Catarata

NOVEMBRO/DEZEMBRO 2010

Lam PTH, Young AL, Cheng LL, Tam PMK, Lee VYM

Randomized controlled trial on the safety of intracameral cephalosporins in cataract surgery
Clin Ophthalmol 2010: 4; 1499–1504.

Objective: To compare the safety profiles of intracameral cephalosporins in cataract surgery.
Patients and methods: In this controlled trial, 129 patients were randomized to one of four groups to receive 1 mg of one of three cephalosporins – cefazolin, cefuroxime, or ceftazidime, or normal saline – given intracamerally during cataract surgery. Central endothelial cell density (ECD) and retinal center point thickness (CPT) were determined by specular microscopy and ocular coherence tomography, respectively, before and at 3 months after surgery.
Results: There were no statistical significant differences in the changes of ECD and CPT between eyes receiving intracameral cephalosporin and control.
Conclusion: The use of intracameral cefazolin, cefuroxime, or ceftazidime (1 mg in 0.1-mL solution) at the time of cataract surgery had no significant effect on ECD and CPT postoperatively.
Keywords: intracameral cephalosporin, endophthalmitis, phacoemulsification

SETEMBRO/OUTUBRO 2010

Bozkurt E, Yazici AT, Pekel G, Albayrak S, Cakir M, Pekel E, Yilmaz OF.

Effect of intracameral epinephrine use on macular thickness after uneventful phacoemulsifica-tion.
J Cataract Refract Surg 2010; 36 (8): 1380-1384.

PURPOSE: To evaluate changes in central macular thickness using optical coherence tomography after uneventful cataract surgery combined with intracameral epinephrine use.
SETTING: Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey.
METHODS: This prospective case series comprised eyes of consecutive patients who had uneventful phacoemulsification and in-the-bag intraocular lens (IOL) implantation between August 2005 and Ja-nuary 2006. The eyes were randomly assigned to 1 of 2 groups. In 1 group, 0.2 mL epinephrine (1:5000 solution) was injected just after the clear corneal incision was created. The other group (control) did not receive epinephrine. Optical coherence tomography was performed in all eyes preoperatively as well as postoperatively at 1 day, 1 week, and 1, 3, and 6 months.
RESULTS: The epinephrine group comprised 73 eyes (73 patients) and the control group, 76 eyes (86 patients). In both groups, the increase in retinal thickness from preoperatively to 1, 3, and 6 months postoperatively was statistically significant (P<.05); the difference was not statistically significant at 1 day or 1 week in either group (P>.05). There were no statistically significant differences between the 2 groups in mean retinal thickness throughout the follow-up (P>.05). Clinically significant macular ede-ma occurred in 3 eyes in the epinephrine group and 3 eyes in the control group.
CONCLUSION: Although epinephrine is a well-known risk factor for central macular edema, intra-cameral injection of 0.2 mL epinephrine (1:5000) did not increase the risk for central macular edema in eyes with no risk factors that had uneventful phacoemulsification with IOL implantation.
FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

ABRIL/MAIO 2010

Pajot O, Mazit C, Jallet G, Ebran JM, Cochereau I.

Phacoémulsification : intérêt de la visite du lendemain ?
J Fr Ophtalmol 2010; 33 (3): 169-173.

INTRODUCTION: Cataract surgery is the most frequent surgery in France. The D1 consultation limits the extension of ambulatory care to patients who can return on their own the day after sugery. We assessed the usefulness of this systematic D1 consultation in terms of therapeutic modifications. MATERIAL AND MéTHODE: Retrospective study of patients who underwent cataract surgery in a teaching hospital from february to july 2006. The major parameter was the modification of postsurgical treatment after the D1 consultation. RESULTS: Of the 380 operated eyes studied, the patients included 145 men and 235 women, the mean age was 73.8 years (range, 43-92), 86% underwent conventional hospitalization, 70% had been operated by a senior surgeon, and 66% had no suture. At the D1 visit, 11 modifications (2.9%) were recorded: one case of athalamia, one Seidel-positive test, four cases of high IOP (>30mmHg), and five severe inflammations of the anterior segment. All the treatment changes were reported in the group of hospitalized patients, none were reported in the ambulatory patients. Of the 380 eyes studied, only one required sutures at D1, the other treatment changes were minor. CONCLUSIONS: The low output of the D1 visit raises the problem of its relevance in terms of public health. In most of the English-speaking and Scandinavian countries, patients have only one postoperative visit at 1 month. Patients could receive written and oral recommendations and a hotline number to contact the surgical team, which could allow the D1 visit to be discontinued for standard patients with uncomplicated surgery.

MARÇO 2010

Bodaghi B, Kodjikian L.

La chirurgie moderne de la cataracte est-elle encore à risque infectieux et inflammatoire ? En 14 questions.
Réflexions ophtalmol 2010; 15 (n° Spécial): 2-11.

1/ Quel est le risque infectieux (endophtalmie) après chirurgie de la cataracte ? Description, fréquence.

2/ L’endophtalmie post-cataracte est-elle ou non à considérer comme une infection nosocomiale ?

3/ Les micro-organismes dans l’endophtalmie : d’où viennent-ils ? Qui sont-ils ?

4/ Existe-t-il une spécificité de la surface oculaire et de sa flore commensale ?

5/ Quel protocole d’antisepsie faut-il utiliser ?

6/ Faut-il utiliser un collyre antibiotique ?

7/ Faut-il utiliser la céfuroxime en chambre antérieure en per-opératoire ?

8/ Arbre décisionnel thérapeutique en cas d’endophtalmie aiguë.

9/ Quel est le risque inflammatoire (OMC…) : description, fréquence.

10/ Comment mesurer l’inflammation postopératoire ?

11/ Quel protocole anti-inflammatoire faut-il conseiller avant, pendant et après une chirurgie de la ca-taracte ?

12/ Quels sont les risques des collyres AINS ?

13/ Quand revoir le patient après une chirurgie de la cataracte ?

14/ Cas compliqués et patients à risque : prise en charge spécifique.