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Introduction: The performance of “en-face” optical coherence tomography (OCT) in screening for chloroquine (CQ) or hydroxychloroquine (HCQ) retinopathy has not been largely explored. The aim of this study was to determine the concordance of “en-face” OCT with multifocal electroretinography (mfERG) in screening for CQ/HCQ retinopathy.
Methods: This is a prospective cohort study conducted at the Rothschild Foundation Hospital – Paris between August 2016 and February 2021. Patients taking hydroxychloroquine were followed up over 2 consecutive years and received an “en-face” OCT and a mfERG on each visit.
Results: A total of 91 patients (182 eyes) were analyzed. mfERG and “en-face” OCT were concordant in 147 eyes (86.3%). Cohen’s Kappa coefficient for concordance between mfERG and “en-face” OCT was considered weak with a value 0.61 (95% CI: 0.50-0.72). The sensitivity and specificity of “en-face” OCT are 70% (95% CI: 59-79%) and 91% (95% CI: 83-96%) respectively, relatively to mfERG. Proportion of abnormal R2/R5 and R3/R5 ratios did not differ between patients with normal and abnormal “en-face” OCT (p=0.2).
Discussion/Conclusion: “En-face” OCT and mfERG have low concordance and cannot be used interchangeably as each investigation evaluates a different facet of CQ/HCQ retinopathy. “En-face” OCT could be used as a complement in screening for CQ/HCQ retinal toxicity if the anomalies detected on “en-face” OCT are confirmed by B-scan OCT sections.
Purpose
To describe a rare complication of phacoemulsification (Phaco) cataract extraction.
Observations
A phaco tip fracture occurred during the sculpting of the nucleus in a cataract extraction surgery of a 60-year-old woman. The surgeon introduced the second instrument through the side port to retrieve the broken portion of the tip while maintaining it inside the sleeve.
Conclusions and improtance
Phaco tip fracture is a rare but serious complication that all cataract surgeons should be able to manage safely. Main risk factors for phaco tip fractures are: Aspiration Bypass System (ABS) phaco tip design and sterilization and reuse of instruments. A step by step plan of action was described in detail for a surgeon to manage a phaco tip fracture which mainly consists of removing the fractured phaco tip while it is still inside the sleeve to prevent any touch between the sharp broken edge of the tip and any intraocular component.
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