Impact of preoperative and intraoperative factors in cataract surgery.

BACKGROUND: Cataract surgery is the most common procedure in ophthalmology. However the surgical outcome depends on various factors. The impact of preoperative and intraoperative factors on the surgical procedure were investigated. PATIENTS AND METHODS: Prospective consecutive study of eyes that underwent cataract surgery. The studied parameters included: age, body mass index (BMI), medical history, type of anaesthesia, preoperative patient's anxiety level (scale from 0 to 10), spherical equivalent (SE), keratometry, axial length (AL), time and percentage of ultrasounds (US), intraoperative complications, duration of surgery. The eyes were separated into two groups: the "no complication group" and the "complication group". RESULTS: 529 eyes were included. Age averaged 75.5 years old (44; 100), mean BMI (kg/m2) was 26.3 (13.7; 45.2), patients had cardiovascular history in 61.05% of cases, the type of anaesthesia used was topical in 93.4%, subtenon in 4.7% and general in 1.9% of cases. Mean preoperative anxiety was 4.04 (0; 10), mean preoperative SE was -0.12 (-10; 7.5), mean keratometry (diopters) was 43.88 (39.5; 49), mean AL (mm) was 23.29 (20.91; 29.78), mean time of US (minutes) was 1.89 (0.08; 9.2), mean percentage of US was 10.5 (2; 30) and mean surgical duration (minutes) was 17.15 (5; 50). There was a statistically significant difference (p < 0.0001 in all cases) between both groups in the preoperative anxiety, the time of US and the duration of surgery. The "complication group" had higher scores in all cases as well as more proportion of patients with cardiovascular history. There was no statistically significant difference between both groups for the BMI, SE, AL, keratometry and percentage of US. CONCLUSIONS: The preoperative anxiety level and a cardiovascular medical history together with a prolonged time of US and a longer surgical duration seem to provide more complications during the surgery. The BMI, SE, AL and keratometry did not influence the surgical procedure.

[Giant nodular posterior scleritis compatible with ocular sarcoidosis simulating choroidal melanoma]. / Escleritis nodular posterior gigante compatible con sarcoidosis ocular simulando un melanoma de la coroides.

CASE REPORT: A 30-year-old man was referred to our ocular oncology service with a diagnosis of amelanotic choroidal melanoma of the left eye. The following tests were performed: ophthalmoscopy, fluorescein angiography, indocyanine green angiography, ultrasonography, magnetic resonance imaging and biopsy. DISCUSSION: The diagnosis of giant nodular posterior scleritis, as suggested by ultrasonography, was confirmed by biopsy. A comprehensive medical evaluation was performed, but no etiology was found. The histology revealed a granuloma compatible with ocular sarcoidosis. A rapid response was obtained by systemic steroid administration (1 mg/kg). Sarcoidosis continues to be a challenge in diagnosis. It is important to distinguish nodular posterior scleritis from choroidal melanoma.

Escleritis nodular posterior gigante compatible con sarcoidosis ocular simulando un melanoma de la coroides / Giant nodular posterior scleritis compatible with ocular sarcoidosis simulating choroidal melanoma

Caso clínico: Un paciente de 30 años fue enviado a nuestro servicio oncológico de referencia con el diagnóstico de melanoma amelanótico de la coroides del ojo izquierdo. Se hicieron los siguientes exámenes: oftalmoscopía, angiografía fluoresceínica, angiografía con verde de indocianina, ecografía, resonancia magnética y biopsia. Discusión: El diagnóstico de escleritis nodular posterior gigante basado en la ecografía se confirmó mediante una biopsia. Se realizó un examen médico completo buscándose el posible agente causal; no se encontró la etiología. La histología reveló un granuloma que era compatible con una sarcoidosis ocular. Mediante la administración de esteroides por vía oral (1 mg/kg), se obtuvo una evolución rápidamente favorable del cuadro. El diagnóstico de esta afección sigue siendo un desafío. Es importante diferenciar una escleritis posterior nodular de un melanoma de la coroides

Case report: A 30-year-old man was referred to our ocular oncology service with a diagnosis of amelanotic choroidal melanoma of the left eye. The following tests were performed: ophthalmoscopy, fluorescein angiography, indocyanine green angiography, ultrasonography, magnetic resonance imaging and biopsy. Discussion: The diagnosis of giant nodular posterior scleritis, as suggested by ultrasonography, was confirmed by biopsy. A comprehensive medical evaluation was performed, but no etiology was found. The histology revealed a granuloma compatible with ocular sarcoidosis. A rapid response was obtained by systemic steroid administration (1 mg/kg). Sarcoidosis continues to be a challenge in diagnosis. It is important to distinguish nodular posterior scleritis from choroidal melanoma