[Retinal detachment after Excimer laser (myopic LASIK or PRK). A retrospective multicentric study: 15 cases]. / Décollement de rétine post laser Excimer (Lasik/PKR myopique). Etude multicentrique rétrospective (15 cas).

INTRODUCTION: Refractive surgery by LASIK or photorefractive keratectomy (PRK) generaly aims at a myopic population that has a high probability of developing rhegmatogenous retinal detachment (RD). The authors report a multicenter study with 15 cases of RD appearing after refractive surgery by Excimer laser and discuss the role played by the techniques used. MATERIAL AND METHODS: Five centers fitted with nine Excimer laser devices took part in this study. Of 22,700 eyes undergoing refractive myopic surgery during the period 1994-2002, 15 eyes developed rhegmatogenous RD. The average age of the patients with RD was 37 years. The average myopia was 13.5 D. RD occurred a mean of 20 months after refractive laser. RESULTS: Fifteen eyes of 13 patients developed a rhegmatogenous RD, two of which were bilateral. Eight of these cases had LASIK surgery and six had photorefractive keratectomy; one of the latter patients was retreated with LASIK because of substantial regression after PRK. RD was total or subtotal in five eyes, partial superior with a temporal tear in six eyes, and nasal in three eyes. One case with inferior RD, two cases with giant retinal tear and one case with posterior tear were also repaired. Fourteen eyes were suitable for operation. The retina was reattached in 12 cases. Mean postoperative visual acuity was 7/10. DISCUSSION: The occurrence of rhegmatogenous RD in the myopic population is estimated at 2.2%. It is estimated at 0.1% in the emmetropic population. The Excimer laser, through its thermic effects, shock wave, traumatism undergone by the suction ring at the time of LASIK surgery, could increase this risk in myopic patients. A review of the literature cast doubt on the cause and effect hypothesis. Personal and multicenter studies (including ours) show that the frequency rate of rhegmatogenous RD after Excimer laser is equivalent and even lower than that estimated with an emmetropic population. The low percentage of RD after Excimer surgery found in the literature as well as in our study (<0.1%) may be explained by patient selection, the systematic monitoring of the peripheral fundus, and the prophylactic treatment of degenerative lesions by photocoagulation. In RD surgery, the cornea must be manipulated carefully, a case of flap dehiscence has been reported in the literature. CONCLUSION: Refractive surgery by LASIK or PRK for severe myopia increases the risk of RD. Systematically monitoring the peripheral fundus and preventive photocoagulation have mitigated its occurrence, and the risk incurred in the myopic population has fallen to the emmetropic population's rate. Nevertheless, candidates for LASIK or PRK surgery must be informed because severe myopia constitutes a non-negligible risk factor.

[Congenital obstruction of lacrimal ducts in 578 children]. / Obstruction congénitale des voies lacrymales chez 578 enfants.

BACKGROUND: Congenital obstruction of the nasa lacrimal ducts is a frequent problem in infancy. Its management is still controversial. REPORT: 578 children aged 6 weeks to 3 years were treated in our department between 1980 and 1987. Congenital obstruction of the nasa lacrimal ducts was bilateral in 172 of them, so that a total of 750 ducts were obstructed. All the infants were treated with antibiotics until they are 2 months old. Permeability was obtained in 97% of the 750 obstructed ducts: this was spontaneous in 38.7%, after a single wash in 3%, and by probing under general anesthesia in 55.3%. The percentage of cases requiring surgery increased with age at time of diagnosis. CONCLUSIONS: The best results are obtained in infants 2 to 4 months old.

[Conjunctival myiasis. 23 cases in the Tunisian Sahel]. / Myiases conjonctivales. A propos de 23 cas dans le Sahel tunisien.

Conjunctival lesions of ocular myiasis are common in the mediterranean region. The authors report 23 cases of conjunctival myiasis. This affection is caused by fly's larvae: Oestrus ovis presenting typically with inflamed and oedematous eyes. We diagnose the affection by directly showing the larvae on conjunctiva. The treatment consisted to extirpate larvae one by one.