[Study of the results scleral-fixated intraocular lenses in the absence of capsular support]. / Étude des résultats de l'implantation fixée à la sclère en l'absence de plan capsulaire.

INTRODUCTION: In the absence of sufficient capsular support, scleral fixation of the intraocular lens is an interesting alternative. The goal is to evaluate this implantation technique when traditional implantation is impossible. PATIENTS AND METHODS: This is an observational, retrospective, monocentric study at the Amiens university medical center between August 2013 and March 2016. Patients all underwent scleral fixation of a three-piece implant without suturing of the haptics, after posterior vitrectomy. All patients requiring implantation in the absence of stable capsular support were included. Patients with adequate iris or capsular support were excluded from our study. RESULTS: Eighteen patients were included, with an average age of 69.3±16.9 years. The surgical indications were: complicated surgery, trauma and endothelial decompensation. The preoperative mean corrected visual acuity was 1.2±0.4 LogMAR while the postoperative acuity was 0.7±0.5 LogMAR. The mean postoperative corneal astigmatism was 1.9±1.9 diopters. The main complications observed were ocular hypertension, macular edema, retinal detachment, iris incarceration and exteriorization of the haptic. DISCUSSION: There are two alternatives when faced with lack of a sufficient capsular support: scleral fixation or iris fixation. Our technique is the only one achievable in the presence of iris atrophy. Furthermore, it induces less astigmatism and enables the repositioning of a three-piece implant dislocated into the vitreous. CONCLUSION: Scleral fixation is a technique allowing both a satisfactory and a lasting functional result and is to be considered when faced with a lack of sufficient capsular support.

Tolerability of intracameral cefuroxime during cataract surgery in case of penicillin allergy.

INTRODUCTION: Since the results of the ESCRS study in 2007 and then the AFSSAPS recommendations of 2011, postoperative endophthalmitis prophylaxis in cataract surgery has evolved toward intracameral cefuroxime. Penicillin allergy is frequent and is not considered as a contra-indication to cefuroxime injection, but cross-reactions do exist. The goal of this study was to assess the tolerability of intracameral cefuroxime in patients with a penicillin allergy. MATERIALS AND METHODS: In this monocentric open prospective study, adult patients undergoing cataract surgery and declaring themselves penicillin-allergic were included. A subcutaneous test of cefuroxime was performed preoperatively. If negative, patients received the intracameral injection of cefuroxime at the conclusion of the surgical procedure. The primary assessment criteria, evaluated on the day after the surgery, was the occurrence of allergic reactions. RESULTS: Forty-eight eyes of 40 patients, 72 ± 8 years old, were included. Forty-three skin tests were performed: 1 was positive and one was unreliable. Thirty-six patients were examined in our center the day after the surgery: 2 presented a conjunctival allergic reaction. No severe anaphylactic reaction was reported. DISCUSSION: Of our patients, 95.3% declaring a penicillin allergy had a negative pre-operative cefuroxime test. According to literature, 80 to 90% of presumed penicillin allergic patients would not actually be allergic to cefuroxime. In our population, we reported 2 benign conjunctival cross-reactions. CONCLUSION: Intracameral cefuroxime injection during cataract surgery seems well-tolerated in penicillin-allergic patients with a negative preoperative skin test.

[Pediatric orbital cellulitis without sinusitis: report of four cases]. / Cellulites orbitaires atypiques d'origine non sinusienne de l'enfant : à propos de quatre cas.

INTRODUCTION: Pediatric orbital cellulitis is most often caused by ethmoid sinusitis. We present a description of 4 atypical cases of orbital cellulitis without sinusitis. PATIENTS AND METHODS: A 4-day-old girl presented with medical canthal swelling and preseptal cellulitis caused by bilateral congenital dacryocystoceles. The second patient was an 8-year-old boy seen for infectious conjunctivitis complicated by preseptal cellulitis without sinusitis. Conjunctival cultures revealed Neisseria gonorrheae. The next patient, a 5-month-old boy, presented with lid swelling, fever, proptosis and epiphora. It was caused by dacryocystitis extending into the ethmoid and complicated by a sub-periostal abscess with mass effect on the globe. The fourth patient was a 10-year-old boy referred for inflammatory eyelid edema and severe non-axial proptosis. Imaging revealed an orbital tumor; the diagnosis of rhabdomyosarcoma was confirmed by anatomopathology. DISCUSSION: Thorough etiologic work-up of orbital cellulitis in children will prevent missing a non-sinus-based cause such as lacrimal infections, conjunctivitis secondary to atypical pathogens, or even tumors. All patients should undergo a detailed clinical examination, orbital imaging and microbiological testing. CONCLUSION: Orbital cellulitis in children poses diagnostic and therapeutic difficulties due to the many possible etiologies. Aside from sinusitis, the most important etiologies to pursue are lacrimal system infections and tumors. When confronted with a non-specific clinical presentation, thorough etiologic work-up is essential, in view of the potential life-threatening, functional and social implications.