Operative versus conservative treatment for giant omphalocele: Study of French and Ivorian management.

INTRODUCTION: The giant omphalocele is currently a surgical challenge. The morbidity and mortality associated with its care is non-negligible. Nowadays, different studies have revived the debate between conservative and surgical management for giant omphalocele. The purpose of this study is to compare the conservative and surgical management of the giant omphalocele in terms of morbidity and mortality. METHODS: Retrospective study including all giant omphaloceles comparing surgical management (French University hospital centers) and tanning (Ivory Coast University hospital center). Epidemiology was studied as well as medical and surgical managements both intra and post operative. RESULTS: One hundred and forty-seven patients included (98 patients in the "tanning" group and 49 in the "surgery" group). Hospital length of stay is significantly shorter in the "tanning" group as they do not spend time in intensive care unit. Morbidity is higher in "surgery" group. The average duration for oral empowerment was acquired at 179 days in the "surgery" group, whereas in the "tanning" group 90% was immediately and exclusively breastfed. No significant differences in terms of epithelialization time. CONCLUSION: The tanning treatment has its own place in the therapeutic arsenal in the management of the giant omphalocele no matter where it takes place. However, its realization in surgical environments prevents certain complications related to the technique or the pathology.

[Cost of managing cataracts. Evaluation of traditional hospitalization and ambulatory surgery]. / Coût de la prise en charge de la cataracte. Evaluation en hospitalisation traditionnelle et en chirurgie de jour.

OBJECTIVE: Demonstrate eventual differences and evaluate the medical costs of treatment of a cataract in traditional hospitalisation and out-patient surgical conditions. METHODS: We conducted a study of minimisation costs in 3 ophthalmologic hospital departments. This retrospective study randomly selected the medical files of 250 patients (100 operated in the out-patient surgical department and 150 operated in traditional surgical conditions). Costs were evaluated on direct hospital costs, according to the standard costs method and the method of true costs. RESULTS: The mean total cost of a cataract is of 10,984 F in traditional hospital conditions and of 7,683 F in out-patient surgical conditions. DISCUSSION: In terms of direct hospital costs, treatment of cataracts in out-patient surgery appears more economic compared with traditional surgery. The difference in cost concerned the fixed hospital charges (structures and staff). CONCLUSION: Out-patient surgery will progress in France in the next few years, but traditional hospitalisation will still be required in ophthalmologic practice.

Sub-Tenon's anaesthesia: an efficient and safe technique.

AIM: To evaluate sub-Tenon's anaesthesia as an alternative to peribulbar anaesthesia. METHODS: 109 consecutive patients listed for various eye operations (including cataract, trabeculectomy, and vitrectomy) under peribulbar anaesthesia were operated on under sub-Tenon's anaesthesia instead. After topical anaesthesia a buttonhole was fashioned through the conjunctiva and Tenon's capsule 10 mm posterior to the limbus. 1.5 ml of lignocaine 2% was then delivered to the posterior sub-Tenon's space using a blunt cannula. The surgical procedure was performed immediately after the completion of the anaesthetic procedure. Chemosis, conjunctival haemorrhage, degree of akinesia, and pain scoring were analysed. RESULTS: There were no anaesthesia related complications. The administration of the block was painless for 99.1% of the patients. In all, 97.3% reported no pain during surgery. There was no akinesia when assessed just after the completion of the block and akinesia was limited when assessed after surgery. Chemosis and conjunctival haemorrhage were frequent but caused no intraoperative problems. CONCLUSION: Sub-Tenon's anaesthesia is an efficient and safe anaesthetic technique. It is a good alternative to peribulbar anaesthesia.

[Phacoemulsification by the anterior approach combined with vitreoretinal surgery]. / Phacoémulsification par voie antérieure combinée à la chirurgie vitréo-rétinienne (22 cas).

Phacoemulsification was combined with vitreoretinal surgery in 22 cases in which lens opacity prevented good visualisation of the fundus. The main indications were proliferative diabetic retinopathy and retinal detachment complicated by proliferative vitreoretinopathy. Phacoemulsification was achieved by a limbal approach. The technique was adapted to the hardness of the lens nucleus. The incision was temporarily or definitely closed. The visualisation system was set up and the endocular surgery performed. In 5 cases an implantation in the bag was realised at the end of surgery. This type of combined procedure offers both the benefits of extra capsular surgery: avoids neovascular glaucoma in diabetic patients, keeps silicone oil in good position, possible implantation in the capsular bag, and those of a small incision: absence of leakage, of myosis, of corneal clouding, rapid rehabilitation.

[Complications of Stableflex anterior chamber intraocular lens implants. Apropos of 150 cases]. / Complications des implants intra-oculaires de chambre antérieure de type Stableflex. A propos d'une série de 150 cas.

Stableflex (ORC) is a PMMA anterior chamber intraocular lens with closed and flexible loops permitting the philosophy of "one size fits all" in 90% of the eyes. Late complications lead to marketing interruption in the USA in July 1987. In a review of 150 cases, we study the occurrence of complications: corneal decompensation (4.5%), iridocorneal angle modification, cystoid macular edema (6.7%), explantation (n = 6). These observations suggest implications of physiopathological mechanisms which are examined.

[Specular microscopy in the diagnosis of the iridocorneal endothelial syndrome]. / Apport de la microscopie spéculaire dans le diagnostic du syndrome endothélial irido-cornéen.

Irido-corneal endothelial syndrome regroups three disorders including: endotheliopathy, peripheral anterior synechiae and iris changes. According to the aspect of these abnormalities, three syndromes are described: essential iris atrophy, Chandler's syndrome and iris naevus (Cogan-Reese) syndrome. Endothelial changes studied by specular microscopy are typical: in early stages, a rounding off cell angles and intracellular blackout areas can be seen; in former stages, black out areas increase and there is a disruption of the regular mosaic. These features are a major point for differential diagnosis. We present six cases reports among which three where effectively diagnosed as iridocorneal endothelial syndrome and three were not.