Journal français d'ophtalmologie
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Migraine with visual aura is marked by recurrent episodes of transient visual disturbance, often followed by headaches. Its pathophysiology has not been fully understood, but visual auras might be related to a self-propagating wave of cortical depolarization called "cortical spreading depression", triggering a trigemino-vascular "storm" ultimately leading to headaches. ⋯ The diagnosis can be made according to the International Classification of Headache Disorders revised in 2013. The main goal of the treatment is to relieve the patient's pain quickly and to decrease the frequency of the episodes.
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Carotid-cavernous fistulae are rare and affect visual prognosis. Their clinical presentation is varied and delayed diagnosis is common. They require rapid neuro-radio-ophthalmologic management. ⋯ The combination of proptosis, corkscrew episcleral vessels and diplopia should rapidly lead to head imaging to search for a carotid-cavernous fistula. Fistula embolization is a safe and effective treatment. The presence of diplopia on initial examination may be associated with a poorer outcome (P=0.044).
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To describe a method of deep sedation without adjunctive periocular injection in phacoemulsification with a scleral tunnel technique. ⋯ The deep sedation method including bolus injections of midazolam and fentanyl and continuous perfusion of dexmedetomidine affords a certain comfort to the patient as well as the surgeon in phacoemulsification of cataract through a scleral tunnel without adjunctive periocular injection.
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Ocular and orbital trauma is a leading cause of acquired monocular blindness in childhood. These injuries differ from those in adults in some aspects of the management and prognosis, notably the risk of amblyopia. The goal of this study was to analyze the epidemiological, clinical and therapeutic features of ocular trauma in children who consulted in an eye emergency department in Île-de-France. ⋯ Ocular trauma accounts for nearly half of pediatric conditions encountered in the eye emergency unit. Adequate emergency care improves the visual prognosis.
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Observational Study
[Assessment of anesthesiologist intervention during cataract surgery under topical anesthesia].
The current demographic situation in France regarding anesthesiologists calls for a reconsideration of anesthesia management for patients undergoing cataract surgery under topical anesthesia. This prospective observational study aimed to assess the requirement for anesthesiologist intervention during cataract surgery performed under topical anesthesia. ⋯ These results question the usefulness of preoperative anesthesia consultation for all patients who underwent phacoemulsification under topical anesthesia, since this consultation does not lead to an anesthesiologist service. Intraoperative medical complications may be treated according to medical protocols developed jointly by surgeons and anesthesiologists. This practice may free up anesthesiologists' time, without compromising patient safety.