Greater surgical experience was found to be associated with reduced early postoperative corneal edema, shorter operative time, and shorter ultrasound time. This suggests that beyond mastering the initial learning curve of phacoemulsification, surgical experience enables faster and safer surgery.

Preoperative aqueous flare is a strong predictive factor for PVR redetachment. The laser flare-cell meter provides a fast and safe tool to accurately identify patients at risk for postoperative PVR, especially when clinical examination did not predict this risk.

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PurposeOphthalmological emergencies are common. Actually, access to care is difficult because of the low medical demography. The Department of Ophthalmology (Nancy, University Hospital, France) created a unit devoted to emergency in 2012.MethodsWe conducted a cross sectional study to describe this activity. All consecutive patients seen in the unit were included from February to April 2012 and from October to December 2014. We used a standardized evaluation (age, sex, access to care, geographic origin, symptoms, diagnosis, treatment, patient outcome). Every physician considered the real nature of the emergency.Results1496 patients were included during the first period (series 1) and 1116 during the second (series 2). The most common patient was a 45 years old man (55.3% and 56.3%). Many patients came by themselves without medical advice (40.1% and 58.4%). Principal symptoms were redness (31.5% and 24.8%), pain (28.5% and 25.0%), visual loss (22.6% and 17.7%), and irritation (20.6% and 17.8%). Traumatic context was frequent (about 25.0% of patients).The most prevalent diagnosis concerned the cornea. Serious infectious condition and vascular diseases were rare. 5.0% of patients were hospitalized and 6.0% received surgical treatment. 62.7% of them benefited only one consultation in emergency. They did not need another clinical control. 62.1–63.1% of consultations were qualified as real emergency.ConclusionsActually, the management of ophthalmic emergencies is a real public health problem. It is important to train emergency physicians and general practitioners, to address wisely to the specialist. Structures such as our unit seem to be an effective way to access care.

PurposeBasal cell carcinoma (BCC) is the most common periocular skin cancer affecting eyelids. Lateral canthus location is very rare. The gold standard treatment consists in an extensive surgery which allows the lowest recurrence rate. We report the case of a man suffering of a lateral canthus eyelid BCC with intraorbital invasion and who declined exenteration.MethodsA 78‐year old man consulted his ophthalmologist for a painless right ptosis associated with a tumefaction of the external orbital angle. He had neither oculomotor disorders nor decreased visual acuity. He was refered to our clinic 6 months later; we noticed a worsening of the ptosis up to visual axis and an abduction limitation. Visual acuity was steady. Pathological analysis revealed the diagnosis of BCC. Orbital tomography showed a location near the lacrimal gland with posterior invasion along the lateral rectus muscle. Multidisciplinary meeting suggested performing an exenteration. The patient refused this treatment. A conservative surgery was then suggested. The patient has been informed about risks of dissemination.ResultsWe performed a tumorectomy with large excision including the lateral part of upper and lower eyelids, the tumor itself, the lacrimal gland and the lateral orbital wall adjacent to the tumor. Pathological analysis revealed clear resection margins on all samples.The 4‐month control revealed no complications.ConclusionsExenteration is the gold standard treatment of orbital invasive BCC. In case of lateral canthus lesions, radiotherapy is not recommended because of major risks of orbital recurrences and side effects. Several authors showed that in case of bone‐adjacent tumors, bone resection is necessary, because tomography is not specific enough to rule out bone invasion. Despite a complete tumor resection, a long term follow‐up is mandatory patients with invasive BCC.

Purpose To specify the benefits of internal limiting membrane (ILM) peeling as a surgical adjunct in primary repair of retinal detachments (RD) complicated by grade B proliferative vitreoretinopathy (PVR). Methods A retrospective comparative study included consecutive patients who underwent vitrectomy for primary RD complicated by grade B PVR between May 2010 and December 2015 at Nancy University Hospital (France). All patients were treated with SF6 or C2F6 gaz tamponade. The ILM was routinely peeled after staining from 2012. The best‐corrected visual acuity and spectral‐domain optical coherence tomography (SD‐OCT) were collected at 1 and 3 months postoperatively, looking for epiretinal membrane formation, macular oedema or photoreceptor damage. Results Thirty seven eyes who underwent ILM peeling (group 1) and 38 eyes without ILM peeling (group 2) were included. At the end of follow‐up, anatomic success after single surgery was higher in group 1 (89%) than in group 2 (66%, p=0.03). Mean final visual acuity was 0.41 ±0.40 logMAR in group 1 versus 0.43 ±0.22 logMAR in group 2 (p=0.82). After 3 months follow up, we found no epiretinal membrane (ERM) formation on OCT scans in group 1 whereas 5 ERM (20%) were detected in group 2 (p=0.012). The 2 groups did not differ in terms of cystoid macular oedema occurence, macular thickness or photoreceptor damage. Conclusions ILM peeling at the macula during vitrectomy for the treatment of retinal detachment complicated by grade B PVR may prevent a second surgery for redetachment or macular pucker.

PurposeTo evaluate anatomical and functional results of epiretinal membrane peeling for patients with asteroid hyalosis (AH) comparing with those of a control population without AH.MethodsRetrospective, case–control study, of a cohort of 1104 patients operated from an epiretinal membrane (EM) between January 2002 and February 2014. Forty‐four consecutive patient were included in the EM associated with AH group and were compared to 44 control patient without AH, matched for: age, sex, date of surgery, and axial length. The best corrected visual acuity (BCVA) and central macular thickness on OCT (CMT) were measured at baseline and postoperatively at 1, 6 and 12 months. Intraoperative and/or postoperative complications were also analyzed.Results34 men and 10 women were included in the AH group. Respectively, the mean initial BCVA was 0.49 ± 0.21 logMar for the AH group vs 0.44 ± 0.21 logMAR for the control group (p = 0.2), and the mean initial CMT was 415 ± 71 µm vs 422 ± 73 µm (p = 0.6). No significant difference was found regarding the final BCVA, with respectively a mean of 0.37 vs 0.24 logMAR (p = 0.26) at 1 month, 0.27 vs. 0.23 logMAR (p = 0.5) at 6 months, and 0.17 vs 0.2 logMAR (p = 0.26) at 12 months. Also, no difference was found regarding the evolution of CMT, with respectively a mean of 368 vs 353 µm (p = 0.5) at 1 month, 347 vs 358 µm (p = 0.61) at 6 months, 345 vs 349 µm (p = 0.87) at 12 months. Only a single macular hole was recorded in the AH group in the follow up.ConclusionsThe presence of asteroid hyalosis does not constitute a factor of poor prognosis for visual recovery after epiretinal membrane peeling.