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Objective: To compare sustainability, financial implications and surgical efficiency of two phacoemulsification cassette systems for cataract surgery: a machine with single-use cassettes and another with daily, reusable ones., Methods: Observational study involving retrospective cataract surgery data collection at the Centre Médical de l'Alliance, Braine-l'Alleud, Belgium, a tertiary eye care centre. Information on cassette weight, quantities and transport volume was obtained from routine procedures and purchasing records. The costs for each machine were calculated by reviewing the invoices received from the accounting department., Results: We found significant differences across comparisons. The reusable cassette machine, when compared with the single-use machine, used 306.7 kg less plastic (75.3% reduction), required 2494 m 3 less storage per 1000 surgeries (67.7% decrease) and cost €54.16 less per 10 procedures (16.9% reduction). The machine with daily reusable cassettes also exhibited a 7-minute priming time advantage for 10 procedures, reducing downtime between cases., Conclusions: Our findings underscore the benefits of adopting reusable cassette systems: reduced plastic consumption, storage volume and priming time, as well as enhanced efficiency and cost-savings. Healthcare professionals and institutions are encouraged to embrace environmentally conscious initiatives. The use of reusable cassette systems for cataract surgeries offers a pathway to sustainable practices., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: We present the first case described in the literature of cataract surgery in a patient with stellate nonhereditary idiopathic foveomacular retinoschisis (SNIF)., Methods: In this case report, we describe the extensive workup we did on our patient, including optical coherence tomography, fundus autofluorescence, fluo-angiography, full field electroretinogram, and genetic testing. We moreover describe the cataract surgery with clear lens extraction and implanting of a multifocal implant., Results: The refractive and lifestyle profile of our patient made implantation of multifocal intraocular implants the only solution for this case. During preoperative measurements, a SNIF diagnosis was suspected after optic coherence tomography imaging which led to an even more extensive workup of our patient and the diagnosis of stellate nonhereditary idiopathic foveomacular retinoschisis. We then proceeded to cataract surgery, which was performed safely and without any sequellae., Conclusion: Stellate nonhereditary idiopathic foveomacular retinoschisis (SNIF) is a relatively new disease entity. Only few cases in the literature describe this disease, and none of them describe cataract surgery in a patient with SNIF. We therefore describe the first known cataract surgery in such a case. Long term follow-up results show that the procedure can be performed safely. Summary Statement . We hereby present the first case described in the literature of cataract surgery of a patient diagnosed with stellate nonhereditary idiopathic foveomacular retinoschisis. A clear lens extraction with implantation of a multifocal intraocular implant was conducted with excellent postoperative results and a happy patient., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Sofie Van der Auwera and Oscar Kallay.)

The arrival of coronavirus disease 2019 (COVID-19) on the African continent resulted in a range of lockdown measures that curtailed the spread of the infection but caused economic hardship. African countries now face difficult choices regarding easing of lockdowns and sustaining effective public health control measures and surveillance. Pandemic control will require efficient community screening, testing, and contact tracing; behavioral change interventions; adequate resources; and well-supported, community-based teams of trained, protected personnel. We discuss COVID-19 control approaches in selected African countries and the need for shared, affordable, innovative methods to overcome challenges and minimize mortality. This crisis presents a unique opportunity to align COVID-19 services with those already in place for human immunodeficiency virus, tuberculosis, malaria, and non communicable diseases through mobilization of Africa's interprofessional healthcare workforce. By addressing the challenges, the detrimental effect of the COVID-19 pandemic on African citizens can be minimized., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

As of June 11, 2020, the Democratic Republic of the Congo (DRC) has reported 4,258 COVID-19 cases with 90 deaths. With other African countries, the DRC faces the challenge of striking a balance between easing public health lockdown measures to curtail the spread of SARS-CoV-2 and minimizing both economic hardships for large sectors of the population and negative impacts on health services for other infectious and noninfectious diseases. The DRC recently controlled its tenth Ebola virus disease (EVD) outbreak, but COVID-19 and a new EVD outbreak beginning on June 1, 2020 in the northwest Équateur Province have added an additional burden to health services. Although the epidemiology and transmission of EVD and COVID-19 differ, leveraging the public health infrastructures and experiences from coordinating the EVD response to guide the public health response to COVID-19 is critical. Building on the DRC's 40 years of experience with 10 previous EVD outbreaks, we highlight the DRC's multi-sectoral public health approach to COVID-19, which includes community-based screening, testing, contact-tracing, risk communication, community engagement, and case management. We also highlight remaining challenges and discuss the way forward for achieving control of both COVID-19 and EVD in the DRC.

The novel severe acute respiratory syndrome-coronavirus-2 pandemic has spread to Africa, where nearly all countries have reported laboratory-confirmed cases of novel coronavirus disease (COVID-19). Although there are ongoing clinical trials of repurposed and investigational antiviral and immune-based therapies, there are as yet no scientifically proven, clinically effective pharmacological treatments for COVID-19. Among the repurposed drugs, the commonly used antimalarials chloroquine (CQ) and hydroxychloroquine (HCQ) have become the focus of global scientific, media, and political attention despite a lack of randomized clinical trials supporting their efficacy. Chloroquine has been used worldwide for about 75 years and is listed by the WHO as an essential medicine to treat malaria. Hydroxychloroquine is mainly used as a therapy for autoimmune diseases. However, the efficacy and safety of CQ/HCQ for the treatment of COVID-19 remains to be defined. Indiscriminate promotion and widespread use of CQ/HCQ have led to extensive shortages, self-treatment, and fatal overdoses. Shortages and increased market prices leave all countries vulnerable to substandard and falsified medical products, and safety issues are especially concerning for Africa because of its healthcare system limitations. Much needed in Africa is a cross-continental collaborative network for coordinated production, distribution, and post-marketing surveillance aligned to low-cost distribution of any approved COVID-19 drug; this would ideally be piggybacked on existing global aid efforts. Meanwhile, African countries should strongly consider implementing prescription monitoring schemes to ensure that any off-label CQ/HCQ use is appropriate and beneficial during this pandemic.

Aims: To establish the results of refractive screening of preschool children with the hand-held autorefractor Retinomax under non-cycloplegic conditions, and to compare these results with those of photoscreening., Methods: Among 1218 children undergoing non-cycloplegic refractive screening, 302 (25%) were also refracted under cycloplegia using the same refractor and were used as controls. Our criteria for a positive screening test were based on the spherical or cylinder values and were: myopia over 3D, astigmatism > or = 2D, spherical or cylindrical anisometropia > or = 1.5D, and hyperopia > or = 1.5D. Absolute myopia over 3D, absolute astigmatism > or = 2D, absolute anisometropia > or = 1.5D and absolute hyperopia > 3.5D were considered as true positives. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated within the group of controls for each refractive anomaly. On the basis of Bayes' theorem, these figures were then corrected to yield the true screening results that would be expected in a population without verification and selection bias. To determine the usefulness of this screening technique, the likelihood ratios for positive test results (+LR) were also calculated. The results of this screening in terms of sensitivity, specificity and predictive values were then compared with those of photoscreening., Results: The basic results of screening with the hand-held autorefractor were as follows: -EHyperopia: sensitivity 46%, specificity 97%, PPV 55%, NPV 96%, +LR 15; -EAstigmatism: sensitivity 37%, specificity 99%, PPV 69%, NPV 96%, +LR 37; -EAnisometropia: sensitivity 66%, specificity 93%, PPV 19%, NPV 99%, +LR 9; -EMyopia: sensitivity 87%, specificity 99%, PPV 33%, NPV 100%, +LR 87. The comparison with photoscreening revealed a similar performance when screening for hyperopia, but the hand-held autorefractor yielded much better figures when screening for astigmatism. In the case of myopia and anisometropia, the lack of consistent information concerning photoscreening invalidates any comparison., Conclusion: The hand-held autorefractor Retinomax appears to have potential as a screening device. Our experience with the non-cycloplegic screening of preschool children for refractive anomalies indicates definite usefulness and reasonable accuracy of the Retinomax for detecting myopia, astigmatism and hyperopia. The weak point of this screening technique is the diagnosis of anisometropia, with only moderate utility and poor accuracy.

AIMS To assess the agreement between the hand-held autorefractor Retinomax(R) and three different on-table autorefractors when measuring cycloplegic refraction in subjects with small and high ametropia. To assess the agreement between the cycloplegic refraction using the Retinomax(R) and by retinoscopy in children with small and high ametropia. METHODS Part A.276 subjects were refracted under cycloplegia using both the Retinomax(R) and an on-table infrared automated refractor (Topcon RM-A 6000, Nidek AR 800 or Nikon NR 5000). They were separated into subjects withsmall ametropia (mean sphere 3.5 D hyperopia, > 3 D myopia). The agreement between both types of refractors regarding the different refractive components was assessed for the whole group and for the two subgroups of small and high ametropia. Part B. 48 infants were refracted under cycloplegia by retinoscopy and by the Retinomax(R). The agreement between both methods of refraction was analyzed in the same manner as in part A. RESULTS Part A. No significant bias was found between the two types of refractors with regard to the spherical equivalent. The 95% limits of agreement were +/- 1 D. Although no clinically significant bias was found with regard to the cylinder power in the 276 subjects, it was found that the 95% limits of agreement were much better (+/- 0.75 D) in small ametropia subjects than in high ametropia subjects (-2.1 to +1.3 D). No significant bias was found with regard to the axis determination. Part B. No significant bias was found between the Retinomax(R) and retinoscopic measurements with regard to the spherical equivalent. The 95% limits of agreement were -1.36 to +1.76 D. However, the mean difference for spheres and cylinders showed a positive bias and a negative bias, respectively, suggesting more positive spheres and larger cylinders when measured by the Retinomax(R) compared to retinoscopy. This was particularly obvious in cases of high ametropia. CONCLUSION Compared to retinoscopy and on-table autorefraction, the hand-held refractor Retinomax(R) is accurate in any ametropia with respect to the spherical equivalent. In small ametropia, there is a good accuracy when measuring the three refractive components (sphere, cylinder and axis). The accuracy decreases in high ametropia, especially with regard to the cylinder power.

The authors evaluate an atraumatic catheterisation of the lacrymal system by using a prolene silastic intubation and a standard nasal aspiration probe. After recovery of both prolene end and nasal probe out of the throat the prolene was threaded into the aspiration probe and both were taken off back out of the nose.

We relate our own experience about bilateral inferior rectus recession as first surgery for traumatic bilateral superior oblique palsy. An adjustable suture is performed on one side. This procedure is combined or not with an inferior oblique recession. Measurements of ocular deviation and torsion, Lancaster tests and binocular single vision fields are reported pre- and postoperatively. Reduction of diplopia, cyclodeviation and V esotropia with an expansion of the binocular single vision field is achieved in all cases, relieving patients' complaints. This surgery is easy to perform and free of important secondary effects. We think it represents a valuable choice for that kind of pathology.

How and why to prescribe an optical correction in hyperopia is described. The reasons for prescribing are closely related to the visual risk of not doing so (amblyopia, lack of stereopsy, strabismus), to the patient's complains and history as well as to his ophthalmological examination. How to correct hyperopia depends on the presence or absence of squint and on the amount of ametropia.

A man aged 68 years presents superior limbal infiltrates at his left eye two weeks before a marginal ulcer which quickly perforates. He has no systemic complaint. Clinical, biological, radiologic and histological evaluations disclose superior airways and lungs implications, an inflammatory syndrome, high ANCA (antineutrophiles cytoplamic antibodies) titer and vasculitis. There is no sign of renal involvement. A limited form of Wegener's granulomatosis is diagnosed. The outcome is favorable with a partial penetrating keratoplasty and systemic corticosteroid therapy in association with immunosuppressive drugs. This so called limited form of Wegener's granulomatosis is sight threatening when eye is the initial presentation. The early diagnostic and treatment will be performed by the help of ANCA in cases with subclinical systemic manifestations.

In this four-month prospective study, we measured astigmatism in 116 patients who had extracapsular cataract extraction through a 13 mm scleral pocket incision. In one group, the wound was closed with five radial 10-0 polypropylene sutures. Early and late postoperative astigmatism in this group was approximately 2 diopters (D), but a significant shift to against-the-rule astigmatism occurred. In a second group, an additional 10-0 polypropylene horizontal suture was placed anteriorly to the radial suture at the 12 o'clock meridian. This reduced the against-the-rule astigmatic decay. Moreover, this group had less postoperative astigmatism. Mean corneal astigmatism was 2.27 D at one week, 1.76 D at one month, 1.37 D at two months, and 1.70 D at four months. In neither group was cutting the sutures necessary.

The authors report the case of a woman with Sturge-Weber syndrome (oculotrigeminate form) presenting with neovascular glaucoma of abrupt onset during pregnancy. Since medical treatment failed, she underwent a retrobulbar alcoholisation. Three months after delivery, enucleation was performed for esthetic reasons. The enucleated eye showed diffuse choroidal angioma, total retinal detachment and a prepapillary glial proliferation. We discuss this uncommon association.

We present a retrospective study of 534 Argon laser trabeculoplasty which we realized from January 1983 to July 1990 on 356 primary open-angle glaucoma and secondary open-angle glaucoma patients. Follow-up is ranging from 3 months to 7 years. Photocoagulation was limited to 180 degrees trabecular surface in 300 cases and were completed to 360 degrees in the 234 other eyes. We observed an overall cumulated success rate of 87% at 6 months, which decreased slowly further to reach 32.6% at 6 years. Before laser, the mean intra-ocular pressure was 25 mmHg, this value decreased "a maxima" after 18 months (6.3 mmHg) and slowly increased afterwards but was still significant at 6 years. Some parameters may be of better prognosis: an age equal or older than 65 years, pigmentary dispersion syndrome and pseudo-exfoliative glaucoma. Laser trabeculoplasty associated with hypotensive drugs are an efficient and innocuous technic for controlling open-angle glaucoma; however, after a 30 months mean period, we observe a decrease of their efficiency.