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Tassignon

 
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ale80



Registrato: 10/05/13 20:27
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MessaggioInviato: Gio 06 Giu, 2013 17:29    Oggetto: Tassignon Rispondi citando

Ho trovato in rete questo post, inviato dall dott.ssa Tassignon cinque anni fa a un paziente, sulla visita presso la sua struttura e sulle procedure operatorie per floaters. E' un po' lungo ma puς essere interessante. La parte relativa alla vitreoc. per floaters nella bursa mi lascia un po' perplesso...


Treatment of vitreous floaters

Secretariaat Oogheelkunde

secretariaat.oogheelkunde@uza.be

tel. +32 3 821 33 72

tel. +32 3 821 32 19

You present an ocular problem called "vitreous floaters". The diagnosis of vitreous floaters needs to be confirmed.
An ophthal­mo­logical investigation will allow us to make a distinction between ill-defined and well-defined vitreous floaters.
Well-defined vitreous floaters can be treated with Nd:YAG laser treatment,
while ill-defined vitreous floaters can only be treated by a vitrectomy procedure.

The costs related to the ophthalmological investigation prior to the treatment are set by the Belgian Social Security
(Rijks Instituut voor Ziekte- en Invaliditeits Verzekering or RIZIV-INAMI):

Description Normal rate Private patient rate

Ophthalmological consultation visit

accredited doctor

(102535 - N8 + Q30) 21,53 € 43,06 €

Binocular biomicroscopy of the

anterior segment with protocol or

iconography (249233 - N10) 6,58 € 13,16 €

Binocular biomicroscopy of the

posterior segment

(248673 - N15) 9,88 € 19,76 €

Dynamometry and/or tonometry

(248636 - N10) 6,58 € 13,16 €

OCT of the vitreoretinal interface
(248791 - N75) 49,38 € 49,38 €

Aberrometry (248776 - N15) 9,88 € 9,88 €

Biometry of the eye (249255 - N125) 82,30 € 164,60 €

Dilatation drop: topical 0,39 € 0,39 €

Total amount 186,52 € 313,39 €

I. Nd:YAG laser treatment for well-defined vitreous floaters

Hereby the reference of the following paper published in the Bulletin de la Sociιtι belge d'Ophtalmologie.
All details and technical aspects of the treatment are covered in this publication.
The Nd:YAG laser used is a Nanolas device (a nanosecond YAG laser).

Vandorselaer T., Van de Velde F. and Tassignon M.J. (2001).
Eligibility criteria for Nd-YAG laser treatment of highly symptomatic vitreous floaters. Bull. Soc. belge Ophtalmol. 280, 15-22

Ask your ophthalmologist to carefully read this publication and let him/her examine your vitreous
thoroughly keeping in mind the eligibility criteria for Nd:YAG laser treatment.

Only well-defined floaters which are suspended at vitreous strands are eligible for Nd:YAG laser.

The treatment is performed on an ambulatory basis.

The costs related to this treatment are set by the Belgian Social Security
(Rijks Instituut voor Ziekte- en Invaliditeits Verzekering or RIZIV-INAMI) and consist of:

Description Normal rate Private patient rate

YAG laser treatment

(355036 - K120) 129,20 € 258,40 €

Vitreous

(248312 - N150) 119,39 € 238,78 €

Material (drops, etc.) 4,00 € 4,00 €

Total amount 252,59 € 501,18 €

The total cost for this treatment combined with the ophthalmological consultation (see above) is therefore:
439,11 € (439 Euros and 11 Eurocents). In case you want to be treated as private patient,
please note that a supplement of 100 % will be charged (private patient rate): 814,57 €
(814 Euros and 57 Eurocents).

Postoperative follow-up may be taken in charge by your own ophthalmologist.

In case re-treatment is necessary six months after the initial treatment, the full amount of 252,59 €
(252 Euros and 59 Eurocents)
will be charged, with a supplement of 100 % in case you have special requests to be treated
by an ophthalmologist of your personal choice: 505,18 € (505 Euros and 18 Eurocents).

In case Nd:YAG laser treatment is not successful, you may be proposed to be treated by vitrectomy (
see further: ill-defined vitreous floaters).

II. Vitrectomy for ill-defined vitreous floaters

This treatment is suitable for the following "floater" pathology:


§ Floaters located in the bursa premacularis

- In this case the diagnosis will depend on the OCT investigation
determining whether or not the posterior hyaloid is detached.

- The vitrectomy needs to induce a posterior hyaloid detachment.

- The vitrectomy is limited to the region close to the macula.

- A 23 Gauge vitrectomy is performed.

- Stitches are only used if the wounds are not waterproof.


§ Floaters located in the vitreous cavity but not clearly suspended by strands

- In this case a vitrectomy is usually performed without
detachment of the posterior hyaloid because this is usually already the case.

- A 23 Gauge vitrectomy is performed.

- Stitches are only used if the wounds are not waterproof.

This treatment may be performed on an ambulatory basis depending upon the type of anaesthesia that will be chosen.

Both local and general anaesthesia may be applied in case a vitrectomy is performed.
The choice will depend upon the wishes of the patient as well as the evaluation of the surgeon.

Potential complications of this surgical procedure will be discussed in detail with the surgeon.


The costs related to this treatment will depend upon the type of anaesthesia that will be used:

Description Local Local General

anesthaesia anesthaesia anesthaesia

preoperative examination 0,00 € 0,00 € 136,99 €

day care clinic / hospitalisation (2 days) day care clinic hospitalisation hospitalisation

545,83 € 1091,66 € 1091,66 €

hospital costs (clinical biology, etc.) 100,83 € 509,06 € 509,06 €

doctor's fees 822,94 € 822,94 € 1193,38 €

medication 35,00 € 45,00 € 45,00 €

materials 463,56 € 463,56 € 463,56 €

Total amount 1968,16 € 2932,22 € 3439,65 €

III. Vitrectomy combined to cataract surgery

In case your lens is cataractous, the vitrectomy procedure may be combined to a cataract procedure.
The costs of this combined procedure are as follows:

Omschrijving Local General

anesthaesia anaesthesia

preoperative examination 0,00 € 136,99 €

day care clinic / hospitalisation (2 days) day care clinic hospitalisation

545,83 € 1091,66 €

hospital costs (clinical biology, etc.) 100,83 € 509,06 €

doctor's fees 1094,83 € 1612,23 €

medication 75,00 € 75,00 €

materials 998,20 € 998,20 €

Total amount 2814,69 € 4423,14 €

IV. Obtaining an appointment

To arrange an appointment please use one of the following telephone numbers: +32 3 821 35 56 or +32 3 821 47 01.
You will be helped by the nurses of the Department of Ophthalmology.
Please specify that you are interested in having an appointment for floater pathology.
The necessary examinations will be scheduled accordingly.

Sincerely yours

Prof. dr. Marie-Josι Tassignon

Head of the Department of Ophthalmology

-------------------

Ora, ma che cavolo vuol dire che in caso di floaters nella bursa la vitreoc. θ limitata "to the region close to the macula"? che entra e toglie solo quella parte? mi pare assurdo...
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MessaggioInviato: Gio 06 Giu, 2013 22:52    Oggetto: Rispondi citando

Io penso che una fov parziale, al giorno d'oggi, possa avere rarissimo senso, ma proprio rarissimo, perchθ la capirei solo su una persona molto giovane con il vitreo assolutamente adeso, ma pieno di CMV da non vedere da un palmo dal naso. In tutti gli altri casi, penso che la FOV parziale sia piω deleteria che altro.
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ale80



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MessaggioInviato: Ven 07 Giu, 2013 7:01    Oggetto: Rispondi citando

Si, ma qui non sembra parlare delle tipica core, che si fa per evitare di indurre il distacco. Il distacco viene indotto, ma si toglie solo la parte di vitreo davanti alla macula, questo non riesco non spiegarmi...
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MessaggioInviato: Ven 07 Giu, 2013 7:47    Oggetto: Rispondi citando

Forse per evitare il pucker maculare, ma il vitreo adeso alla retina negli altri punti, prima o poi, comincerebbe a trazionare (parere personale ovviamente).
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