in management is a major prognostic factor. In our study, we analyzed the treatment delay for retinal detachments in the Midi-Pyrenees area, and factors which may influence it. MATERIAL AND METHODS: Observational, cross-sectional, multicentric study, carried out over a 6-month period. PRIMARY OUTCOME: time between diagnosis and surgery. Secondary outcome: time between first symptoms and surgery. Non-parametric tests were used to analyze the influence of sociodemographic features, clinical features, distance between home and surgical center, and occurrence over a weekend. RESULTS: One hundred and fiftty-nine patients were included. The mean time between diagnosis and surgery was 4.4 ± 12.3 days (2.7 ± 4.3 for recent RD, less than 1 month), and was increased by the presence of a weekend (P<0.001), or of a weekend with public holiday (P=0.023), and by macular detachment (P=0.008). The mean time between first symptoms and surgery was 12.0 days and was increased by the absence of RD history (P=0.023), and by macular detachment (P=0.046). No association was observed between these times to surgery and the distance between the patient's home address and the place of surgery. CONCLUSION: The time between diagnosis and surgery was relatively short in the Midi-Pyrénées area, but we often noted a delayed diagnosis, which may be due to the patient's lack of awareness of the symptoms and difficult access to specialty consultations. However, no relationship was found between this time-to-surgery and the distance between the patient's home and the surgical center.

[Multimodal imaging in the diagnosis of acute macular neuroretinopathy]. / Intérêt de l'imagerie multimodale dans le diagnostic de neurorétinopathie maculaire aiguë

INTRODUCTION: Acute macular neuroretinopathy is a retinal disease, usually presenting with a "normal fundus". Thus, this condition can be mistaken for optic neuropathy. Herein we present five clinical cases of patients affected with acute macular neuroretinopathy; one of them is a retrospective diagnosis while the others were diagnosed on initial examination. In the five cases, multimodal imaging with infrared photography and OCT helped to establish the diagnosis. MATERIAL AND METHODS: Retrospective study of five clinical cases. Initial and final best visual acuities as well as infrared and OCT imaging were collected for all patients. RESULTS: All patients initially reported a visual disturbance associated with a more or less severe decrease in visual acuity. Infrared imaging showed a dark, perifoveolar appearance of the lesions. In all cases, OCT images showed thickening and hyperreflectivity of the outer plexiform layer, extending towards the outer retinal layers. CONCLUSION: Acute macular neuroretinopathy is a clinical entity that has been long-described, which now benefits widely from new imaging technologies, allowing an earlier and more accurate diagnosis, but calling into question the actual name of this condition. The exact pathophysiology of the condition remains nonetheless incompletely elucidated.

[Recurrent bilateral anterior uveitis due to Leishmania infantum in a patient with immune deficiency related to HIV infection: a case report and literature review]. / Uvéite antérieure bilatérale récidivante à Leishmania infantum chez un patient présentant un déficit immunitaire lié à une infection à VIH : à propos d'un cas et revue de la littérature.

We report the case of a 56-year-old patient, presenting with bilateral hypertensive anterior uveitis due to Leishmania infantum, in the setting of immune deficiency related to HIV infection. The etiology of the uveitis was diagnosed following detection of L. infantum DNA on anterior chamber paracentesis. Initially, the patient received an intravitreal injection of liposomal amphotericin B, systemic antiparasitic treatment, topical steroid and ocular hypotensive treatment. Due to unfavourable disease progression in the right eye, we re-evaluated the anti-inflammatory, antiretroviral and antiparasitic medications (beginning meglumine antimoniate): the uveitis in the left eye was thus able to be controlled. We followed the efficacy of treatment with weekly quantification of Leishmania DNA in the aqueous humor. Uveitis secondary to leishmaniasis is rare and serious. Physicians must be aware of this cause of uveitis, particularly in immunodeficient patients. The quantitation of Leishmania DNA in the aqueous humor is an indispensible tool for monitoring the disease.

[Intravitreal bevacizumab pretreatment in vitrectomy for severe diabetic retinopathy: a series of six cases]. / Utilisation du bévacizumab (Avastin(®)) en injection intravitréenne avant vitrectomie pour rétinopathie diabétique sévère, à propos de six cas.

INTRODUCTION: Bevacizumab (Avastin(®), Roche) is a full-length humanized monoclonal antibody applicable to all subtypes of vascular endothelial growth factor (VEGF). The purpose of this study was to report the results of its use as a surgical additive in severe cases of proliferative diabetic retinopathy (PDR). PATIENTS AND METHOD: This retrospective study focused on six eyes of six patients with complicated diabetic retinopathy. A vitrectomy was performed within 13.6 days after an intravitreal bevacizumab injection of 0.1 mL (2.5mg), with dissection of the fibrovascular proliferation using a mono- or bimanual delamination technique. RESULTS: The mean follow-up after intravitreal injection was 13.3 months. The mean surgery time was 64 minutes. The bimanual technique was not necessary. Only one iatrogenic retinal tear was repaired. The intraoperative bleeding was negligible. No adverse events resulting from the drug nor recurrence were observed throughout the follow-up period. CONCLUSION: Intravitreal bevacizumab is useful as a surgical additive in severe cases of PDR, significantly improving surgical conditions. Nevertheless, its use beyond approved indications should be reserved for complex surgical cases.

[Dynamic phototherapy with silicone oil in treating choroidal subfoveal neovascularization in high myopia]. / Photothérapie dynamique sous huile de silicone pour traiter des néovaisseaux choroïdiens du myope fort.

UNLABELLED: We report a case of a high myopic patient, treated with photodynamic therapy for macular neovascularization in the presence of silicon oil. Four months later, the patient's vision was again at 4/40, with no active neovascularization. INTRODUCTION: Retinal detachment and macular neovascularization are common complications in high myopia patients. Sometimes these two conditions occur simultaneously and their treatment can become more problematic. OBSERVATION: We report the case of a high myopia patient treated with photodynamic therapy for subfoveal neovascularization through a vitreous cavity filled with silicone oil. The treatment was successfully completed with no problems. CONCLUSION: Photodynamic therapy can be achieved successfully through a vitreous cavity filled with silicone oil.

[Pars plana vitrectomy, subretinal injection of recombinant tissue plasminogen activator and fluid-gas exchange in the management of massive submacular hemorrhages secondary to age-related macular degeneration]. / Traitement des hématomes maculaires compliquant la DMLA par vitrectomie, injection sous-rétinienne de rt-PA et tamponnement intraoculaire par gaz.

INTRODUCTION: The natural prognosis of eyes with subretinal hemorrhage resulting from age-related macular degeneration is generally poor. A variety of therapeutic approaches have been developed but no consensus was found. Therefore, we evaluated a technique consisting of pars plana vitrectomy and subretinal rt-PA injection followed by evacuation of the liquid blood using sulfur hexafluoride (SF6). PATIENTS AND METHODS: This study was a retrospective clinical case series examining 18 eyes of 16 patients with age-related macular degeneration and thick submacular hemorrhage treated with vitrectomy, subretinal injection of rt-PA (0.5mg), and fluid-gas exchange. RESULTS: The subretinal hemorrhage was displaced in all 18 cases, revealing a choroidal lesion in 17 eyes. A treatable lesion accountable for the bleeding was identified in ten eyes, which all received a secondary treatment (intravitreal injection or photodynamic therapy). After a mean follow-up of 6 months, the final visual acuity improved in ten eyes. Complications consisted of one case of retinal detachment and one case of hyphema. CONCLUSION: This surgical technique seems useful in displacing thick submacular hemorrhage secondary to age-related macular degeneration, allowing postoperative fluorescein angiography testing and, potentially, subsequent treatments. However, further controlled and multicentric studies will be required to assess its efficacy and safety in the management of this difficult clinical problem.

[Intravitreal bevacizumab for treatment of neovascular glaucoma. Report of 20 cases]. / Utilisation du bevacizumab en injection intravitréenne dans le traitement du glaucome néovasculaire. A propos de 20 cas.

INTRODUCTION: Bevacizumab is a recombinant humanised monoclonal antibody directed against the vascular endothelial growth factor (VEGF). We report the results of bevacizumab injections in the treatment of 20 cases of neovascular glaucoma. PATIENTS AND METHODS: Seven women and 13 men, of average age 73 years old, presented with neovascular glaucoma secondary to central retinal vein occlusion in 8 cases, proliferative diabetic retinopathy in 8 cases, central retinal artery occlusion in 2 cases, radiation retinopathy in 1 case and ocular ischemic syndrome in 1 case. Iris fluorescein angiography was performed before and two days after 2,5 mg intravitreal bevacizumab. Diode laser cyclophotocoagulation was realised in 12 cases of grade 4 neovascular glaucoma in the week following the injection. Panretinal photocoagulation was conducted in all cases. RESULTS: After a 4 months and a half follow up, iris angiography revealed dramatic regression of iris neovascularisation in a few days. In grade 2 and 3 neovascular glaucoma, the single injection is sufficient to control intraocular pressure. In grade 4 neovascular glaucoma, intraocular pressure was controlled in 87,5 % of cases with one injection and one or more diode laser cyclophotocoagulation. DISCUSSION: The antiangiogenic effect of bevacizumab leads to fast reduction of the iris neovascularization with control of intraocular pressure without any surgery in grade 2 or 3 neovascular glaucoma. Panretinal photocoagulation was facilitated by improvement of corneal swelling. Diode laser cyclophotocoagulation was necessary in grade 4. CONCLUSION: Intravitreal bevacizumab was effective in reversing iris neovascularization in association with panretinal photocoagulation and cyclophotocoagulation.

[Combined cataract and macular disease surgery]. / Chirurgie combinée cataracte et affection maculaire.

Cataract is frequently associated with vitreoretinal diseases. Moreover, cataract is one of the most frequent complications of pars plana vitrectomy. In cases of cataract associated with vitreoretinal diseases such as age-related macular degeneration complicated by massive submacular hemorrhage or macular hole, combined phacoemulsification and vitrectomy surgery in one session can be considered. Therefore, phacoemulsification performed before the pars plana vitrectomy for epiretinal membrane seems to be the best solution when preoperative cataract is present. In all cases, phacoemulsification with a corneal incision, insertion of a posterior capsule intraocular lens with a large diameter and a large anterior capsulorhexis are necessary.

[Treatment of central retinal vein occlusion by isovolemic hemodilution]. / Traitement par hémodilution des occlusions de la veine centrale de la rétine.

PURPOSE: Evaluate the effects of hemodilution in the treatment of central retinal vein occlusion (CRVO). PATIENTS AND METHODS: We carried out a retrospective, noncomparative study of 25 patients presenting unilateral CRVO, treated with one to three hemodilution sessions. The patients were re-examined in the 1st, 2nd, 3rd, 6th and 12th months following treatment with measurement of visual acuity, fluorescein angiography, and optical coherence tomography. RESULTS: Our study included 17 men and eight women, averaging 63 years of age (range, 35-87 years), and monitored for an average of 7 months (range, 3-12 months). After the 6th month following treatment, average visual acuity improved compared to initial visual acuity. Initial visual acuity of less than 1/10, with the existence of poorly irrigated areas in the angiography, presented negative prognosis factors. The number of hemodilutions did not produce a significant difference in final visual acuity. No serious complications due to hemodilution were observed. DISCUSSION: Treatment of CRVO is subject to debate. Some practitioners recommend against treatment, while others advocate intervention and offer laser-induced chorioretinal venous anastomosis. Surgical vitrectomy and radial optical neurotomy, with or without injection of triamcinolone, await evaluation. Hemodilution may offer a therapeutic approach to this pathology, in which the etiopathogenesis is not yet recognized, but in which blood viscosity plays a key role. This treatment is well tolerated. CONCLUSION: Hemodilutions appear to have beneficial effects in treating CRVO, whatever the number of hemodilutions used. This study should be confirmed by a prospective study using an untreated control group.

[Surgical treatment of inferior retinal detachment: advantages of postoperative traction of the right inferior muscle]. / Traitement chirurgical des décollements de rétine inférieurs: intérêt de la mise en traction postopératoire du muscle droit inférieur.

AIM: To evaluate the advantages of keeping the right inferior muscle in traction during external surgery for inferior retinal detachment. PATIENTS AND METHODS: This was a prospective study involving ten patients consecutively operated on for rhegmatogenous retinal detachment at the Toulouse-Rangueil Teaching Hospital. Internal plugging by air or a C2F6-air mixture was systematically performed, together with external indentation and total subretinal fluid puncture. At the end of surgery, a 2.0 silk thread was set beneath the right inferior muscle and kept in traction from the forehead for a few days. The patient was maintained feet up, in a dorsal decubitus posture. RESULTS: Results proved excellent, with ten anatomical successes. However, one patient had to have gas reinjected and in another subretinal fluid persisted for 3 months. DISCUSSION: The risk of surgical failure in inferior retinal detachment is greater because dabbing is more difficult to perform. To make this dabbing easier, we propose maintaining the ocular globe rearward by maintaining traction on the right inferior muscle, which produced excellent results. CONCLUSION: The technique proposed is easy to perform, and combined with internal dabbing and adequate patient positioning, it should help improve the surgical outcome of inferior retinal detachments.

[Management of complicated retinal detachment using a heavy silicon oil as temporary tamponade]. / Tamponnement interne par huile de silicone lourde (Oxane Hd) dans les décollements de rétine complexes.

PURPOSE: To assess the efficacy and safety of a heavy silicon oil (a silicon oil-RMN3 mixture, a mixed fluorinated and hydrocarbonated olefin) as temporary internal tamponade in selected cases of retinal detachment with inferior breaks. PATIENTS AND METHODS: Forty-six patients were operated on (inferior and/or posterior breaks: 38; proliferative vitreoretinopathy > or =C2: 18; anterior proliferative vitreoretinopathy: 14), with a mean follow-up of 39 months. Seventeen patients were operated on with a heavy silicon oil of a 1.03 g/cm3 density and 29 patients with a silicon oil of a 1.02 g/cm3 density. Heavy silicon oil was removed in 41 patients after a mean of 9.3 weeks. RESULTS: Anatomic success was achieved in 35 cases after a mean follow-up of 39 months. Recurrent retinal detachment with proliferative vitreoretinopathy occurred in eight cases during heavy silicon oil tamponade. The removal was difficult in three cases with the 1.02 g/cm3 density silicon oil. Complications included glaucoma (eight eyes), major emulsification (two eyes), and an intraocular inflammation reaction to topical steroids (five eyes). CONCLUSION: Heavy silicon oil (Oxane Hd) is as safe and effective as standard silicon oil in the treatment of selected retinal detachment, but intraocular manipulations are quite difficult. A prospective study is necessary to compare the efficacy of Oxane Hd and standard silicon oil in selected cases of retinal detachment with inferior breaks and in cases of large inferior retinectomy.

[Specifications of retinal detachment surgery in highly myopic eyes of 10 or more dioptres and hemorrhagic complications: 79 cases]. / Particularités du traitement chirurgical du décollement de rétine du myope fort de plus de 10 dioptries et son risque hémorragique. A propos de 79 cas.

INTRODUCTION: We report a series of 79 eyes undergoing primary surgery for rhegmatogenous retinal detachment associated with severe myopia greater than 10 diopters. Specific surgical procedures are recommended for these patients in order to minimize the high incidence of postoperative hemorrhagic complications. MATERIALS AND METHODS: Seventy-nine eyes of 76 patients treated for retinal detachment with severe myopia greater than 10 diopters were reviewed. Scleral buckling was performed in 21 eyes and pars plana vitrectomy in 58 eyes. RESULTS: After a mean follow-up period of 23.8 months, the final anatomical success rate was 93.7% (74 cases). Postoperative hemorrhagic complications (suprachoroidal hemorrhage and vitreous hemorrhage) occurred in four cases after scleral buckling and in ten cases after vitrectomy. DISCUSSION: In this study, primary scleral buckling for retinal detachment was less frequently performed than vitrectomy. Broad scleral buckling may not be associated with higher postoperative hemorrhagic complications, when the buckle does not extend over six clock hours. Postoperative hemorrhagic complications also occurred after vitrectomy; however, scleral buckling associated with vitrectomy does not seem to increase the complication rate. CONCLUSION: This retrospective study of 79 cases of rhegmatogenous retinal detachment with severe myopia higher than 10 diopters suggests that vitrectomy is often considered a primary procedure. Broad scleral buckling associated with vitrectomy is a safe and effective procedure, with an acceptable incidence of complications when not extending over six clock hours.

[Retinal detachment by inferior tear: a poor prognosis?]. / Décollement de rétine par déchirure inférieure, facteur de mauvais pronostic?

AIM: To determine whether a lower location of retinal wounds is a factor for poor prognosis in retinal detachment. PATIENTS AND METHOD: This retrospective study involved 248 medical records of patients who were operated on for retinal detachment in 2001 at the Toulouse-Rangueil Hospital Ophthalmology Department. We excluded retinal detachment of very short-sighted patients, diabetic patients and detachment secondary to trauma or relapses. We compared the incidence of surgical failure according to various parameters: condition of the crystalline lens, operative technique, operator, vitreoretinal proliferation, retinal wound location, patient age and the operative side. Thirty-six patients presented with lower wounds; 17 patients obtained incomplete results and relapsed within 1 year of surgery. RESULTS: Vitreoretinal proliferation and inferior location of the retinal detachment were found to be poor prognostic factors. No significant differences were found between the other parameters studied. DISCUSSION: A variety of prognostic factors of retinal detachment surgery are now clearly identified (vitreoretinal proliferation, old detachment). A lower location of the detachment constitutes an additional difficulty for retinal applications. Indeed, it is more difficult to perform effective buffering in this type of case. We recommend that retinal detachment be operated internally, to reduce the risk of relapse. CONCLUSION: An inferior location of the retinal wound during retinal detachment appears to be a factor of poor prognosis, but this remains to be ascertained through an ongoing, prospective study.