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Biomedical subjects

D A Lebuisson

Publications and source records attributed to D A Lebuisson.

At least 19 recordsLinked to original sources
PubMed2000

Macular hemorrhage after laser in situ keratomileusis for high myopia.

We describe 2 women with high myopia of -12.0 and -18.0 diopters who presented with myopic macular hemorrhages 1 and 4 days, respectively, after being treated by laser in situ keratomileusis (LASIK). One hemorrhage was related to a pre-existing choroidal neovascularization and the other to the presence of lacquer cracks. The hemorrhages resolved but resulted in a permanent decrease in vision. A careful fundus examination should be conducted before performing LASIK in highly myopic patients. In cases of similar macular pathology, fluorescein angiography should be done before LASIK.

Adult↗
PubMed1998

Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens.

PURPOSE: To evaluate the advantages of vitrectomy combined with endoscopy for the management of retained lens fragments and/or posteriorly dislocated intraocular lens (IOL). METHODS: A consecutive series of 30 eyes with these complications treated by this technique was reviewed retrospectively. An endoscopic probe which incorporates a video channel, a fibreoptic light source, and a diode laser was used for visualization. Lens material or the IOL was extracted through the corneal wound in 18 eyes (60%). They were either aspired or grasped or lifted using perfluorocarbon liquids (PFCL), under endoscopic control. In 9 eyes (30%) pars plana phakoemulsification was performed. PFCL was used in 11 eyes (36.6%). In 16 eyes (53.3%) an IOL was sutured in the ciliary sulcus. RESULTS: Final visual acuity was > or = 20/40 in 19 eyes (63.3%), > or = 20/30 in 15 eyes (50%). Intraoperative breaks occurred early in the series in two eyes (in one case from use of the endoprobe, in the other from pars plana phakoemulsification). Poor final acuity was related to proliferative vitreoretinopathy, which developed in both cases with an intraoperative iatrogenic retinal break, senile macular degeneration, myopia and amblyopia, cystoid macular oedema, corneal oedema and high astigmatism. CONCLUSION: We found that endoscopy facilitated the management of these complications of cataract surgery once the peculiar difficulties of the technique (absence of stereoscopy, manipulation of the endoprobe, video monitor control) were mastered. Endoscopy facilitated and shortened localization of lens fragments embedded into the vitreous base for aspiration, grasping and phakoemulsification, enabled detection of small anterior retinal breaks, permitted resection of adhesions between anterior hyaloid, lens capsule and ciliary sulcus and facilitated PFCL manipulations, whatever the status of the anterior segment (corneal edema, myosis, synechiae, presence of IOL).

Aged↗
PubMed1997

[Patient information and preoperative informed consent: comments on an experience].

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, written texts seem to be the easiest procedure. Quality medical records and personal relation between patient and surgeon are of great importance to prevent patient unsatisfaction and disappointment.

Adult↗
PubMed1996

[Dynamic viscosity and corneal endothelial protection with Healonid, Healon GV, Provisc and Viscoat during phacoemulsification].

PURPOSE: To demonstrate the utility of a viscoelastic substance which maintains high viscosity during phacoemulsification, we conducted a double study. METHODS: We compared in vitro the corneal endothelial protection offered by Healon, Healon GV, Provisc and Viscoat after < > 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. RESULTS: 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) between the Viscoat group and all other samples. The values of the viscosity at different shear rates and the graph of viscosities as a function of shear rate of the four viscous solutions are given. CONCLUSION: Viscoat has a very high dynamic viscosity at high shear rate. This property and a poor cohesion provide a better corneal endothelial protection during in vitro phacoemulsification.

Animals↗
PubMed1996

[Topical anesthesia for cataract surgery in adults].

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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 if no premedication is associated. Many doctors will continue to ask for an akinesia during cataract surgery even is the analgesia is obtained.

Aged↗
PubMed1995

Complications of intraocular lens surgery.

Complications of cataract surgery and intraocular lens implantation are increasingly rare. New problems are emerging with foldable intraocular lenses. This annual review gives importance only to documented complications published during the last 14 months. Older complications can still be observed and the reader is referred to our last two articles in this journal, which are still fully valuable (Lebuisson and Weiser, Curr Opin Ophthalmol 1993, 4:75-82 and Lebuisson.

Cataract Extraction↗
PubMed1995

[Opinion of patients on the functioning of an ophthalmologic surgical outpatient center within a hospital. Analysis and consequences].

GOAL: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Adult↗
PubMed1995

[Local anesthesia for cataract surgery in adults. Retrospective study of peribulbar, subconjunctival and topical anesthesia].

PURPOSE: A retrospective analysis of 4 methods of local anaesthesia for adult cataract surgery compares the efficiency of: peribulbar anaesthesia injection, subconjonctival anaesthesia injection, both of these techniques and eye topical anaesthesia. No sedation is used. All patients are classified in ASA I or ASA II grade of the anaesthesiologist classification. All the surgeries are performed in an out patient center. The anaesthetic solution combines equally bupivacaine 0.5%, lidocaine 2% and hyaluronidase 250 UI. Phacoemulsification is performed through a scleral small incision. METHODS: 390 patients are separated in 4 groups. Analgesia and Akinesia are evaluated in 3 levels: total, partial and absent. RESULTS: They show that a single peribulbar injection less of 8 ml is sufficient in 86.5% of cases. In case of a unique subconjonctival injection 2 ml are used with a rate of full success of 67.8%. When combining these 2 methods the surgery is easily possible in 97.9% of cases. A complementary subconjonctival injection is necessary in 4.9% of eyes receiving only the inferior peribulbar infiltration and in 13% of eyes anaesthezied by the single subconjonctival injection. 20.3% of eyes receiving only topical anaesthesia need a complementary subconjonctival injection during surgery. But the study covers the first series of patients operated with this new method, most of these cases are men. Results are better with experience, confidence and corneal incision. CONCLUSION: Local anaesthesia is a safe procedure offering very few local and general risks. General sedation or premedication is not necessary. The choice depends on the akinesia factor which is far more difficult to obtain with so few anaesthetic volumes than the analgesia.

Adult↗