Retinal detachment after phacoemulsification: a study of 114 cases.

PURPOSE: To analyze the features of retinal detachment (RD) occurring after cataract surgery performed by Kelman phacoemulsification (KPE) and to identify any potential correlations between KPE intraoperative complications and the features of RD (incidence apart) as well as the final visual outcome. DESIGN: Interventional consecutive case series. METHODS: Retrospective review of 114 eyes of 114 consecutive patients with RD occurring after KPE and followed for 6 months or more after surgery. RESULTS: Removal of posteriorly dislocated lens fragments during KPE by pars plana vitrectomy (PPV) was associated with a significantly shorter time interval between KPE and RD (3.89 vs. 15.7 months, P =.0044). Once RD occurred, no other statistically significant correlation between its features or the final visual outcome and KPE intraoperative complications (posterior capsular rupture, vitreous loss, posteriorly dislocated lens fragments) was detected. The overall anatomic reattachment rate was 94%. Only redetachment associated with the development of proliferative vitreoretinopathy (PVR) was significantly correlated with ultimate anatomic failure (P =.0036). A best-corrected visual acuity of 20/60 or better was achieved in 58 out of 114 eyes (51%). Three variables were independently correlated with visual results: more extensive RD (P =.0001), redetachment associated with the development of PVR (P =.0029), and failure to identify retinal breaks (P =.0114). CONCLUSIONS: Posterior capsular rupture and vitreous loss during KPE do not seem to affect the features (incidence apart) or the final visual outcome of RD occurring afterwards, except for a shorter time interval between KPE and RD in eyes that underwent PPV to remove posteriorly dislocated lens fragments.

Unusual case of difficult double-lumen endotracheal tube removal.

A reusable Robertshaw red rubber double-lumen endotracheal tube (DLT) was placed to facilitate lung isolation for thoracoscopy in a 49-year-old atopic patient. In spite of its smooth insertion, it was then not possible to remove the DLT. Direct laryngoscopy showed severe laryngeal edema. After 48 hours of medical treatment with steroids, the trachea was extubated. The laryngeal edema could have been the result of physical and chemical irritation by the reusable rubber DLT itself, or from the substances formed during repeated cleaning and sterilization of the DLT. Atopic patients who are prone to developing latex allergy are also more liable to develop severe reactions to chemical, mechanical, and physical irritation from reusable red rubber DLTs or from the chemical solution used for its cleaning and sterilization.

Presentation delay in patients affected with exudative age-related macular degeneration.

BACKGROUND: Presentation delay (i.e. duration of visual symptoms before initial presentation) is an established critical parameter for visual prognosis in patients with exudative age-related macular degeneration (ARMD) considering the natural history of the disease and the limitations of current treatments. The purpose of this study was to determine the duration of presentation delay and its evolution in two periods 4 years apart. METHODS: Presentation delay in 1598 patients affected with exudative ARMD was retrospectively reviewed during two similar 8-month periods in 1994 and 1998 in a tertiary referral center. RESULTS: The proportions of patients examined either within 1 month, between 1 and 3 months, and between 3 and 6 months after onset of symptoms, respectively, increased between 1994 and 1998 from 23% to 33%, from 27% to 32.5%, and from 14% to 18.5%. The proportions of patients examined between 6 and 12 months and after 12 months decreased from 16% to 12% and from 20% to 4%, respectively. Furthermore, the proportion of patients presenting with a first eye involvement during the first month following the onset of symptoms rose from 42% in 1994 to 52% in 1998. All these differences were statistically significant. CONCLUSION: This first specific review of presentation delay in exudative ARMD showed a significant decrease in this parameter between 1994 and 1998 that should be taken into account when assessing the overall evolution of visual outcome. Further studies are warranted to ascertain that these findings reflect a global improvement in the management of macular diseases.