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D A Lebuisson

Publications and source records attributed to D A Lebuisson.

At least 19 recordsLinked to original sources
PubMed2005

[Topical anesthesia for out-patient adult cataract surgery without an anesthesiologist].

To review the local anesthesia environment in France in adult out-patient cataract surgery. The author considers the presence or absence of an anesthesiologist in the operating room. The report shows that in many circumstances there is no need for an anesthesiologist if the following criteria are respected: the adult is fully informed, in rather good health, with no acute risk factors, and surgery is performed by a senior surgeon in a certified operating room. In France, a move toward more flexible regulations is expected, with a new cooperation between ophthalmologists and anesthesiologists that will lead to a new true risk/benefit/obligation ratio. Respect of the individual and safety remain crucial requirements making systematic generalizations impossible.

Ambulatory Surgical Procedures↗
PubMed2005

[ISO 9001-2000 certification for refractive laser treatment].

PURPOSE: To obtain ISO 9001-2000 certification for laser corneal refractive treatment, never before sought in Europe. MATERIAL AND METHODS: The consulting firm Veritas led the certification process with the clinic's staff manager. This ISO norm is dedicated to the implementation of a quality management system. We assessed and optimized all necessary resources, evaluating customer satisfaction using patient and referring-physician surveys. We started quality rounds including surgeons, nurses, and technicians. Based on this preparation, we redefined and explained all processes including staff responsibilities and necessary resources in the quality manual. The procedure lasted 14 months with substantial involvement on the part of the management. RESULTS: Unconditional ISO 9001-2000 certification was granted by the independent audit firm, BVQI, in december 2003 for refractive laser treatment. CONCLUSION: The 2000 version of the new ISO 9001-2000 seeks to meet the demand for improving health care delivery in this field, most particularly by establishing a clear procedural orientation. Such certification enhances team work, stabilizes methodologies, and reinforces cohesion and self-audit. Patients notice that the center follows a consistent quality policy and are assured that the clinic respects rules and regulations. Certification is an advantageous alternative when accreditation cannot be considered. Our article discusses the steps taken in upper management, quality management, procedural guidance, as well as customer and staff counselling. It also discusses the project's cost/benefit ratio for the organization.

Certification↗
PubMed2004

[Leber's optic neuropathy presenting as an alcohol- and tobacco-related optic neuropathy].

The authors report a case of a 70-year-old man presenting a recent unilateral decrease in visual acuity, appearing in a context of alcohol and tobacco intoxication. Diagnosis of Leber's optic neuropathy was evoked after elimination of other causes of a visual acuity decrease such as giant cell arteritis and compressive or inflammatory optic neuropathy. The authors emphasize that Leber's optic neuropathy must be evoked in a recent decrease in visual acuity, even if it appears in an unusual context.

Aged↗
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↗