To review the local anesthesia environment in France in adult out-patient cataract surgery. The a... more To review the local anesthesia environment in France in adult out-patient cataract surgery. The author considers the presence or absence of an anesthesiologist in the operating room. The report shows that in many circumstances there is no need for an anesthesiologist if the following criteria are respected: the adult is fully informed, in rather good health, with no acute risk factors, and surgery is performed by a senior surgeon in a certified operating room. In France, a move toward more flexible regulations is expected, with a new cooperation between ophthalmologists and anesthesiologists that will lead to a new true risk/benefit/obligation ratio. Respect of the individual and safety remain crucial requirements making systematic generalizations impossible.
The authors report a case of a 70-year-old man presenting a recent unilateral decrease in visual ... more The authors report a case of a 70-year-old man presenting a recent unilateral decrease in visual acuity, appearing in a context of alcohol and tobacco intoxication. Diagnosis of Leber's optic neuropathy was evoked after elimination of other causes of a visual acuity decrease such as giant cell arteritis and compressive or inflammatory optic neuropathy. The authors emphasize that Leber's optic neuropathy must be evoked in a recent decrease in visual acuity, even if it appears in an unusual context.
We gave consideration to the new legal obligation to a medical doctor to prove that he has given ... more We gave consideration to the new legal obligation to a medical doctor to prove that he has given to a patient adequate information. 312 cases of cataract or glaucoma received written information about their disease and the risks of surgery. An informed consent regarding the operation and the post-opérative care were signed by all patients. Information cover surgical risks, sides effects, unpredictable events, care steps and all last minute protocol modifications. These documents were given when scheduling the surgery. No cancellation and no objection were noticed. The French Code Civil article 1315 was not dedicated to medical exercise but it concerns physicians. The way to give a proof is not clear. Nothing is asked in the by-laws and every medical doctor can choose the method he prefers. A signature is not an obligation and an informed consent is not an authorization. A discussion is opened to clear the best and safest recommendations to obtain a legal proof of information. Now, w...
This prospective study compares the analgesia obtained by topical anaesthesia versus a single per... more This prospective study compares the analgesia obtained by topical anaesthesia versus a single peribulbar anaesthesia. The comparison is made during clearcornear phacoemulsification in adult patient. Ninety-six eyes are operated with Lidocaine 2% (66) or Tetracaine 1% (30) topical anaesthesia, 38 eyes received an unique anterior periocular injection. The same surgeon performs the phacoemulsification in 2 different centers. Analgesia is evaluated in the per and post operative period by the surgeon and a nurse. Four cases (4.2%) in the topical anaesthesia group required a complementary subconjonctival anaesthetic injection. Seven cases (7.3%) had pain during surgery but without any need for a complementary injection. In the other group 1 injection was necessary (2.5%). A slight pain was felt by 5% of patients during surgery. Topical anaesthesia is reliable but needs a patients selection, a well trained staff and a non beginner surgeon. The advantages are obvious for out patient surgery...
To demonstrate the utility of a viscoelastic substance which maintains high viscosity during phac... more To demonstrate the utility of a viscoelastic substance which maintains high viscosity during phacoemulsification, we conducted a double study. We compared in vitro the corneal endothelial protection offered by Healon, Healon GV, Provisc and Viscoat after <traumatic> phacoemulsification. Eight samples of ten to fifteen freshly enucleated pig eyes were operated; the first four groups were the controls, whereas the other four tested the different viscous solutions. In parallel, we determined the rheologic properties of the four viscoelastic substances in a physicS laboratory. To measure the percentage of corneal endothelial cell damage, we used the Janus Green spectrometric technique. Corneal endothelial cell damage averaged 31.67% in eyes in which no viscoelastic substance was used. Damage was 14.29% in specimens that received Healon, 12.85% with Healon GV, 2.48% in the Viscoat group and 15.43 in those that received Provisc. There is a significant difference (p <0.001) betwee...
The purpose of this analysis is to appreciate the patients perception of ambulatory cataract surg... more The purpose of this analysis is to appreciate the patients perception of ambulatory cataract surgery performed in an out patient center localized inside a public hospital. An anonymous postal questionnaire was designed to cover the aspects of ambulatory surgery which could influence the patients perception. 576 patients were included and the study collected 487 answers to 12 questions. Authors give attention to the pros and cons detected during the study time. The key question shows that most patients recommend this procedure as the treatment of choice. The percentage increases with surgical experience of surgeons: the response rate to the questionnaire was both rapid and impressive. Final visual acuity did not influence significatively the overall perceptions of patients. Answers to the 12 questions point of importance of information, coordination and preparation. A high level of surgical and anesthetic formation is required to obtain an easy out patient ambulatory procedure.
To review the local anesthesia environment in France in adult out-patient cataract surgery. The a... more To review the local anesthesia environment in France in adult out-patient cataract surgery. The author considers the presence or absence of an anesthesiologist in the operating room. The report shows that in many circumstances there is no need for an anesthesiologist if the following criteria are respected: the adult is fully informed, in rather good health, with no acute risk factors, and surgery is performed by a senior surgeon in a certified operating room. In France, a move toward more flexible regulations is expected, with a new cooperation between ophthalmologists and anesthesiologists that will lead to a new true risk/benefit/obligation ratio. Respect of the individual and safety remain crucial requirements making systematic generalizations impossible.
The authors report a case of a 70-year-old man presenting a recent unilateral decrease in visual ... more The authors report a case of a 70-year-old man presenting a recent unilateral decrease in visual acuity, appearing in a context of alcohol and tobacco intoxication. Diagnosis of Leber's optic neuropathy was evoked after elimination of other causes of a visual acuity decrease such as giant cell arteritis and compressive or inflammatory optic neuropathy. The authors emphasize that Leber's optic neuropathy must be evoked in a recent decrease in visual acuity, even if it appears in an unusual context.
We gave consideration to the new legal obligation to a medical doctor to prove that he has given ... more We gave consideration to the new legal obligation to a medical doctor to prove that he has given to a patient adequate information. 312 cases of cataract or glaucoma received written information about their disease and the risks of surgery. An informed consent regarding the operation and the post-opérative care were signed by all patients. Information cover surgical risks, sides effects, unpredictable events, care steps and all last minute protocol modifications. These documents were given when scheduling the surgery. No cancellation and no objection were noticed. The French Code Civil article 1315 was not dedicated to medical exercise but it concerns physicians. The way to give a proof is not clear. Nothing is asked in the by-laws and every medical doctor can choose the method he prefers. A signature is not an obligation and an informed consent is not an authorization. A discussion is opened to clear the best and safest recommendations to obtain a legal proof of information. Now, w...
This prospective study compares the analgesia obtained by topical anaesthesia versus a single per... more This prospective study compares the analgesia obtained by topical anaesthesia versus a single peribulbar anaesthesia. The comparison is made during clearcornear phacoemulsification in adult patient. Ninety-six eyes are operated with Lidocaine 2% (66) or Tetracaine 1% (30) topical anaesthesia, 38 eyes received an unique anterior periocular injection. The same surgeon performs the phacoemulsification in 2 different centers. Analgesia is evaluated in the per and post operative period by the surgeon and a nurse. Four cases (4.2%) in the topical anaesthesia group required a complementary subconjonctival anaesthetic injection. Seven cases (7.3%) had pain during surgery but without any need for a complementary injection. In the other group 1 injection was necessary (2.5%). A slight pain was felt by 5% of patients during surgery. Topical anaesthesia is reliable but needs a patients selection, a well trained staff and a non beginner surgeon. The advantages are obvious for out patient surgery...
To demonstrate the utility of a viscoelastic substance which maintains high viscosity during phac... more To demonstrate the utility of a viscoelastic substance which maintains high viscosity during phacoemulsification, we conducted a double study. We compared in vitro the corneal endothelial protection offered by Healon, Healon GV, Provisc and Viscoat after <traumatic> phacoemulsification. Eight samples of ten to fifteen freshly enucleated pig eyes were operated; the first four groups were the controls, whereas the other four tested the different viscous solutions. In parallel, we determined the rheologic properties of the four viscoelastic substances in a physicS laboratory. To measure the percentage of corneal endothelial cell damage, we used the Janus Green spectrometric technique. Corneal endothelial cell damage averaged 31.67% in eyes in which no viscoelastic substance was used. Damage was 14.29% in specimens that received Healon, 12.85% with Healon GV, 2.48% in the Viscoat group and 15.43 in those that received Provisc. There is a significant difference (p <0.001) betwee...
The purpose of this analysis is to appreciate the patients perception of ambulatory cataract surg... more The purpose of this analysis is to appreciate the patients perception of ambulatory cataract surgery performed in an out patient center localized inside a public hospital. An anonymous postal questionnaire was designed to cover the aspects of ambulatory surgery which could influence the patients perception. 576 patients were included and the study collected 487 answers to 12 questions. Authors give attention to the pros and cons detected during the study time. The key question shows that most patients recommend this procedure as the treatment of choice. The percentage increases with surgical experience of surgeons: the response rate to the questionnaire was both rapid and impressive. Final visual acuity did not influence significatively the overall perceptions of patients. Answers to the 12 questions point of importance of information, coordination and preparation. A high level of surgical and anesthetic formation is required to obtain an easy out patient ambulatory procedure.
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Papers by D. Lebuisson