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Chua AW, Chua MJ, Harrisberg BP, Kumar CM. Retinal artery occlusion after ophthalmic surgery under regional anaesthesia: A narrative review. Anaesth Intensive Care 2024; 52:82-90. [PMID: 38041616 DOI: 10.1177/0310057x231215826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Two recent cases of central retinal artery occlusion under otherwise uncomplicated sub-Tenon's block that resulted in significant visual loss after cataract surgery prompted us to undertake a literature review of such cases. We identified 97 cases of retinal artery occlusion after ophthalmic surgery under regional anaesthesia that had no immediate signs of block-related complications. These occurred after various intraocular (87%) and extraocular (13%) operations, across a wide range of ages (19-89 years) on patients with (59%) or without (39%) known risk factors. The anaesthetic techniques included 40 retrobulbar blocks, 36 peribulbar blocks, 19 sub-Tenon's blocks, one topical anaesthetic and one unspecified local anaesthetic. Different strengths of lidocaine, bupivacaine, mepivacaine and ropivacaine, either alone or in various combinations, were used. The details of the anaesthetic techniques were often incomplete in the reports, which made comparison and analysis difficult. Only nine cases had their cause (optic nerve sheath injury) identified, while the mechanism of injury was unclear in the remaining patients. Various mechanisms were postulated; however, the cause was likely to be multifactorial due to patient, surgical and anaesthetic risk factors, especially in those with compromised retinal circulation. As there were no definite risk factors identified, no specific recommendations could be made to avoid this devastating outcome. We have provided rationales for some general considerations, which may reduce this risk, and propose anaesthetic options for ophthalmic surgery on the fellow eye if required, based both on our literature review and our personal experience.
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Affiliation(s)
- Alfred Wy Chua
- Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Matthew J Chua
- Department of Anaesthetics, Liverpool Hospital, Liverpool, Australia
| | - Brian P Harrisberg
- Department of Ophthalmology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Chandra M Kumar
- Newcastle University Medical School, EduCity, Johor, Malaysia
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Gong D, Deng S, Dang K, Yan Z, Wang J. Causes and management strategies for elevated intraocular pressure after implantable collamer lens implantation. Front Med (Lausanne) 2024; 11:1351272. [PMID: 38384405 PMCID: PMC10879591 DOI: 10.3389/fmed.2024.1351272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/25/2024] [Indexed: 02/23/2024] Open
Abstract
With the widespread application of Implantable Collamer Lens (ICL) implantation surgery in the field of myopia correction, a comprehensive understanding of its potential complications, especially those related to intraocular pressure (IOP), becomes crucial. This article systematically reviews various complications that may lead to IOP elevation after ICL surgery. Firstly, common complications after ICL surgery, including residual viscoelastic, steroid response, and excessive vault of the ICL, are detailed, emphasizing their potential impact on intraocular pressure. Regarding residual viscoelastic, we delve into its direct relationship with postoperative elevated IOP and possible preventive measures. For steroid response, we stress the importance of timely adjustment of steroid therapy and monitoring intraocular pressure. Additionally, excessive vault of the ICL is considered a significant potential issue, and we elaborate on its mechanism and possible management methods. In further discussion, we focus on relatively rare complications such as Toxic Anterior Segment Syndrome (TASS), Urrets-Zavalia Syndrome (UZS), Pigment Dispersion Syndrome (PDS), and malignant glaucoma. For these relatively rare complications, this review thoroughly explores their potential mechanisms, emphasizes the importance of prevention, and provides guidance for early diagnosis and treatment. This is a comprehensible review that aims to offer eye care professionals a comprehensive understanding and effective management guidance for complications of elevated IOP after ICL surgery, ultimately providing optimal care for patients' visual health.
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Affiliation(s)
- Di Gong
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
| | - Simin Deng
- The 2nd Clinical Medical College (Shenzhen People's Hospital) of Jinan University, Shenzhen, China
| | - Kuanrong Dang
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
| | - Zonghui Yan
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
| | - Jiantao Wang
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
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Shi X, Wang WJ, Fan Y, Liu HY, Wang H, Chen YH, Rong A, Wu ZF, Xu X, Liu K. Pars plana vitrectomy for retinal detachment using perfluoro-n-octane as intraoperative tamponade: a multicenter, randomized, non-inferiority trial. Int J Ophthalmol 2024; 17:82-91. [PMID: 38239947 PMCID: PMC10754668 DOI: 10.18240/ijo.2024.01.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/20/2023] [Indexed: 01/22/2024] Open
Abstract
AIM To evaluate the efficacy and safety of perfluoro-n-octane (PFO) for ophthalmic surgery versus F-Octane as an intraoperative tamponade in pars plana vitrectomy (PPV) in management of retinal detachment. METHODS This multicenter, prospective, randomized, double-masked, parallel-controlled, non-inferiority trial was conducted in three ophthalmology clinical centers in China. Patients with retinal detachment, who were eligible for PPV were consecutively enrolled. Participants were assigned to PFO for ophthalmic surgery or F-Octane for intraocular tamponade in a 1:1 ratio. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, and dilated fundus examination were performed preoperatively and at 1, 7±1, 28±3d postoperatively. The primary outcome was complete retinal reattachment rate at postoperative day one. The non-inferiority margin was set at 9.8%. The secondary outcomes included intraoperative retinal reattachment rate, and mean changes in IOP and BCVA from baseline to 1, 7±1, 28±3d postoperatively, respectively. Safety analyses were presented for all randomly assigned participates in this study. RESULTS Totally 124 eligible patients completed the study between Mar. 14, 2016 and Jun. 7, 2017. Sixty of them were randomly assigned to the PFO for ophthalmic surgery group, and 64 were assigned to the F-Octane group. Baseline characteristics were comparable between the two groups. Both groups achieved 100% retinal reattachment at postoperative day one (difference 0, 95%CI: -6.21% to 5.75%, P=1). The pre-defined noninferiority criterion was met. No significant difference was observed in intraoperative retinal reattachment rate (difference 1.77%, P=0.61), mean changes in IOP (difference 0.36, -0.09, 2.22 mm Hg at 1, 7±1, 28±3d postoperatively, with all P>0.05) and BCVA (difference 0.04, -0.02, 0.06 logMAR at 1, 7±1, 28±3d postoperatively, all P>0.05) between the two groups. No apparent adverse events related to the utilization of PFO were reported. CONCLUSION In patients with retinal detachment undergoing PPV, PFO for ophthalmic surgery is non-inferior to F-Octane as an intraocular tamponade, and both are safe and well-tolerated.
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Affiliation(s)
- Xin Shi
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200085, China
| | - Wei-Jun Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200085, China
| | - Ying Fan
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200085, China
| | - Hai-Yun Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200085, China
| | - Hong Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200085, China
| | - Yu-Hui Chen
- Shanghai Jieshi Medical Technology Co. Ltd., Shanghai 201201, China
| | - Ao Rong
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Zhi-Feng Wu
- Department of Ophthalmology, Wuxi No.2 People's Hospital (Jiangnan University Medical Center, JUMC), Wuxi 214002, Jiangsu Province, China
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200085, China
| | - Kun Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200085, China
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Nuliqiman M, Xu M, Sun Y, Cao J, Chen P, Gao Q, Xu P, Ye J. Artificial Intelligence in Ophthalmic Surgery: Current Applications and Expectations. Clin Ophthalmol 2023; 17:3499-3511. [PMID: 38026589 PMCID: PMC10674717 DOI: 10.2147/opth.s438127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Artificial Intelligence (AI) has found rapidly growing applications in ophthalmology, achieving robust recognition and classification in most kind of ocular diseases. Ophthalmic surgery is one of the most delicate microsurgery, requiring high fineness and stability of surgeons. The massive demand of the AI assist ophthalmic surgery will constitute an important factor in boosting accelerate precision medicine. In clinical practice, it is instrumental to update and review the considerable evidence of the current AI technologies utilized in the investigation of ophthalmic surgery involved in both the progression and innovation of precision medicine. Bibliographic databases including PubMed and Google Scholar were searched using keywords such as "ophthalmic surgery", "surgical selection", "candidate screening", and "robot-assisted surgery" to find articles about AI technology published from 2018 to 2023. In addition to the Editorials and letters to the editor, all types of approaches are considered. In this paper, we will provide an up-to-date review of artificial intelligence in eye surgery, with a specific focus on its application to candidate screening, surgery selection, postoperative prediction, and real-time intraoperative guidance.
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Affiliation(s)
- Maimaiti Nuliqiman
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
| | - Mingyu Xu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
| | - Yiming Sun
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
| | - Jing Cao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
| | - Pengjie Chen
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
| | - Qi Gao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
| | - Peifang Xu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
| | - Juan Ye
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
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Upadhyay P, Ichhpujani P, Solanki A. Recent trends in anesthetic agents and techniques for ophthalmic anesthesia. J Anaesthesiol Clin Pharmacol 2023; 39:343-348. [PMID: 38025549 PMCID: PMC10661636 DOI: 10.4103/joacp.joacp_555_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/01/2023] Open
Abstract
Effective and safe ophthalmic anesthesia is essential for the delivery of ophthalmic perioperative care both for children and adults. Recent years have seen a major change in form of smaller incisions for most ophthalmic surgical techniques, thus making them less invasive. Additionally, most ophthalmic surgeries are now day-care surgeries at ambulatory surgical centers. The parallel advancements in the field of anesthesiology have boosted the standard of perioperative care. The purpose of this narrative review was to evaluate current trends in anesthetic agents and techniques for ophthalmic anesthesia primarily centered around deep sedation and general anesthesia as per the concerns of practicing anesthesiologists while briefly acquainting with local anesthesia advances.
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Affiliation(s)
- Prateek Upadhyay
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Parul Ichhpujani
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Abhilasha Solanki
- Department of Anesthesiology, Weill Cornell Medicine, New York-Presbyterian Hospital, NY, USA
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Markatia Z, Al-Khersan H, Kalavar M, Watane A, Yannuzzi N, Sridhar J. Ergonomics of Ophthalmic Surgery: Evaluating the Effect of a Posture Trainer on Trainee Intraoperative Back Posture. J Acad Ophthalmol (2017) 2023; 15:e276-e279. [PMID: 38059191 PMCID: PMC10697791 DOI: 10.1055/s-0043-1777411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/09/2023] [Indexed: 12/08/2023]
Abstract
Purpose Ophthalmic surgeons are at an increased risk for musculoskeletal disorders resulting from ophthalmology-specific routines and equipment, which have become widely associated with poor posture. The purpose of this study was to observe the effect that a commercially available posture trainer, Upright Go, can have on the improvement of posture of ophthalmic surgeons. Methods Eight ophthalmologists-in-training were studied over a period of 4 weeks during their surgical rotations between September 2020 and June 2021. Participants underwent an "observation" period, followed by a 2-week "training" period, then a final "testing" period. The percentage of time users spent upright intraoperatively pre- and posttraining was evaluated. Pre- and poststudy surveys were also administered to help measure participant satisfaction and self-reported changes in posture. Results All eight participants demonstrated an increase in the percentage of time spent upright after the training period. Across all participants, the total average percentage spent upright in the observation period was 59.8%, while in the testing period was 87.1%, resulting in an average improvement of 27.3% of time spent in an upright position after the completion of the training period ( p < 0.0001). The range of improvement of time spent upright was 16.0 to 46.5%. Conclusion This cohort study utilized the Upright Go device to help determine the effect that its training could have on the improvement of posture in ophthalmic surgeons. The results indicated a significant increase in the average proportion of time spent with upright posture compared after the training period.
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Affiliation(s)
- Zahra Markatia
- Department of Ophthalmology, Baylor College of Medicine Cullen Eye Institute, Houston, Texas
| | | | - Meghana Kalavar
- Department of Ophthalmology, Ohio State University Ophthalmology, Columbus, Ohio
| | - Arjun Watane
- Department of Ophthalmology, Yale Eye Center, New Haven, Connecticut
| | - Nicolas Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami Florida
| | - Jayanth Sridhar
- Department of Ophthalmology, University of California Los Angeles Stein Eye Institute, Los Angeles, California
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Navas L, Di Palma C, Pasolini MP, Montano C, de Chiara M, Lamagna F, Uccello V, Micieli F, Amalfitano C, Paciello O, Lamagna B. Outcomes of Treatment of Eyelids and Third Eyelid Tumours in Dogs Using High-Frequency Radiowave Surgery. Animals (Basel) 2023; 13:2105. [PMID: 37443903 DOI: 10.3390/ani13132105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
In human ophthalmology, the benefits of using high-frequency radiowave (HFR) electrocautery for surgical procedures were demonstrated and include effective haemostasis, shorter surgery times, and rapid recovery. In canine eyelid surgery, intraoperative bleeding is a common feature that may obscure the surgical field view and lead to the increased swelling of adjacent tissues, bruising, and pain. To evaluate the efficacy and benefits of HFR electrocautery in canine eyelid and third eyelid surgery, the medical records of 48 surgical excisions of eyelid tumours (involving up to one-third of the eyelid length) and 4 third eyelid excisions were reviewed. The information was collected including the breed, age, clinical signs, HFR power setting and mode of the surgical unit, electrode used for the surgery, intraoperative complications, histopathological diagnosis, and postoperative outcomes. Surgical techniques were performed using the Surgitron Dual 3.8 MHz Frequency RF device (Ellman International, Oceanside, NY, USA). Intraoperative bleeding was recorded as absent or very mild, and the surgical procedures were very fast. No complications occurred during the procedures. Healing within 10 days was observed in all the dogs. No tumour recurrences were recorded at the 12-month follow-up. HFR electrosurgery proved to be a safe, effective, and easy-to-perform technique for the removal of eyelid and third eyelid tumours in dogs.
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Affiliation(s)
- Luigi Navas
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via Federico Delpino 1, 80137 Naples, Italy
| | - Cristina Di Palma
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via Federico Delpino 1, 80137 Naples, Italy
| | - Maria Pia Pasolini
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via Federico Delpino 1, 80137 Naples, Italy
| | - Chiara Montano
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via Federico Delpino 1, 80137 Naples, Italy
| | - Mariaelena de Chiara
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via Federico Delpino 1, 80137 Naples, Italy
| | - Francesco Lamagna
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via Federico Delpino 1, 80137 Naples, Italy
| | - Valeria Uccello
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via Federico Delpino 1, 80137 Naples, Italy
| | - Fabiana Micieli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via Federico Delpino 1, 80137 Naples, Italy
| | | | - Orlando Paciello
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via Federico Delpino 1, 80137 Naples, Italy
| | - Barbara Lamagna
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via Federico Delpino 1, 80137 Naples, Italy
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Kumar C, Seet E, Chua A. Updates in ophthalmic anaesthesia in adults. BJA Educ 2023; 23:153-159. [PMID: 36960436 PMCID: PMC10028395 DOI: 10.1016/j.bjae.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/17/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- C.M. Kumar
- Khoo Teck Puat Hospital, Yishun, Singapore
- Newcastle University Medical School, EduCity, Johor, Malaysia
| | - E. Seet
- Khoo Teck Puat Hospital, Yishun, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - A.W.Y. Chua
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Sun T, Zhang BW, Xiong R, Zhou WT, Qiu JJ. Clinical Observation of Low-Temperature Plasma Ablation Combined with Drug Therapy in the Treatment of Fungal Keratitis. Infect Drug Resist 2023; 16:1895-1904. [PMID: 37020797 PMCID: PMC10069428 DOI: 10.2147/idr.s399715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/07/2023] [Indexed: 04/07/2023] Open
Abstract
Objective To observe the efficacy and prognosis of low-temperature plasma ablation + drug therapy in the treatment of fungal corneal ulcers. Methods The present paper presents a retrospective clinical study with a subject base of 34 eyes. Patients with a fungal corneal ulcer who visited the Affiliated Eye Hospital of Nanchang University between August 2019 and December 2021 were selected as the study participants. They were found to have highly reflective fungal hyphae in the corneal stroma layer via confocal microscope examination, which were revealed to be positive on etiology examination, with the ulcer and infiltration depths ≤1/2 of the corneal thickness. The efficacy and prognosis were observed after treatment with low-temperature plasma ablation + drug therapy. Results A total of 34 cases (34 eyes) had clinical manifestations of corneal infiltration and corneal ulcer formation, with a corneal lesion diameter of 1.31-8.64 mm (average = 4.79 ± 2.03 mm). The average healing time of corneal ulcers was 6.2 ± 1.7 days. Among a total of 34 cases (34 eyes) in patients with fungal keratitis, the infection was controlled and the ulcers gradually healed after treatment with low-temperature plasma system + drug therapy in a total of 30 cases (30 eyes, 88%). A total of three cases (3 eyes, 9%) exhibited no clear improvement after the treatment, and the patients underwent conjunctival flap covering surgery. One case (one eye, 3%) exhibited no clear improvement after further treatment, with the patient experiencing corneal perforation and ultimately undergoing penetrating keratoplasty. Conclusion Low-temperature plasma ablation + drug therapy can effectively control the progression of fungal keratitis infection, as well as significantly shorten the ulcer healing time, and is, therefore, an effective method.
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Affiliation(s)
- Tao Sun
- Affiliated Eye Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Ophthalmic Disease, Nanchang City, Jiangxi Province, 330006, People’s Republic of China
- Jiangxi Research Institute of Ophthalmology and Visual Science, Nanchang City, Jiangxi Province, 330006, People’s Republic of China
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang City, Jiangxi Province, 330006, People’s Republic of China
| | - Bo-Wen Zhang
- Affiliated Eye Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Ophthalmic Disease, Nanchang City, Jiangxi Province, 330006, People’s Republic of China
- Jiangxi Research Institute of Ophthalmology and Visual Science, Nanchang City, Jiangxi Province, 330006, People’s Republic of China
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang City, Jiangxi Province, 330006, People’s Republic of China
| | - Rui Xiong
- Affiliated Eye Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Ophthalmic Disease, Nanchang City, Jiangxi Province, 330006, People’s Republic of China
- Jiangxi Research Institute of Ophthalmology and Visual Science, Nanchang City, Jiangxi Province, 330006, People’s Republic of China
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang City, Jiangxi Province, 330006, People’s Republic of China
| | - Wen-Tian Zhou
- Affiliated Eye Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Ophthalmic Disease, Nanchang City, Jiangxi Province, 330006, People’s Republic of China
- Jiangxi Research Institute of Ophthalmology and Visual Science, Nanchang City, Jiangxi Province, 330006, People’s Republic of China
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang City, Jiangxi Province, 330006, People’s Republic of China
| | - Jing-Jing Qiu
- Department of Ophthalmology of The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, 330006, People’s Republic of China
- Correspondence: Jing-Jing Qiu, Department of Ophthalmology of The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang City, Jiangxi Province, 330006, People’s Republic of China, Tel +86 15070001118, Email
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Chen R, Folio D, Ferreira A. Optimal Design of a Multipole-Electromagnet Robotic Platform for Ophthalmic Surgery. Micromachines (Basel) 2022; 14:91. [PMID: 36677152 PMCID: PMC9865419 DOI: 10.3390/mi14010091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
The aim of this study was to design a multipole-electromagnet robotic platform named OctoRob. This platform provides a minimally invasive means for targeted therapeutic interventions in specific intraocular areas. OctoRob is capable of generating both appropriate magnetic fields and gradients. The main scientific objectives were: (i) To propose an optimal reconfigurable arrangement of electromagnets suitable for ophthalmic interventions. (ii) To model, design and implement a one-degree-of-freedom robotic arm connected with an electromagnet in order to optimize the generation of magnetic fields and gradients. (iii) To evaluate the magnetic performances of the OctoRob platform, including different tilted angles. The results show that OctoRob platform has great potential to be applied for ophthalmic surgery.
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Affiliation(s)
| | - David Folio
- Correspondence: (D.F.); (A.F.); Tel.: +33-(0)2-48-48-40-75 (D.F.); +33-(0)2-48-48-40-79 (A.F.)
| | - Antoine Ferreira
- Correspondence: (D.F.); (A.F.); Tel.: +33-(0)2-48-48-40-75 (D.F.); +33-(0)2-48-48-40-79 (A.F.)
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Kikushima W, Sakurada Y, Kashiwagi K. Characteristics of Grape Shelf Eye Injuries at Vineyards in Japan. J Clin Med 2022; 11:jcm11237079. [PMID: 36498654 PMCID: PMC9738691 DOI: 10.3390/jcm11237079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022] Open
Abstract
We aimed to investigate the characteristics and visual outcomes of farm work-associated eye injuries at vineyards. We retrospectively reviewed medical charts of patients with farm work-associated eye injuries. The eyes were divided into two groups according to the type of farming that contributed to the eye injury: the vineyard and other farming groups. Injury types, surgical procedures, and changes in visual acuity were statistically evaluated. After initial treatment, patients were followed up at different periods. We examined 30 eyes, including 14 eye injuries in the vineyard group and 16 eye injuries in the other farming group. The mean age of the patients was 58.8 ± 16.7 years, and 83.3% were male. None of the patients wore any safety eyewear at the time of injury. After initial treatment, the mean best-corrected visual acuity significantly improved from 0.83 ± 0.94 at baseline to 0.30 ± 0.57 at the final follow-up (p = 5.8 × 10-4). Eye injuries in the vineyard group were mostly caused by the penetration of wires of grape shelves and were frequent from winter to spring. We concluded that farm work-associated eye injuries at vineyards have characteristic properties compared with those during other farm work. The use of safety eyewear is strongly recommended to prevent eye injuries during farm work.
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12
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Baldascino A, Ripa M, Carlà MM, Caporossi T, Grieco G, Gambini G, De Vico U, Raguso G, Kilian R, Rizzo C, Rizzo S. Optical Coherence Tomography Angiography to Estimate Early Retinal Blood Flow Changes after Uncomplicated Cataract Surgery. Vision (Basel) 2022; 6. [PMID: 35893755 DOI: 10.3390/vision6030038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To investigate macular microvascular changes after uncomplicated phacoemulsification surgery according to the cataract severity grade. Methods: Retrospective, cross-sectional study involving 23 eyes of 23 patients who underwent elective cataract extraction. All patients underwent routine ophthalmologic examination, including optical coherence tomography angiography (OCTA) at baseline (preoperative visit, T0) and seven days postoperatively (T7). OCTA scans were obtained with the spectral domain system Cirrus 5000 (Carl Zeiss Meditec, Inc., Dublin, CA, USA), and 3 mm × 3 mm raster fovea-centered scans were obtained to evaluate the superficial capillary plexus (SCP) vessel density, perfusion density, and foveal avascular zone (FAZ) parameters. Results: SCP perfusion density significantly increased from 28.3 ± 5.73% to 33.74 ± 4.13% after the surgery (p < 0.001). Similarly, SCP vessel density significantly increased from 15.14 ± 3.41 mm−1 to 18.14 ± 2.57 mm−1 after surgery (p < 0.001). The mean preoperative FAZ area significantly increased from 0.27 ± 0.12 mm to 0.24 ± 0.11 mm seven days postoperatively (p = 0.008). When comparing softer and harder cataracts, no significant variations in SCP vessel density, as well as SCP perfusion density parameters and the FAZ area, perimeter, and circularity index, were noted before and after surgery. Conclusions: Macular SPC vessel density and macular SCP perfusion density increase after uncomplicated cataract surgery regardless of the cataract severity.
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13
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Sarkar S, Deb AK, Singh R, Dhodapakar R, Gokhale T, Kaliaperumal S. Ophthalmology practice in COVID-19 pandemic: Performance of rapid antigen test versus real time-reverse transcription polymerase chain reaction in a tertiary eye care institute in South India. Indian J Ophthalmol 2022; 70:1761-1765. [PMID: 35502068 PMCID: PMC9333034 DOI: 10.4103/ijo.ijo_21_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To assess the rapid antigen test (RAT) against the gold standard reverse transcription-polymerase chain reaction (RT-PCR) to screen COVID-19 infection in asymptomatic patients undergoing ophthalmic procedures. Methods: This was a retrospective hospital-based study. Point-of-care (PoC) RAT was performed using nasopharyngeal swab, while RT-PCR for SARS-CoV-2 viral RNA was performed using both nasopharyngeal and throat swabs. Results: A total of 629 patients were tested for SARS-CoV-2 by using both RAT and RT-PCR. Only one patient had tested positive for SARS-CoV-2 with both RAT and RT-PCR, while two patients had tested positive with RT-PCR after an initial negative RAT. The positivity rate for RAT was 0.15% (1/629), and that for RT-PCR was 0.47%. Percent agreement or proportion of agreement observed between the two tests was 99.68%, while Cohen’s kappa coefficient value was 0.49. The sensitivity of RAT in comparison to RT-PCR was 33.33%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 99.68%. Conclusion: The sensitivity and Cohen’s kappa coefficient in our study were low but that can be attributed to the overall low positivity rates with both RAT and RT-PCR. However, percent agreement observed between the two tests was very high. Therefore, we recommend initial screening of all the patients for COVID-19 symptoms followed by RAT before performing any ophthalmic surgical procedure to ensure the safety of the health care professionals as well as the patients.
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Affiliation(s)
- Sandip Sarkar
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Amit Kumar Deb
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Rakesh Singh
- Department of Microbiology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Rahul Dhodapakar
- Department of Microbiology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Tanmay Gokhale
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Subashini Kaliaperumal
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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14
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Gupta Y, Tandon R. Optimization of surgeon ergonomics with three-dimensional heads-up display for ophthalmic surgeries. Indian J Ophthalmol 2022; 70:847-850. [PMID: 35225528 PMCID: PMC9114587 DOI: 10.4103/ijo.ijo_1548_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/21/2021] [Accepted: 10/16/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To describe the variables that may be utilized in the optimization of three-dimensional heads-up surgeries (3D-HUS) for achieving better ergonomics among ophthalmic surgeons. METHODS A. cross-sectional study was conducted at the operating room of a tertiary eye care center, equipped with an ARTEVO 800 3D surgical microscope and display monitor. The parameters noted were monitor height (MH), surgeon eye-to-floor distance (ETFD), surgeon eye-to-monitor distance (ETMD) and viewing tilt (VT) angle. The neck and eye strain of the surgeon and assistant were scored as per Borg's CR-10 scale, before and after surgeries. RESULTS Thirty (13 right, 17 left) eye surgeries were analyzed. The minimum ETMD was 51 inches (in) and the eye strain reduced with shorter ETMD (within the range 51 inches to 83 inches).The VT and ETFD were higher for right eye surgeries. The optimum MH was between 50 and 55 in. Overall, the neck strain and eye strain were in the range of 0-3 and 0-1, respectively. CONCLUSION The various parameters affecting the 3D image quality, neck and eye strain are chair height, VT angle, eye centration, monitor distance, laterality of the eye, and room illumination.
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Affiliation(s)
- Yogita Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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15
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Almarzouki N, Alessa S, Raffa L. Clinical profile of patients with endophthalmitis: A 16- year retrospective, cross-sectional study at tertiary care hospital in Western Saudi Arabia. Niger J Clin Pract 2021; 24:1527-1530. [PMID: 34657020 DOI: 10.4103/njcp.njcp_514_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aim This study aimed to profile the clinical features and demographics of patients with endophthalmitis in a tertiary care center, Western region, Saudi Arabia. We used a retrospective cross-sectional case series at King Abdulaziz University Hospital. Materials and Methods Endophthalmitis was diagnosed in a total of 14 eyes of 14 patients treated in our hospital between 2002 and 2018. The patients' medical records were reviewed to gather demographic and clinical data. Results The mean age of patients was 52.8 ± 19.2 years, and 50% of patients were male. The majority of endophthalmitis cases were post-ophthalmic surgery (50%), 35.7% were of endogenous origin, 7.2% were associated with corneal ulcer with perforation, and 7.2% were post open globe injury. Patients' admission to the hospital ranged from 2 to 10 days from symptoms occurrence with a median of 5 days. Half of the patients presented with no light perception vision, counting fingers in 14.2%, hand motion in 14.2%, light perception in 7.2%, and 20/300 in 7.2%. The final visual outcome improved in four cases (28.5%) with best corrected visual acuity of 20/40 reached in one patient. Conclusion Post- ophthalmic surgery and endogenous endophthalmitis were the most common causes of endophthalmitis among our patients, with late presentation to the hospital and poor vision at presentation also being common findings. These findings highlight the necessity of proper patient education, after care and adherence to sterile techniques in ensuring that patients recover successfully from ophthalmic surgery.
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Affiliation(s)
- N Almarzouki
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - S Alessa
- King Abdulaziz University, Faculty of Medicine, Jeddah, Saudi Arabia
| | - L Raffa
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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16
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Sanjay S, Leo SW, Au Eong KG, Adriono GA, Fong KC, Anand K, Kadarisman RS, Granet DB, Mahendradas P, Shetty R, Souza SD, Iyer SP. Global Ophthalmology Practice Patterns during COVID-19 Pandemic and Lockdown. Ophthalmic Epidemiol 2021; 29:233-244. [PMID: 34167454 DOI: 10.1080/09286586.2021.1934037] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aim: To assess the impact of practice patterns amongst global ophthalmologists during severe acute respiratory syndrome Coronavirus 2 (SARS Cov2) causing Corona virus disease (COVID-19) and understand the various modifications made to address emergency surgeries and practice needs.Methods: An online survey was sent to practicing ophthalmologists around the world through email, Whatsapp™ ListServ17.0™ (for pediatric ophthalmologists), WeChat™ (China) and ophthalmology associations (Indonesia, Philippines, Ireland). All queries were collected and categorized. Responses to the queries were given according to the recommendations by the Ophthalmology association. Practices ability to deal with the COVID were also classified according to country and type of access to PPE. Statistical analyses of the association between these data and queries, where appropriate were carried out.Results: One thousand nine hundred sixteen ophthalmologists were invited to participate in a survey between April 10th and April 30th, 2020 of which 1207 responded, which is a response rate of approximately 63%. The majority of respondents were from India, Indonesia, China, Singapore and the USA. Our study indicates a precipitous drop in surgical procedures with 46% (n = 538) ophthalmologists ceased to operate on their patients and almost 40% (n = 486) were doing less than 25% of their original number of surgeries. The intent to resume elective surgeries was a consideration in 41% (n = 495) after an evaluation of the situation and in consultation with professional bodies. More than 2/3 of the respondents (n = 703) made it a priority to use and mandate their patients to practice physical distancing, wearing masks, and hand dis-infection for protection to limit the spread of infection.Conclusion: This global survey provides a real-world assessment of diverse practices that were in various forms of "shut down mode" and circumstances with varying capabilities to deal with COVID. It is unprecedented that the collective wisdom for a curtailment of practice has had an enormous immediate and far reaching implications on the livelihoods of ophthalmologists, their staff, and their families. Nevertheless, ophthalmologists and their staff remain resilient and have adapted to these changes pragmatically.
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Affiliation(s)
- Srinivasan Sanjay
- Department of Uvea and Ocular Immunology, Narayana Nethralaya, Bengaluru, India
| | - Seo Wei Leo
- Dr Leo Adult & Paediatric Eye Specialist Pte Ltd, Mount Elizabeth Medical Centre, Singapore
| | - Kah-Guan Au Eong
- International Eye Cataract Retina Center, Mount Elizabeth Medical Center and Farrer Park Medical Center, Singapore.,Department of Ophthalmology & Visual Sciences, Khoo Teck Puat Hospital, Singapore
| | - Gitalisa Andayani Adriono
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Kartik Anand
- Great Plains Health Callahan Cancer Center, University of Nebraska, North Platte, Nebraska, USA
| | | | - David B Granet
- Ratner Children's Eye Center, Shiley Eye Institute, University of California, San Diego, USA
| | | | - Rohit Shetty
- Department of Cornea and Refractive Services, Narayana Nethralaya, Bengaluru, India
| | - Sharon D Souza
- Department of Cornea and Refractive Services, Narayana Nethralaya, Bengaluru, India
| | - Swaminathan P Iyer
- Department of Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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17
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Abstract
Endophthalmitis remains a serious complication following intraocular procedures. Preoperative prophylactic measures for endophthalmitis decrease the morbidity associated with this disease and represent a standard of care prior to ophthalmic surgery. The literature supports as measures for ocular antisepsis: povidone-iodine solution for ocular surface preparation, chlorhexidine in patients with iodine allergy and application of topical antibiotics. Povidone-iodine is regarded as the most effective antiseptic associated with significant reduction in ocular surface bacterial counts. Currently, the recommended preoperative management is the application of 5% povidone-iodine solution in the conjunctival fornix, prior to surgery. This paper reviews the preoperative measures for ocular antisepsis, used in order to decrease the risk of culture-proven endophthalmitis.
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Affiliation(s)
| | - Otilia-Maria Dumitrescu
- Ophthalmology Department, "Dr. Carol Davila" Central Military Emergency Hospital, Bucharest, Romania
| | - Roxana-Elena Rogoz
- Ophthalmology Department, "Dr. Carol Davila" Central Military Emergency Hospital, Bucharest, Romania
| | - Andreea Elena Dimirache
- Ophthalmology Department, "Dr. Carol Davila" Central Military Emergency Hospital, Bucharest, Romania
| | - Mihail Zemba
- Ophthalmology Department, "Dr. Carol Davila" Central Military Emergency Hospital, Bucharest, Romania
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18
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Greco A, Costanza D, Senatore A, Bruzzese D, Micieli F, Chiavaccini L, Di Giancamillo M, Della Valle G, Vesce G, Brunetti A, Meomartino L. A computed tomography-based method for the assessment of canine retrobulbar cone volume for ophthalmic anaesthesia. Vet Anaesth Analg 2021; 48:759-766. [PMID: 34391668 DOI: 10.1016/j.vaa.2021.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/01/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop a comprehensive formula for calculating the volume of local anaesthetic solution used for retrobulbar anaesthesia in dogs with different skull morphologies. STUDY DESIGN Retrospective cohort imaging study. ANIMALS Skull computed tomography (CT) images of 188 dogs of different breeds collected between January 2009 and December 2017. METHODS Anatomical integrity of the orbit and adjacent structures, presenting complaint, clinical signs and CT findings were verified to exclude ocular abnormalities. The volume of the retrobulbar cone of 376 eyes was calculated using CT scans of the dogs' skulls. Additional data recorded included morphology of the skull, body weight, sex and size of the dogs, all of which were matched for possible association to the retrobulbar cone volume through univariable and multivariable linear regression models. Results of linear regression models were expressed as estimated beta coefficients with the corresponding 95% confidence intervals (95% CIs). RESULTS Using univariate analysis, the retrobulbar cone volume was positively associated with weight and male sex. In addition, brachycephalic and dolichocephalic dogs showed a larger retrobulbar cone volume than mesocephalic dogs, while sex was no longer significantly associated with the retrobulbar cone volume. In multivariate analysis, when considering all variables in the model, weight emerged as the strongest predictor (beta coefficient: 0.062 mL kg-1, 95% CI: 0.056-0.067 mL kg-1, p < 0.001). CONCLUSIONS and clinical relevance In the veterinary literature, there is no agreement on the precise volume of local anaesthetic solution that should be used to achieve intraconal retrobulbar anaesthesia in dogs. Here we suggest a formula to calculate the retrobulbar cone volume and, accordingly, the injection volume of local anaesthetic solution for effective retrobulbar anaesthesia.
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Affiliation(s)
- Adelaide Greco
- Centro Interdipartimentale di Radiologia Veterinaria, Università di Napoli 'Federico II', Naples, Italy; Dipartimento di Medicina Veterinaria e Produzioni animali, Università di Napoli 'Federico II', Naples, Italy.
| | - Dario Costanza
- Centro Interdipartimentale di Radiologia Veterinaria, Università di Napoli 'Federico II', Naples, Italy
| | - Andrea Senatore
- Centro Intedipartimentale di Ricerca sui Biomateriali, Università degli Studi di Napoli 'Federico II', Naples, Italy
| | - Dario Bruzzese
- Dipartimento di Sanità Pubblica, Università di Napoli 'Federico II', Naples, Italy
| | - Fabiana Micieli
- Dipartimento di Medicina Veterinaria e Produzioni animali, Università di Napoli 'Federico II', Naples, Italy
| | - Ludovica Chiavaccini
- Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Mauro Di Giancamillo
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Della Valle
- Dipartimento di Medicina Veterinaria e Produzioni animali, Università di Napoli 'Federico II', Naples, Italy
| | - Giancarlo Vesce
- Dipartimento di Medicina Veterinaria e Produzioni animali, Università di Napoli 'Federico II', Naples, Italy
| | - Arturo Brunetti
- Dipartimento di Scienze Biomediche Avanzate, Università di Napoli 'Federico II', Naples, Italy
| | - Leonardo Meomartino
- Centro Interdipartimentale di Radiologia Veterinaria, Università di Napoli 'Federico II', Naples, Italy; Dipartimento di Medicina Veterinaria e Produzioni animali, Università di Napoli 'Federico II', Naples, Italy
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19
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Abstract
Eye health is an integral part of well-being that may be at increased risk when health service delivery is affected by sudden-onset disasters, complex humanitarian events, or conflict in resource-scarce environments. This study proposes a design plan for a mobile eye hospital to support health systems between the initial emergency response and recovery of health infrastructure in resource-scarce environments of low- and middle-income countries. The facility benefits from high mobility and modularity, it can be assembled and operated by minimal personnel, and easily expanded as necessary. It has capacity to host high-volume ophthalmological services without the logistical complexity of large-scale emergency medical team responses or military operations. The design provides a medium-term service that can either operate from a fixed location or be redeployed in-country with ease. Mobile eye hospitals may provide a useful facility for local governments suffering damaged health systems, or as a way to complement current eye health provision. The design may also be used by charitable nongovernmental organizations during an initial emergency response, with the ability to quickly deploy to a target location and establish eye services.
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20
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Ramsali MV, Puduchira KG, Maganti SP, Vankaylapatti SD, Pasupuleti S, Kulkarni D. Anesthetic management and outcomes of patients with Steven-Johnson Syndrome-A retrospective review study. J Anaesthesiol Clin Pharmacol 2021; 37:119-123. [PMID: 34103835 PMCID: PMC8174442 DOI: 10.4103/joacp.joacp_46_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 01/16/2020] [Accepted: 03/06/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Steven-Johnson Syndrome (SJS) is a rare and severe form of erythema exudative multiforme. Multisystem involvement in SJS and the suspicion of precipitation of the disease with exposure to anesthetic drugs makes anesthesia a challenging task. The concerns during anesthesia are the mucosal lesions and special care that is required to prevent injury to the oropharynx and larynx during airway management and also the drugs used for anesthesia. In the literature, very few isolated case reports or case series are available. Here, we have analyzed the cases of SJS coming for ophthalmic anesthesia, taking into consideration factors like mode of presentation, precipitating factors, associated diseases, types of anesthesia, anesthetic modifications, and various drugs used during anesthesia. Material and Methods: The electronic medical records of 497 cases of SJS who required interventions like ophthalmic examination or surgery (either under local or general anesthesia) over a period of 18 months were analyzed retrospectively. The records were reviewed to obtain the concerned details like anesthesia-inducing agents, muscle relaxants, inhalational agents, and analgesics. The problems concerned with monitoring and intubation were also noted. The data were analyzed and presented as frequency and percentage. Results: Patient age ranged between 9 months and 72 years. Many surgeries were conducted under general anesthesia (441) although a few required local (peribulbar block) anesthesia (56). The drugs administered for general anesthesia were sevoflurane, isoflurane, propofol, thiopentone, vecuronium, and atracurium and those administered for pain management were fentanyl, tramadol, butorphanol, and paracetamol. The patients who were sensitive to nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol were not administered the same. None of the patients reacted adversely to the different drugs used for anesthesia. Conclusion: Identifying the precipitating factors, understanding the pathophysiology and its implications for anesthesia will help in successfully managing anesthesia in the rare cases of SJS.
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21
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Wang H, Zhang L, Sun M, Kang L, Wei X. Perioperative treatment compliance, anxiety and depression of elderly patients with ophthalmic surgery and the influential factors. Ann Palliat Med 2021; 10:2115-2122. [PMID: 33615808 DOI: 10.21037/apm-21-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ophthalmic surgery is invasive, and treatment efficacy is affected by a variety of factors. We aimed to analyze perioperative treatment compliance, anxiety and depression of elderly patients undergoing ophthalmic surgery and the influential factors. METHODS The study group comprised 119 elderly patients undergoing ophthalmic surgery between March 2018 and March 2020. Clinical and treatment compliance data of all patients were collected. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were administered to all patients, and logistic regression analysis was used for multivariate analysis. RESULTS During the perioperative period the 119 elderly patients had a mean SAS score of 65.13±14.36, and SDS score of 61.94±17.39. Treatment compliance was as follows: 76 cases of complete compliance, 25 of incomplete compliance, and 18 of complete non-compliance. Economic status, complications, treatment options and levels of TNF-α, IL-6, and IL-8 are independent risk factors that affected the compliance of elderly patients undergoing ophthalmology surgery (P<0.05). Education level, marital status, economic status, complications, treatment options and levels of TNF-α, IL-6, and IL-8 were independent risk factors affecting perioperative anxiety and depression. CONCLUSIONS There are many factors affecting the perioperative treatment compliance, anxiety and depression of elderly patients undergoing ophthalmic surgery. Effective intervention measures should be taken to improve patients' compliance, reduce their negative emotions, and improve the surgical efficacy.
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Affiliation(s)
- Hui Wang
- Department of Ophthalmology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, China
| | - Leiming Zhang
- Department of Ophthalmology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, China
| | - Ming Sun
- Department of Ophthalmology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, China
| | - Le Kang
- Department of Physical Examination, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, China
| | - Xuelian Wei
- Department of Operation, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, China.
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22
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Bin Helayel H, Al-Mazidi S, AlAkeely A. Can the Three-Dimensional Heads-Up Display Improve Ergonomics, Surgical Performance, and Ophthalmology Training Compared to Conventional Microscopy? Clin Ophthalmol 2021; 15:679-686. [PMID: 33633441 PMCID: PMC7901555 DOI: 10.2147/opth.s290396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/13/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose To explore ophthalmic surgeons’ opinions regarding three-dimensional heads-up display (3D HUD) use and investigate musculoskeletal (MSK) complaints among ophthalmologists. Methods Physicians were invited to complete an online questionnaire. Musculoskeletal complaints and data of the HUD system use were correlated with demographic information. We explored surgeons’ feedback on image quality, depth perception, and the educational value of 3D microscopy. Results In this study, the prevalence of self-reported MSK pain was 82.6% (n=132). The pain started after joining ophthalmology practice and significantly improves on weekends and vacations. We found that the pain intensity in non-HUD users is higher than in HUD users, but this correlation was not statistically significant. Sixty-one (84.7%) of HUD system users were satisfied with depth perception, and 27 (37.5%) reported improvement in peripheral acuity. Thirty-seven (51.4%) of the participants believed they perform surgeries better through HUD; this was why most participants (83.3%) recommended its use in surgical training. Conclusion Heads-up display use provides more comfortable sitting positions for surgeons, superior depth perception, and serves as a better educational tool. We believe that adopting this technology may help improve career longevity and productivity.
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Affiliation(s)
- Halah Bin Helayel
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Sarah Al-Mazidi
- Department of Physiology, College of Medicine, Al-Imam Mohammed Bin Saud Islamic University, Riyadh, Saudi Arabia
| | - Adel AlAkeely
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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23
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Lee YJ, Kim BY, Park JH, Kim SY, Park HY, Do SH. The Effect of Intraoperative Magnesium Sulphate Infusion on Emergence Agitation after Ambulatory Ophthalmic Surgery in Children. J Clin Med 2020; 9:E4126. [PMID: 33371377 DOI: 10.3390/jcm9124126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/25/2022] Open
Abstract
This study investigated whether intraoperative infusion of magnesium sulphate reduces the incidence of emergence agitation (EA) in paediatric patients who undergo ambulatory ophthalmic surgery using the Paediatric Anaesthesia Emergence Delirium (PAED) scale. Ninety-two paediatric patients who were scheduled for elective ophthalmic surgery were randomly allocated to two groups: control or magnesium. In the magnesium group, patients received an initial intravenous loading dose of 30 mg/kg of 10% solution of magnesium sulphate over 10 min and then a continuous infusion of 10 mg/kg×h during the surgery. In the control group, an equal volume of 0.9% isotonic saline was administered in the same way as in the magnesium group. The PAED scale was assessed at 15-min intervals until the PAED score reached below 10 at the postanaesthetic care unit. EA was defined as a PAED score of 10 or higher. Of the 86 patients recruited, 44 and 42 were allocated to the control and magnesium groups, respectively. The incidence of EA was 77.3% in the control group and 57.1% in the magnesium group (odds ratio, 0.392; 95% confidence interval, 0.154 to 0.997; p = 0.046). The intraoperative infusion of magnesium sulphate significantly reduced the incidence of EA.
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Miranda DB, Bastos MM, Govêia CS, Silva RE, Rodrigues FW. Efficacy of ropivacaine versus bupivacaine in preventing peribulbar block failure: A meta-analysis. Eur J Ophthalmol 2020; 31:2731-2737. [PMID: 33135463 DOI: 10.1177/1120672120969370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Peribulbar block is considered a standard of care in ophthalmological practice due to its easy execution and minor complications. There is a paucity of studies confirming efficacy between ropivacaine and bupivacaine for this specific technique. We evaluated the efficacy of ropivacaine or bupivacaine in preventing total or partial peribulbar block failure in ophthalmic surgeries. METHODS Meta-analysis of randomized clinical trials, comparing patients submitted to ophthalmic surgeries under peribulbar anesthesia with ropivacaine and bupivacaine. We searched in different databases for articles published until March, 2018. Data on patients, anesthesia, procedures and akinesia were tabulated. After calculating the chi-square of heterogeneity, we adopted a random-effects model with DerSimonian-Laird test, as well as an odds ratio and a 95% confidence interval. RESULTS From the 310 articles identified, 21 studies were selected. The use of ropivacaine was considered a protective factor for ocular akinesia failure in peribulbar block when compared to bupivacaine (OR = 0.53, 95% CI = 0.35-0.81 and p value = 0.003). CONCLUSIONS In ophthalmic surgeries, ropivacaine in peribulbar anesthesia is associated with lower rate of block failure when compared to bupivacaine.
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Affiliation(s)
- Denismar B Miranda
- Department of Ophthalmology, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | - Marcela Ma Bastos
- Department of Ophthalmology, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | - Catia S Govêia
- Department of Anesthesiology, University of Brasília, Brasília, Federal District, Brazil
| | - Rodrigo E Silva
- Department of Ophthalmology, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | - Francisco W Rodrigues
- Department of Ophthalmology, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
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Li S, Hu X, Tan F, Li W. Effects of Cisatracurium, Rocuronium, and Mivacurium on Intraocular Pressure During Induction of General Anesthesia in Ophthalmic Surgery. Drug Des Devel Ther 2020; 14:1203-1208. [PMID: 32273682 PMCID: PMC7102886 DOI: 10.2147/dddt.s224544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 03/03/2020] [Indexed: 11/24/2022]
Abstract
Objective Maintaining intraocular pressure (IOP) is important in preventing ocular complications in patients undergoing ophthalmic surgery for general anesthesia. The effects of non-depolarizing neuromuscular blockers on IOP remain unclear. The present study compared the effects of cisatracurium, rocuronium, and mivacurium on IOP during induction of general anesthesia in vitreous retinal surgery. Materials and Methods In this prospective randomized double-blinded study, 133 patients undergoing vitreous retinal surgery were randomized into one of the three groups: Group cisatracurium (n=45), Group rocuronium (n=44), or Group mivacurium (n=44). Each drug (cisatracurium 0.1 mg kg−1 in Group cisatracurium, rocuronium 0.6 mg kg−1 in Group rocuronium, and mivacurium 0.2 mg kg−1 in Group mivacurium) was administered during induction of anesthesia. IOP and hemodynamic parameters were measured at 1 min before anesthesia induction (T0). Bispectral index (BIS) was maintained between 45 and 55 after propofol administration (T1). Train-of-four stimulation (TOF) was below 0 after muscle relaxant administration (T2) and after laryngeal mask implantation (T3). Results Both ipsi-operative and control-operative IOP at T1, T2, and T3 significantly decreased from the baseline values (T0) in all three groups (P<0.05). The IOP changes between T1 and T2 among three groups were similar (P>0.05). The values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) at T1 and T2 significantly decreased in all three groups compared to T0 (P<0.05). Conclusion Bilateral IOP significantly decreased from the baseline values in all three groups during the induction phase. Cisatracurium, rocuronium, and mivacurium did not induce significant changes in bilateral IOP.
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Affiliation(s)
- Shuangshuang Li
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai 200031, People's Republic of China
| | - Xiao Hu
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai 200031, People's Republic of China
| | - Fang Tan
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai 200031, People's Republic of China
| | - Wenxian Li
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai 200031, People's Republic of China
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Mole G, Edminson R, Higham A, Hopper C, Hildebrand D. The Management of Childhood Intracranial Tumours and the Role of the Ophthalmologist. Neuroophthalmology 2020; 43:375-381. [PMID: 32165896 DOI: 10.1080/01658107.2019.1597130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/05/2019] [Accepted: 03/16/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE This study looked at a single paediatric neuro-oncology centre's experience of childhood intracranial tumours seen in the ophthalmology clinic over an approximately five-year period. This was used to analyse the role of the ophthalmologist in their long term follow up. METHODS A database was compiled of all children discussed at the neuro-oncology multi-disciplinary team (MDT) meeting between January 2012 and April 2017. All children who had an intracranial tumour determined by histology or suspected on neuro-imaging, who had also been seen in the ophthalmology clinic, were included. A retrospective case review was performed to create a record for each child. RESULTS The database contained 129 children of which 82 (64%) were boys and 47 (36%) were girls. Of these 89 (69%) had a histological diagnosis and 40 (31%) had a tumour suspected on neuroimaging. The most common tumour locations were the posterior fossa (n = 54, 42%), diencephalon (n = 20, 16%) and the visual pathways (n = 17, 13%). Papilloedema at first presentation was only found in 39 (30%) children. The most common other neuro-ophthalmic manifestations were non-paralytic strabismus (n=33), sixth nerve palsy (n=19) and seventh nerve palsy (n=12). Non-paralytic strabismus was a presenting symptom in only one case. There were 13 ophthalmic surgical procedures required for these children, the most common being strabismus surgery. CONCLUSION We report the types and locations of paediatric intracranial tumours seen in the ophthalmology clinic as well as their neuro-ophthalmic manifestations. Only 30% presented with papilloedema and approximately 10% required an ophthalmic surgical procedure.
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Affiliation(s)
- G Mole
- Department of Paediatric Ophthalmology, Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - R Edminson
- Department of Paediatric Ophthalmology, Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - A Higham
- Department of Paediatric Ophthalmology, Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - C Hopper
- Department of Postgraduate Medical Education, Brighton & Sussex Medical School, Brighton, UK
| | - D Hildebrand
- Department of Paediatric Ophthalmology, Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
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Brooks CC, Jabbehdari S, Gupta PK. Dexamethasone 0.4mg Sustained-Release Intracanalicular Insert in the Management of Ocular Inflammation and Pain Following Ophthalmic Surgery: Design, Development and Place in Therapy. Clin Ophthalmol 2020; 14:89-94. [PMID: 32021072 PMCID: PMC6968807 DOI: 10.2147/opth.s238756] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/19/2019] [Indexed: 01/19/2023] Open
Abstract
Inflammation and pain are two prevalent findings after ocular surgery. Corticosteroids are widely administrated as a core treatment to control post-surgical inflammation and pain. Improper patient adherence to post-operative eye drop regimens, limited bioavailability of topical eye drops, and the negative impact of preservatives used in many of these eye drops, has made a strong case for novel therapies in the treatment of post-operative pain and inflammation. This review of the literature will focus on the role of intracanalicular sustained-release dexamethasone (Dextenza, Ocular Therapeutix, Bedford, MA, USA) for the management of ocular inflammation and pain.
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Affiliation(s)
- Cassandra C Brooks
- Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA
| | - Sayena Jabbehdari
- Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA.,Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Preeya K Gupta
- Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA
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Hung NK, Lee MS, Lai HC, Huang YH, Lin BF, Chan SM, Wu ZF. Optimal effect-site concentration of propofol for tracheal suctioning during emergence from ophthalmic surgery. Medicine (Baltimore) 2020; 99:e18669. [PMID: 31895833 PMCID: PMC6946375 DOI: 10.1097/md.0000000000018669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
In ophthalmic surgery, coughing during emergence from general anesthesia may have a detrimental effect on intraocular pressure. Tracheal suction during emergence may elicit this reflex. The optimal effect-site concentration (EC) of propofol to prevent triggering of the cough reflex during tracheal suctioning is unknown. The aim of this study is to assess the optimal EC of propofol for tracheal suctioning during emergence in patients undergoing ophthalmic surgery.Twenty-one patients were enrolled, all of them American Society of Anesthesiologists (ASA) physical status I or II non-smokers undergoing ophthalmic surgery. Anesthesia was induced and maintained under total intravenous anesthesia using target-controlled infusion. During emergence from general anesthesia, tracheal suction was performed at different propofol concentrations as required for Dixon's up-and-down method with a step size of 0.2 μg/ml. A propofol concentration at which the cough reflex was not triggered during tracheal suctioning was considered successful.The EC50 of propofol for tracheal suction without cough was 1.4 μg/ml and the EC95 was 1.6 μg/ml.Tracheal suction may be accomplished without triggering the cough reflex when the propofol effect-site concentration is higher than 1.6 μg/ml.
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Affiliation(s)
- Nan-Kai Hung
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
| | | | - Hou-Chuan Lai
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
| | - Yi-Hsuan Huang
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
| | - Bo-Feng Lin
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
| | - Shun-Ming Chan
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
| | - Zhi-Fu Wu
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan ROC
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Abstract
Many patients undergoing ophthalmic surgery are elderly with comorbidities requiring antiplatelet therapy to prevent thromboembolic or atherothrombotic events. The use of antiplatelet therapy has expanded over the years, predisposing these patients to hemorrhagic complications perioperatively. The risk of hemorrhagic complications must be weighed against the risk of thromboembolic events with cessation of antiplatelet therapy. The decision to continue or interrupt antiplatelet therapy in the setting of ophthalmic surgery is based upon various factors, including the type of surgery and each patient’s comorbidities. This review examines the risks of thrombotic complications versus hemorrhagic complications in different types of ophthalmic surgeries with the use of antiplatelet medications and provides evidence-based recommendations regarding perioperative management of antiplatelet therapy
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Affiliation(s)
- Sana Idrees
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Ajay E. Kuriyan
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
- Retina Service, Wills Eye Hospital, Philadelphia, PA, USA
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Hsu YP, Chu KCW, Bai CH, Huang CJ, Chen C, Hsu CW. Safety and efficacy of clonidine on postoperative vomiting and pain in pediatric ophthalmic surgery: A systematic review and meta-analysis. Paediatr Anaesth 2019; 29:1011-1023. [PMID: 31343796 DOI: 10.1111/pan.13712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 07/03/2019] [Accepted: 07/22/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Postoperative vomiting and pain are common, unpleasant phenomena in pediatric patients undergoing ophthalmic surgery. Clonidine has antiemetic and analgesic properties and thus may be used as premedication to reduce postoperative vomiting and pain. AIM To assess whether clonidine premedication may safely decrease postoperative vomiting and postoperative pain in pediatric patients who received an ophthalmic surgery. METHODS We systematically searched PubMed, EMBASE, Cochrane Library, and Scopus databases from their inception to September 2018. Randomized clinical trials comparing clonidine premedication with a placebo or an active comparator that investigated postoperative vomiting or postoperative pain in pediatric patients undergoing ophthalmic surgery were included. The primary outcome was postoperative vomiting. The secondary outcome was postoperative pain. We also evaluated the safety of clonidine premedication by tracking hemodynamic instability associated with its use. RESULTS Ten studies with 979 patients were eligible for inclusion. Clonidine achieved a significantly lower incidence of postoperative vomiting within 6 hours postoperatively, 6-24 hours postoperatively, and at the end of the study (risk difference: -0.15; 95% confidence interval: -0.32 to -0.05; risk difference: -0.15; 95% confidence interval: -0.29 to 0.01; and risk difference: -0.23; 95% confidence interval: -0.34 to -0.12, respectively) than placebo. For the subgroup of patients who received strabismus surgery, clonidine produced a lower incidence of postoperative vomiting than placebo (risk difference: -0.19; 95% confidence interval: -0.29 to -0.05). Compared to benzodiazepine, clonidine achieved a lower incidence of postoperative vomiting at the end of the study (risk difference: -0.19; 95% confidence interval: -0.31 to -0.07); the effect was only observed in patients receiving clonidine 4 μg/kg. Furthermore, children receiving clonidine had lower postoperative pain scores, lower analgesic requirements, and more of them were pain-free compared to those who received a placebo. No patient using clonidine had any major hemodynamic instability. CONCLUSION Compared to placebo or benzodiazepine, clonidine premedication was effective in reducing postoperative vomiting in pediatric patients undergoing ophthalmic surgery. Clonidine premedication also provided more reduction in postoperative pain when compared to placebo. The use of clonidine premedication was not associated with adverse hemodynamic events.
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Affiliation(s)
- Yuan-Pin Hsu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Karen Chia-Wen Chu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Jen Huang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chiehfeng Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.,Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Evidence-based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chin-Wang Hsu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Lai HC, Pao SI, Huang YS, Chan SM, Lin BF, Wu ZF. The Relationship Between Postoperative Pneumonia and Endotracheal Suctioning Under General Anesthesia in Ophthalmic Surgery: A Retrospective Study. Asian J Anesthesiol 2018; 56:33-8. [PMID: 29847970 DOI: 10.6859/aja.201803_56(1).0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Postoperative pneumonia is the third most common postoperative complication. It may result from aspiration of secretions accumulating in the subglottic space during general anesthesia (GA). However, the relationship between endotracheal suctioning (ETS) during extubation from GA emergence and postoperative pneumonia has not been well investigated. Therefore, the aim of this study was to investigate the effectiveness of ETS during extubation in prevention of postoperative pneumonia in ophthalmic surgery under GA in our medical center from 2011 through 2015. METHODS Three thousand, seven hundred and ninety-four patients receiving ophthalmic surgery under GA were included and divided into two groups by the anesthesiologists. The first group underwent the conventional ETS during extubation, while the other group was extubated without ETS. The incidences of postoperative pneumonia were compared between the two groups to find the correlation between ETS during extubation and postoperative pneumonia. In addition, other complication such as postoperative hemorrhage was also recorded. RESULTS Of the 3,794 patients undergoing ophthalmic surgery under GA, 2,187 (58%) patients underwent extubation with ETS, whilst 1,607 (42%) patients were extubated without ETS. The incidence rates of postoperative pneumonia with or without ETS during extubation were both 0%. Besides, the incidence rates of postoperative hemorrhage were also both 0% in two groups. CONCLUSIONS Extubation from GA without ETS seemed not to increase the risk of postoperative pneumonia. Thus, no routine ETS during extubation seemed not to be a risk factor for postoperative pneumonia under GA in ophthalmic surgery.
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McHugh TA. Implications of Inspired Carbon Dioxide During Ophthalmic Surgery Performed Using Monitored Anesthesia Care. AANA J 2019; 87:285-290. [PMID: 31587712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Inspired concentration of carbon dioxide (FICO₂) in ophthalmic surgery performed under monitored anesthesia care (MAC) has been largely ignored in the recommended monitoring standards of professional anesthesia societies. Most ophthalmic procedures are performed using MAC with facial draping that has been shown to retain carbon dioxide in the ambient air surrounding the patient. The administration of supplemental oxygen has been shown to prevent hypoxia but not hypercapnia. Hypercapnia can lead to physiologic changes, including tachypnea, tachycardia, and increased intraocular pressure. Several closed-claim analyses have described adverse outcomes related to ventilation and oxygenation of patients during MAC. A literature search using the keywords of ophthalmic surgery, monitored anesthesia care, and inspired carbon dioxide was conducted, and relevant articles dealing with possible complications, methods of measurement, and abatement strategies were examined. No procedure has gained widespread acceptance, yet practitioners employ a variety of methods to decrease FICO₂, a parameter not mentioned in the anesthetic record although it is measured by current anesthesia workstations. The goal of this review is to encourage investigation of this underreported parameter.
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Affiliation(s)
- Thomas A McHugh
- is a graduate of Berkshire Medical Center School of Nurse Anesthesia. He wrote this article while a student in the generalist Master of Nursing program at Athabasca University, Athabasca, Alberta, Canada. He is currently employed as a staff CRNA at the John Cochran Veterans Affairs Medical Center, St Louis, Missouri
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Abstract
Video recording in ophthalmic surgery has immense potential to drive quality improvement in patient care, ophthalmology training, and research. Not only do surgical videos permit introspective and critical analyses of surgical technique, they also allow for objective assessment, allow for more informative audits, and are an invaluable medium for surgical education. Unfortunately, medical-grade video recording equipment is often costly. Various novel methods of video recording that utilize commercially available products offer adequate alternatives. Certain ethical and legal issues also need to be considered before the commencement of video recording in the operating room to protect both the patient and surgeon. We review the current applications and methods of video recording in ophthalmic surgery described in the literature, as well as the potential ethical and legal issues surrounding video recording.
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Abstract
The article describes a clinical case of a giant post-traumatic iris cyst occupying the anterior chamber in a 3-year-old child successfully treated with laser methods (YAG-laser and diode-pumped laser with doubled frequency). Cyst scarring was achieved with preservation of visual acuity of 1.0. The follow-up period lasted 10 years. The question of indications for laser methods of eliminating cysts of the anterior segment of the eye in children remains debatable. The huge size is traditionally considered a contraindication for laser treatment of the cyst; it leads to death of the organ more often, especially after radical surgical removal of the cyst. The described case confirms the feasibility of non-invasive laser treatment efforts even if the cyst is huge in size.
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Affiliation(s)
- N N Arestova
- Helmholtz Moscow Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - N S Egiyan
- Helmholtz Moscow Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
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Elkamshoushy A, Langue MA. Outcomes of bilateral lateral rectus recession in treatment of recurrent exotropia after bilateral medial rectus resection. Eur J Ophthalmol 2018; 29:402-405. [PMID: 30460864 DOI: 10.1177/1120672118795066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the results of bilateral lateral rectus muscle recession for recurrent exotropia in cases where the primary surgery was a bilateral medial rectus resection. METHODS Retrospective chart review of 15 subjects who completed 6 months of follow-up. Data collected included patients' demographics and pre- and post-operative measurements of ocular alignment and motility. Surgical nomogram used was the same nomogram we use for primary cases of exotropia. RESULTS At 6-month follow-up, 73.3% of cases had a successful surgical outcome (defined as 8 PD of esotropia to 10 PD of exotropia). In addition, recession of lateral rectus muscles against the previously resected medial recti did not result in a significant increase in the limitation of abduction. CONCLUSION Bilateral lateral rectus recession using standard surgical tables is a safe and effective method for treating recurrent exotropia following bilateral medial rectus resection. Even large primary resections up to 12 mm do not seem to affect the results of bilateral lateral rectus recession.
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Affiliation(s)
- Amr Elkamshoushy
- 1 Department of Ophthalmology, Alexandria University, Alexandria, Egypt
| | - Michael A Langue
- 2 Department of Ophthalmology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, PA, USA
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36
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Bleicher ID, Jackson-Atogi M, Viehland C, Gabr H, Izatt JA, Toth CA. Depth-Based, Motion-Stabilized Colorization of Microscope-Integrated Optical Coherence Tomography Volumes for Microscope-Independent Microsurgery. Transl Vis Sci Technol 2018; 7:1. [PMID: 30405965 PMCID: PMC6218157 DOI: 10.1167/tvst.7.6.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/29/2018] [Indexed: 01/20/2023] Open
Abstract
Purpose We develop and assess the impact of depth-based, motion-stabilized colorization (color) of microscope-integrated optical coherence tomography (MIOCT) volumes on microsurgical performance and ability to interpret surgical volumes. Methods Color was applied in real-time as gradients indicating axial position and stabilized based on calculated center of mass. In a test comparing colorization versus grayscale visualizations of prerecorded intraoperative volumes from human surgery, ophthalmologists (N = 7) were asked to identify retinal membranes, the presence of an instrument, its contact with tissue, and associated deformation of the retina. In a separate controlled trial, trainees (N = 15) performed microsurgical skills without conventional optical visualization and compared colorized versus grayscale MIOCT visualization on a stereoptic screen. Skills included thickness identification, instrument placement, and object manipulation, and were assessed based on time, performance metrics, and confidence. Results In intraoperative volume testing, colorization improved ability to differentiate membrane from retina (P < 0.01), correctly identify instrument contact with membrane (P = 0.03), and retinal deformation (P = 0.01). In model microsurgical skills testing, trainees working with colorized volumes were faster (P < 0.01) and more correct (P < 0.01) in assessments of thickness for recessed and elevated objects, were less likely to inadvertently contact a surface when approaching with an instrument (P < 0.01), and uniformly more confident (P < 0.01 for each) in conducting each skill. Conclusions Depth-based colorization enables effective identification of retinal membranes and tissue deformation. In microsurgical skill testing, it improves user efficiency, and confidence in microscope-independent, OCT-guided model surgical maneuvers. Translational Relevance Novel depth-based colorization and stabilization technology improves the use of intraoperative MIOCT.
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Affiliation(s)
- Isaac D Bleicher
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Hesham Gabr
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.,Department of Ophthalmology, Ain-Shams University, Cairo, Egypt
| | - Joseph A Izatt
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.,Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.,Department of Biomedical Engineering, Duke University, Durham, NC, USA
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Grosso A, Ceruti P, Scarpa G, Giardini F, Marchini G, Aragona E, Bert F, Bandello F, Siliquini R. Choosing wisely and the use of antibiotics in ophthalmic surgery: There is more than meets the eye. Eur J Ophthalmol 2018; 28:625-632. [PMID: 29577739 DOI: 10.1177/1120672117747043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: One of the directions of modern ophthalmology is toward an odontoiatric model, and new settings of eye care are becoming the standard of care: one day surgery and also office-based therapies. METHODS: Retrospective analysis of three tertiary-care centers in Italy and analysis of the literature. RESULTS: We provide readers with state-of-the-art measures of prophylaxis in ophthalmic surgery. DISCUSSION AND CONCLUSION: Role of antibiotics is criticized in the light of stewardship antimicrobial paradigm.
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Affiliation(s)
- Andrea Grosso
- 1 Santo Spirito Hospital, Casale Monferrato, Italy.,2 Centre for Macular Research, San Mauro Torinese, Italy
| | | | | | - Franco Giardini
- 5 Microbiological Laboratory, Turin Eye Hospital, Turin, Italy
| | | | - Emanuela Aragona
- 6 Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Fabrizio Bert
- 7 Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Francesco Bandello
- 6 Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Roberta Siliquini
- 7 Department of Public Health and Pediatrics, University of Turin, Turin, Italy.,8 Consiglio Superiore di Sanità, Rome, Italy
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Ye H, Chen R, Lian X, Huang J, Mao Y, Lu R, Ai S, Ma W, Lin J, Yang H, Guo W. Risk factors associated with postoperative pain and discomfort in oculoplastic surgery with general anesthesia: a prospective study. J Pain Res 2018; 11:407-415. [PMID: 29503577 PMCID: PMC5827462 DOI: 10.2147/jpr.s156104] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate patient pain and discomfort following oculoplastic surgery performed under general anesthesia and to assess key factors associated with postoperative pain and discomfort. Methods A prospective observational cohort study was conducted among 212 consecutive patients who underwent oculoplastic surgery performed under general anesthesia. The patients were assessed according to quantified levels of pain and discomfort postoperatively. Analgesic requests were recorded, and responses were statistically analyzed. Results Pain and discomfort after oculoplastic surgery under general anesthesia were reported by 32.1% and 28.3% of the patients, respectively; 2.8% of the patients requested analgesic medication within 18 hours after surgery. The patients who underwent orbital decompression, secondary orbital implantation, and orbital fracture repair were more likely to develop significant postoperative pain and discomfort (P<0.001), and the patients who underwent enucleation/evisceration during orbital implantation were more likely to develop postoperative discomfort (P<0.001). The predictors of pain were smoking history, prior surgery on the operative eye, and anxiety (P<0.05), and the predictor of discomfort was anxiety (P<0.05). Conclusion Patients undergoing oculoplastic surgery tend to experience postoperative pain and discomfort. Anxiety is a risk factor for both postoperative pain and discomfort, while smoking history and prior surgery on the operative eye may be associated with postoperative pain.
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Affiliation(s)
- Huijing Ye
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Rongxin Chen
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xiufen Lian
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Jingxia Huang
- Department of Anesthesia, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Yuxiang Mao
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Rong Lu
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Siming Ai
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Wenfang Ma
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Jingyi Lin
- Department of Anesthesia, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Huasheng Yang
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Wenjun Guo
- Department of Anesthesia, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
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Forer Y, Block C, Frenkel S. Preoperative Hand Decontamination in Ophthalmic Surgery: A Comparison of the Removal of Bacteria from Surgeons' Hands by Routine Antimicrobial Scrub versus an Alcoholic Hand Rub. Curr Eye Res 2017; 42:1333-1337. [PMID: 28557536 DOI: 10.1080/02713683.2017.1304559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The goal of this experiment was to evaluate and compare the antimicrobial efficacy of routine preoperative hand washing using commercial medicated sponge brushes versus an alcoholic hand rub, by comparing bacterial growth on ophthalmic surgeons' hands after application of each of these methods. METHODS Twenty ophthalmic surgeons were recruited at the Hadassah-Hebrew University Medical Center in Jerusalem, Israel. Samples were collected twice from the hands of each surgeon after hand decontamination using two different protocols during routine surgical practice. The routine preparation consisted of a 3-minute surgical scrub using commercial brush-sponges incorporating either 4% chlorhexidine gluconate (CHG) or 1% povidone-iodine (PVP-I) formulations with detergent, followed by drying the hands with a sterile towel, while the 70% ethanol solution was applied for 60-seconds and allowed to air dry. Half of the group was randomly assigned to provide samples first after the routine method and the alcoholic solution a week later, and the other half of the group was sampled in the reverse order. Viable counts of bacteria were evaluated using a modified glove juice method. Bacterial colonies were enumerated after incubation for 24 hours and expressed as colony forming units (CFU)/mL for each pair of hands. RESULTS Geometric mean counts were 1310 and 39 CFU/mL, in the routine and alcohol rub groups, respectively, representing a mean log10 reduction in 1.53. The difference between the paired bacterial counts for the routine versus the alcohol rub was statistically significant (p < 0.0001). There was no statistically significant difference between log10 reductions for CHG and PVP-I (p = 0.97). CONCLUSIONS This study provides evidence that an alcohol rub protocol is more effective in reducing bacterial counts on hands than routine surgical hand preparation with PVP-I and CHG in a population of practicing ophthalmic surgeons in the operative clinical setting. Thus, it provides a safe alternative as a preoperative hand disinfection method.
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Affiliation(s)
- Yaara Forer
- a Department of Ophthalmology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Colin Block
- b Clinical Microbiology & Infectious Diseases , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Shahar Frenkel
- a Department of Ophthalmology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
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Stadler S, Dennler M, Hetzel U, Del Chicca F, Hoey S, Spiess BM, Voelter K, Pot SA. Sub-Tenon's injection in equine cadaver eyes: MRI visualization of anesthetic fluid distribution and comparison of two different volumes. Vet Ophthalmol 2016; 20:488-495. [PMID: 28008696 DOI: 10.1111/vop.12452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the localization and distribution of two different anesthetic fluid volumes around equine cadaver eyes to determine an appropriate volume for a single sub-Tenon's injection in horses. PROCEDURE A single sub-Tenon's injection of 2% lidocaine was performed in 10 equine cadaver heads (20 eyes) using two different volumes (7 mL on one side and 10 mL on the opposite side). The posterior circular distribution of the anesthetic was quantified in sagittal, dorsal, and transverse MRI (T2W-TSE) sequences and evaluated independently by three board-certified radiologists. The distribution of the two fluid volumes was compared via a paired Student's t-test. The interobserver reliability was evaluated via a Kruskal-Wallis test. RESULTS Extension of the injection fluid was observed along the dorsal and temporal quadrants of the globe within the subconjunctival space, the anterior and posterior sub-Tenon's space, and into the muscle sheaths along the extraocular muscles. Accumulation of anesthetic fluid directly surrounding the optic nerve was detected in three of 20 cadaver eyes. Circular distribution of the 7 and 10 mL anesthetic volumes was not significantly different (P = 0.849). More retrograde leakage of the anesthetic was observed using the 10 mL volume. Evaluation of interobserver reliability revealed no significant differences between observers (P = 0.21-0.92). CONCLUSIONS Sub-Tenon's anesthesia can have potential as an alternative to retrobulbar anesthesia for ophthalmic surgeries in equines. A 7- to 10-mL injection volume should be appropriate based on the results of this study. The distribution of the anesthetic solution in live tissues, the clinical effects, and the potential for complications will have to be evaluated in vivo.
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Affiliation(s)
- Silvia Stadler
- Ophthalmology Unit, Vetsuisse Faculty, Equine Department, University of Zurich, Winterthurerstrasse 260, Zurich, CH-8057, Switzerland
| | - Matthias Dennler
- Diagnostic Imaging Unit, Vetsuisse Faculty, Department for Small Animals, University of Zurich, Zurich, CH-8057, Switzerland
| | - Udo Hetzel
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, CH-8057, Switzerland
| | - Francesca Del Chicca
- Diagnostic Imaging Unit, Vetsuisse Faculty, Department for Small Animals, University of Zurich, Zurich, CH-8057, Switzerland
| | - Sèamus Hoey
- Diagnostic Imaging Unit, Vetsuisse Faculty, Department for Small Animals, University of Zurich, Zurich, CH-8057, Switzerland
| | - Bernhard M Spiess
- Ophthalmology Unit, Vetsuisse Faculty, Equine Department, University of Zurich, Winterthurerstrasse 260, Zurich, CH-8057, Switzerland
| | - Katrin Voelter
- Ophthalmology Unit, Vetsuisse Faculty, Equine Department, University of Zurich, Winterthurerstrasse 260, Zurich, CH-8057, Switzerland
| | - Simon A Pot
- Ophthalmology Unit, Vetsuisse Faculty, Equine Department, University of Zurich, Winterthurerstrasse 260, Zurich, CH-8057, Switzerland
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Russo S, Petroni G, Quaglia C, Niccolini M, Rossi F, Menabuoni L, Pini R, Fortuna D, Dario P, Menciassi A. ESPRESSO: A novel device for laser-assisted surgery of the anterior eye segment. MINIM INVASIV THER 2015; 25:70-8. [PMID: 26429150 DOI: 10.3109/13645706.2015.1092450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Merging robotics with laser eye surgery could enhance precision, repeatability and automation. During some eye laser procedures the patient is awake, thus eye stabilization is desired to avoid movements that could affect the treatment. MATERIAL AND METHODS The ESPRESSO platform has a two-stage actuation system to position a stabilization tool on the eye, a proximity sensing unit to monitor the stabilization tool position, and a sensing unit to monitor the pressure exerted on the eye. The platform is tested in-vitro and ex-vivo with clinicians. A maximum pressure to be exerted on the eye is defined with expert ophthalmic surgeons to be 22 mmHg: physiological intraocular pressure (IOP) range is 10-21 mmHg. This pressure corresponds to a force of 0.3 N. RESULTS The necessary contact force to have eye fixation (according to the clinicians' feedback) is evaluated: maximum values resulted always below 0.3 N. A maximum IOP increase of 4.67 mmHg is observed, that is a slight variation with respect to the performance of other platforms (IOP elevations up to 328 mmHg). CONCLUSION Design and initial assessment of the platform is presented. Eye stabilization is performed without exceeding the critical contact force value and causing large/sudden IOP increases.
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Affiliation(s)
- Sheila Russo
- a The BioRobotics Institute, Scuola Superiore Sant'Anna , Pisa , Italy
| | - Gianluigi Petroni
- a The BioRobotics Institute, Scuola Superiore Sant'Anna , Pisa , Italy
| | - Claudio Quaglia
- a The BioRobotics Institute, Scuola Superiore Sant'Anna , Pisa , Italy
| | - Marta Niccolini
- a The BioRobotics Institute, Scuola Superiore Sant'Anna , Pisa , Italy
| | - Francesca Rossi
- b Institute of Applied Physics "Nello Carrara", Italian National Research Council , Fiorentino ( FI ), Italy
| | - Luca Menabuoni
- c U.O. Oculistica, Nuovo Ospedale S. Stefano , Prato , Italy
| | - Roberto Pini
- b Institute of Applied Physics "Nello Carrara", Italian National Research Council , Fiorentino ( FI ), Italy
| | - Damiano Fortuna
- d PhotobiolabResearch Unit, El.En. Group , Calenzano ( FI ), Italy
| | - Paolo Dario
- a The BioRobotics Institute, Scuola Superiore Sant'Anna , Pisa , Italy
| | - Arianna Menciassi
- a The BioRobotics Institute, Scuola Superiore Sant'Anna , Pisa , Italy
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Ascaso FJ, Grzybowski A. Hermenegildo Arruga (1886-1972): a versatile ophthalmologist who simplified cerclage to retinal surgery. Acta Ophthalmol 2014; 92:814-7. [PMID: 24460641 DOI: 10.1111/aos.12345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 12/07/2013] [Indexed: 11/29/2022]
Abstract
Hermenegildo Arruga Liró (1886-1972) was a versatile Spanish ophthalmologist who specialized in retinal surgery. He designed numerous surgical instruments and introduced significant improvements in ophthalmic surgical techniques. Thus, he was among the first ophthalmologists to advocate the intracapsular cataract extraction. Furthermore, he refined several surgical procedures such as dacryocystorhinostomy, corneal transplantation, evisceroenucleation and pterygium excision. Arruga perfected Gonin's operation and contributed significantly for retinal detachment surgery to be put in place. Later, he adopted the injection of air at the end of surgery. In the 1950s, Arruga simplified the technique of equatorial cerclage using a suture to encircle the equator of the eye.
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Affiliation(s)
- Francisco J. Ascaso
- Department of Ophthalmology; “Lozano Blesa” University Clinic Hospital; Zaragoza Spain
- Aragon Health Sciences Institute; Zaragoza Spain
| | - Andrzej Grzybowski
- Department of Ophthalmology; Poznan City Hospital; Poznań Poland
- Chair of Ophthalmology; University of Warmia and Mazury; Olsztyn Poland
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Pacella E, Pacella F, Troisi F, Dell'edera D, Tuchetti P, Lenzi T, Collini S. Efficacy and safety of 0.5% levobupivacaine versus 0.5% bupivacaine for peribulbar anesthesia. Clin Ophthalmol 2013; 7:927-32. [PMID: 23723684 PMCID: PMC3665566 DOI: 10.2147/opth.s43553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background This randomized double-blind study examined the use of a new anesthetic agent, levobupivacaine 0.5%, which is the S(−)-enantiomer of a racemic mixture of bupivacaine, for peribulbar anesthesia and compared it with racemic bupivacaine 0.5% alone or in combination with hyaluronidase 10 IU/mL. Methods A total of 160 patients undergoing ophthalmic surgery were randomized into four groups (n = 40 each) to receive inferotemporal peribulbar injection of levobupivacaine 0.5% (group L), racemic bupivacaine 0.5% (group B), levobupivacaine + hyaluronidase 10 IU/mL (group LH), or racemic bupivacaine + hyaluronidase 10 IU/mL (group BH) by two anesthetists and two ophthalmologists in a ratio of 25% each. Ocular akinesia and orbicularis oculi function were evaluated using a three-point scale; a value < 5 points was considered as requiring surgery, and movements were re-evaluated the day following surgery to confirm regression of the block. Results The time to onset (12 ± 2.6 minutes versus 13 ± 2.8 minutes) and duration of anesthesia (185 ± 33.2 minutes versus 188 ± 35.7 minutes) were similar between groups L and B. Complete akinesia (score 0) was obtained more frequently when hyaluronidase was used in addition to the anesthetic, with occurrences of 72.5% versus 57.5% in group LH versus L, respectively, and 67.5% versus 45% in group BH versus B. Moderate hypotension (<30% of baseline) was observed in four patients (10%) in group L, two (5.0%) in group B, one (2.5%) in group LH, and three (7.5%) in group BH. The time to onset was significantly different between groups L and BH, B and BH, and LH and BH, and the duration of anesthesia differed significantly between groups B and LH, B and BH, and L and LH. The akinesia score differed significantly between groups L and LH and between groups B and LH (P = 0.043 and P = 0.018, respectively), and the number of patients with a score of 0 differed significantly between groups B and LH and between groups B and BH (P = 0.004 and P = 0.017, respectively). Conclusion Levobupivacaine is a long-lasting local anesthetic with limited cardiotoxicity and neurotoxicity, and may be considered the landmark for vitreoretinal surgery in elderly patients.
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Affiliation(s)
- Elena Pacella
- Department of Sense Organs, Faculty of Medicine and Dentistry, Rome, Italy
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Cheng YC, Li Y, Xu CT, Xu LX, Pan BR. Effects of propofol versus urapidil on perioperative hemodynamics and intraocular pressure during anesthesia and extubation in ophthalmic patients. Int J Ophthalmol 2011; 4:170-4. [PMID: 22553635 DOI: 10.3980/j.issn.2222-3959.2011.02.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 03/31/2011] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the effect of propofol versus urapidil on hemodynamics and intraocular pressure during anesthesia and extubation for ophthalmic patients. METHODS Eighty-two surgical patients (Class: ASA I-II) were randomly assigned to propofol (n=41) and urapidil groups (n=41). Their gender, age, body mass, operation time and dosage of anesthetics had no significant difference between the two groups (P>0.05). The patients of propofol and urapidil groups were given propofol (1.5mg/kg) and urapidil (2.5mg/kg) respectively; and two drugs were all diluted with normal saline to 8mL. Then the drugs were given to patients by slow intravenous injection. After treatment, the patients were conducted immediate suction, tracheal extubation, and then patients wore oxygen masks for 10 minutes. By double-blind methods, before the induction medication, at the suction, and 5, 10 minutes after the extubation, we recorded the systolic and diastolic blood pressure (BP), heart rate (HR), pH, PaO(2), PaCO(2), SaO(2) and intraocular pressure (IOP) respectively. The complete recovery time of the patients with restlessness (on the command they could open eyes and shaking hands) was also recorded during the extubation. The data were analyzed by using a professional SPSS 15.0 statistical software. RESULTS The incidence of cough, restlessness and glossocoma was significantly lower in the propofol group than that in the urapidil group after extubation (P<0.05). There were no episodes of hypotension, laryngospasm, or severe respiratory depression. There was no statistical difference in recovery time between two groups (P>0.05). In propofol group, the BP and HR during extubation and thereafter had no significant difference compared with those before induction, while they were significantly lower than those before giving propofol (P<0.05), and had significant difference compared with those in urapidil group (P<0.05). Compared to preinduction, the BP of urapidil group showed no obvious increase during aspiration and extubation. The HR of urapidil group had little changes after being given urapidil, and it was obviously increased compared with that before induction. The stimulation of aspiration and extubation caused less cough and agitation in propofol group than that in urapidil group (P<0.05). The IOP of propofol group showed no obvious increase during extubation compared with that in preinduction, while in the urpidil group, extubation caused IOP significantly increased (P<0.05). The changes in these indicators between the two groups had no significant difference (P>0.05). CONCLUSION Compared to urapidil, propofol is superior for preventing the cardiovascular and stress responses and IOP increases during emergence and extubation for the ophthalmic patients. Moreover, it has no effects on patient's recovery.
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Affiliation(s)
- Yong-Chong Cheng
- Department of Anesthesiology, the Third Hospital of Chinese PLA, Baoji 721004, Shaanxi Province, China
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Kohnen T, Baumeister M, Kook D, Klaproth OK, Ohrloff C. Cataract surgery with implantation of an artificial lens. Dtsch Arztebl Int 2009; 106:695-702. [PMID: 19946433 DOI: 10.3238/arztebl.2009.0695] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 04/08/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cataract surgery, the most frequently performed operative procedure worldwide, typically concludes with the implantation of an artificial intraocular lens (IOL) to correct aphakia (absence of the crystalline lens). METHOD Selective literature review including current regulations, guidelines and recommendations for cataract surgery. RESULTS The main symptom of cataract is loss of visual acuity, which usually progresses slowly. It can arise in one eye or both. There is a basic distinction between congenital and acquired cataracts. The probability of developing a cataract rises with age because of biochemical aging processes. The development of a cataract becomes highly likely from the sixth decade of life onward. CONCLUSIONS As no effective medications for cataract are available at present, its current standard treatment is the removal of the clouded lens. In industrialized countries, this is usually done with ultrasound (phacoemulsification), followed by the implantation of an IOL.
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Affiliation(s)
- Thomas Kohnen
- Klinik für Augenheilkunde, Goethe-Universität, Frankfurt am Main.
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Abstract
The mainstay in the treatment of ocular inflammation, either post-surgical or endogenous, is the use of steroids. While these agents effectively address inflammation, they are not without their risks, including ocular hypertension and acceleration of cataract formation. The most notorious culprits are the strong steroids, such as prednisolone acetate and betamethasone. This review aims to cover the biochemistry and drug development of difluprednate, a novel synthetic strong steroid emulsion. In vivo pharmacokinetics as well as ocular distribution and metabolism are discussed, followed by a comprehensive summary of phase I, II, and III clinical trials evaluating safety and efficacy in patients suffering from postoperative inflammation or anterior uveitis. The objective is to provide an increased familiarity with this newly approved medication as a welcome addition to the ophthalmologist’s armamentarium.
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