Anesthetic Eye Drops Research Articles

Pain perception during intravitreal injections is related to the timing of instilling anesthetic eyedrops

Pain perception during intravitreal injections is related to the timing of instilling anesthetic eyedrops

РАЗРАБОТКА СОСТАВА И ТЕХНОЛОГИИ ГЛАЗНЫХ КАПЕЛЬ АНЕСТЕЗИРУЮЩЕГО ДЕЙСТВИЯ

In modern ophthalmological practice, the use of local anesthetics for surface anesthesia of the eyeball becomes an integral stage in preparing the patient for diagnostic studies, therapeutic manipulations, surgical and laser interventions. The share of regional pain management methods is steadily increasing. However, at the same time, the list of requirements that local anesthetics must meet is also growing. According to them, the drug that combines high anesthetic activity and minimal toxicity should be considered the best. The local anesthetic anilocaine hydrochloride, developed according to the author's method in PGFA, exhibits high surface anesthetic activity with relatively low toxicity, and also has anti-inflammatory and moderate antimicrobial activity, which distinguishes it very favorably from the local anesthetics used and is an alternative to the use of expensive imported drugs. The purpose of this study is to develop the composition and technology of anesthetic eye drops. Materials and methods. The pharmaceutical substance anilocaine hydrochloride was used as a pharmacologically active component. The determination of the hydrogen index was carried out by the potentiometric method in accordance with the requirements of the OFS "Ionometry". To study the stability of eye drops, characterized by the indicator "Related impurities", a high-pressure liquid chromatograph "ShimadzuLCProminence" (Japan) was used. Statistical processing of the results of chemical studies was carried out according to generally accepted methods using standard EXCEL computer programs. Results and discussion. As a result of the conducted research, the composition of anesthetic eye drops based on anilocaine hydrochloride has been substantiated and developed. A technology for manufacturing eye drops has been developed to ensure the sterility of the resulting form. Conclusion. Based on technological and microbiological studies, the composition and technology of locally anesthetic eye drops based on anilocaine hydrochloride for surface (drip) anesthesia of the eyeball has been developed.

Pain control and subconjunctival haemorrhage after intravitreal injection using cooled anaesthetic eyedrops and antiseptics: A prospective, double-blind, randomized controlled trial.

To evaluate whether cooled anaesthetic eyedrops and antiseptics alleviate pain and minimise subconjunctival haemorrhage following intravitreal injection. A prospective, double-masked, randomised controlled trial of 100 participants receiving either cooled (n = 50) or room temperature (n = 50) topical anaesthetic eyedrops and antiseptics before receiving an injection of bevacizumab. Baseline tolerability was estimated using a self-reported pain sensitivity questionnaire. Overall tolerability was comparable between the study group and the control group (0.75 ± 0.13 vs. 0.74 ± 0.14, respectively, p = 0.99). Subconjunctival haemorrhage incidence was similar in both groups (80% vs. 86%, respectively, p = 0.113), as was subconjunctival haemorrhage size (2.75 ± 5.51 mm2 vs. 5.53 ± 10.72 mm2, respectively, p = 0.11). Sub-group analysis demonstrated that the participants taking daily ocular eyedrops who received cooled anaesthetic eyedrops and antiseptics reported less pain at 10 min and less burning sensation at 24 h compared with matched controls (0.67 ± 1.50 vs. 2.50 ± 3.03, respectively, p = 0.040 and 0.00 ± 0.00 vs. 1.44 ± 2.96, respectively, p = 0.045). Participants who received cooled eyedrops and did not use antithrombotic therapy had smaller-sized subconjunctival haemorrhages compared with matched controls (1.55 ± 1.87 mm2 vs. 8.29 ± 14.61 mm2, respectively, p = 0.038). Participants with hypertension who received cooled eyedrops had smaller-sized subconjunctival haemorrhage compared with matched controls (2.33 ± 4.99 mm2 vs. 6.89 ± 12.41 mm2, respectively, p = 0.045). The benefit of using cooled anaesthetic eyedrops and antiseptics to alleviate pain and minimise subconjunctival haemorrhage following intravitreal injection was not proven in the general population. It may be beneficial in part for some patients, such as those who regularly use eyedrops, patients with hypertension or those not on antithrombotic therapy.

Preservative-Free Topical Anesthetic Unit-Dose Eye Drops for the Management of Postoperative Pain Following Photorefractive Keratectomy.

Ocular pain is a common complication following photorefractive keratectomy (PRK). The level of patient satisfaction with current pain control strategies is not high. This study aims to assess the efficacy and safety of a novel regimen of preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops for post-PRK pain control. In a contralateral eye study, 144 eyes of 72 patients who underwent bilateral transepithelial PRK (TransPRK) were stratified into experimental and control groups. The experimental group received preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops five times daily postoperatively until complete epithelial healing, while the control group received sodium hyaluronate 0.2% instead. The main outcome measures were pain scores assessed by the verbal rating scale and visual analogue scale (VRS, VAS), the corneal epithelial defect (CED) area, epithelial healing duration evaluated by slit-lamp biomicroscopy and anterior segment optical coherence tomography (AS-OCT), and endothelial cell density (ECD) measured before and 1 month after surgery. Pain scores assessed by VRS and VAS were significantly lower in the experimental group 8h after surgery, and 1, 2, and 3days postoperatively (P < 0.001). The mean CED area showed no significant differences between the two groups at different follow-ups (P value > 0.05). The corneal epithelial healing had a mean duration of 3.32 ± 0.47 days in both studied groups and was parallel in both eyes of each patient. In each group, 49 eyes (68%) and 72 eyes (100%) had a fully epithelialized surface on the third and fourth postoperative days, respectively. No significant changes were observed in the mean ECD 1 month following surgery in both groups (P value > 0.05). Preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops are effective and safe in controlling early postoperative pain following TransPRK. The availability of the single-dose unit preparation can overcome the problem of topical anesthetic abuse. ClinicalTrials.gov Identifier: NCT05733741.

Controlled Drug Delivery Device for Cornea Treatment and Novel Method for Its Testing.

A new solution for local anesthetic and antibiotic delivery after eye surgery is presented. A contact lens-shaped collagen drug carrier was created and loaded by Levofloxacin and Tetracaine with a riboflavin crosslinked surface layer, thus impeding diffusion. The crosslinking was confirmed by Raman spectroscopy, whereas the drug release was investigated using UV-Vis spectrometry. Due to the surface barrier, the drug gradually releases into the corneal tissue. To test the function of the carrier, a 3D printed device and a new test method for a controlled drug release, which mimics the geometry and physiological lacrimation rate of the human eye, were developed. The experimental setup with simple geometry revealed that the prepared drug delivery device can provide the prolonged release profile of the pseudo-first-order for up to 72 h. The efficiency of the drug delivery was further demonstrated using a dead porcine cornea as a drug recipient, without the need to use live animals for testing. Our drug delivery system significantly surpasses the efficiency of antibiotic and anesthetic eyedrops that would have to be applied approximately 30 times per hour to achieve the same dose as that delivered continuously by our device.

Effect of Intra-Stromal Bevacizumab on Corneal Vascularization

Purpose: To study the effect of Intra-stromal Bevacizumab on corneal vascularization. Study Design: Quasi experimental study. Place and Duration of Study: Outpatient department of the Combined Military Hospital, Multan from April 2022 to August 2022. Methods: Thirty patients were recruited through non-probability, convenience sampling technique. Ethical approval was taken from Institutional Review Board. Complete ocular examination was performed by a consultant ophthalmologist and patients with corneal neovascularization were included in the study. Area of corneal vascularization was measured on slit lamp. After taking all the aseptic measures and administering anesthetic eye drops, patients were administered 0.2 ml of (2.5 mg/0.1 mL) Bevacizumab (Avastin, Roche) using an ophthalmic microscope. The patient was then called for a follow up after 4 weeks and then the grade of corneal vascularization was checked by a consultant ophthalmologist on slit lamp examination. Data analysis was doneusing SPSS version 25. Results: Mean age of the patients was 43.4 ± 13.7 years (range 25 to 72 years). Male to female ratio was 2:3. There was significant decrease in the area of corneal neovascularization from 2.78mm ± 0.30 to 2.50mm ± 0.27 (p = 0.0003). The mean change in the area of corneal neovascularization was 10.07%. Two patients had sub-conjunctival hemorrhage which settled over due course of time. Conclusion: Intra-stromal Bevacizumab resulted in significant reduction in vascularized area of cornea with minimal side effects indicating that intra-stromal Bevacizumab is an effective and safe modality in the treatment of corneal neovascularization.

Simulated keratometry and central corneal thickness measured in cats by autokeratometer, ultrasonic pachymeter, and Galilei G6™.

The aims of this study were to compare the central corneal thickness (CCT) measured by an ultrasonic pachymeter (SP-100, Tomey, Japão) versus the Galilei G6™ (Ziemer Ophthalmics System AG, Port, Switzerland) and to compare the simulated keratometry (SimK) measured by an autokeratometer (KM 500 Nidek) versus the Galilei G6™. Eighteen mixed-breed cats, 10 males, and eight females, aged between 18 and 48 months, were evaluated (n=36 eyes). The cats were manually restrained using a blanket. The operator held the autokeratometer close to the eye and measured the SimK. Next, one anesthetic eye drop was applied; the operator lightly touched the corneal using the ultrasound pachymeter and measured the CCT. At another moment, the cats were sedated using meperidine and xylazine and then evaluated using the Galilei. Student's t-test was employed to perform the statistical analyzes. Considering the CCT, the ultrasound pachymeter provided mean ± SD of 623.03 ± 48.17 μm and the Galilei 617.34 ± 53.38 μm. The autokeratometer produced a SimK of 38.20 ± 0.84D (8.84 ± 0.20 mm) and the Galilei 38.37 ± 0.83D (8.80 ± 0.19 mm). The CCT and SimK did not differ statistically regardless of the device used. To the best of the authors' knowledge, this is the first work to compare the CCT measured by the Galilei versus the ultrasonic pachymeter and to compare the SimK measured by the Galilei versus the keratometer in cats. No statistical difference was found considering the CCT and the SimK measured by the different devices.

Analgesia for retinopathy of prematurity screening: A systematic review.

Background and AimsPremature neonates require regular ophthalmological examination, generally indirect ophthalmoscopy, to screen for retinopathy of prematurity (ROP). Conventional analgesia is provided with topical anesthetic eyedrops and oral sugar solution, but neonates still experience significant pain. Here, the literature base was examined to evaluate the usefulness of other pharmacological analgesics.Materials and MethodsA systematic review was undertaken, adhering to a PROSPERO preregistered protocol in accordance with PRISMA guidelines (identifier CRD42022302459). Electronic databases were searched for primary research articles on pharmacological pain interventions used for ROP screening in neonates. The primary outcome measure was pain scores recorded using validated pain scoring tools, with and without pharmacological interventions in neonates during eye examination. For analysis, studies were separated into two categories: topical anesthesia and alternative pharmacological treatments.ResultsEleven studies met the inclusion criteria. Topical analgesia, oral paracetamol, and intranasal fentanyl were found to be effective in reducing the pain of eye examination. Oral morphine and inhaled nitrous oxide had no significant effect on premature infant pain profile (PIPP) scores during indirect ophthalmoscopy.DiscussionIn addition to topical anesthesia, premedication with oral paracetamol is recommended during screening examination for ROP. The routine use of fentanyl is not recommended due to the risk of potential side effects. Non‐pharmacological measures, such as sweet oral solutions and comfort techniques should also be employed. Further research is required to determine whether the use of nitrous oxide has a role, and to develop a safe and effective analgesic strategy to fully ameliorate the pain of ROP screening.

Effects of Regular/Dilute Proparacaine Anesthetic Eye Drops in Combination with Ophthalmic Antibiotics on Corneal Wound Healing.

Purpose: Topical, local anesthetic eye drops in conjunction with antibiotics are commonly used to reduce ocular pain and treat patients in emergency clinics; however, their effects on corneal healing are poorly understood. This study examined whether regular or diluted proparacaine eye drops given in combination with common ophthalmic antibiotics affect corneal wound healing parameters using in vitro and in vivo models. Methods: Primary human corneal fibroblasts generated from donor corneas and New Zealand white rabbits were used. Regular (0.5%) and diluted (0.05%) proparacaine eye drops, twice daily for 3 days, were applied to cultures and rabbit eyes, with or without ophthalmic antibiotics (polymyxin B sulfate and trimethoprim). Trypan blue, 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT), and scratch wound assays measured cellular viability, proliferation, and migration, respectively, in vitro. Slit lamp biomicroscopy, tonometry, fluorescein eye test, hematoxylin and eosin (H&E) staining, and 4',6-diamidino-2-phenylindole (DAPI) immunofluorescence were used for in vivo studies. Results: Both regular and diluted proparacaine affected wound healing response in the cornea in vitro and in vivo in a time-dependent manner. Adjunct antibiotic treatments had additive effects characterized by reduced corneal fibroblast viability, proliferation, and migration in vitro and corneal epithelial recovery in vivo. Regular proparacaine with antibiotics showed most pronounced effects on corneal wound healing parameters, and diluted proparacaine without antibiotics had minimal negative effects in vitro and in vivo. Conclusion: Both methods of regular (0.5%) and diluted (0.05%) proparacaine topical application to the cornea are safe, but impede corneal wound healing in vitro and in vivo. Adjunct antibiotic treatments had additive negative effects on corneal wound repair.

Corneal Ulcer in a Sheep - Treatment with Third Eyelid Flap

Background: Corneal ulcers are frequently reported in the literature in several species, however, the treatment of traumatic lesions on the corneal surface of ruminants is still poorly described. The use of the third eyelid flap is questioned when applied to deep ulcers, since the technique prevents the evolutionary follow-up of corneal healing and compromises care. However, several authors report its successful use for the treatment of superficial and deep corneal ulcers. This technique protects the ocular surface and prevents the occurrence of new lesions or their aggravation. The aim of this study was to report the treatment of corneal ulcers in sheep through the third eyelid flap associated with the use of topical antibiotics.Case: A 2-year-old Dorper sheep, with ocular discomfort, conjunctival hyperemia and mucopurulent secretion in the left eye, was assisted in a private rural property in the West region of Bahia, Brazil. The owner reported that before seeking veterinary help he used a spray based on oxytetracycline and hydrocortisone, which worsened the animal's condition. Upon inspection, it was observed eyelid asymmetry, slight lateralization of the head to the left, periorbital alopecia on the left face, intense blepharospasm in the left eye, with projection of the third eyelid occurring at times. The ophthalmic examination was performed after application of anesthetic eye drops based on proxymetacaine to reduce eye discomfort. A corneal stromal lesion, edema and fibrovascular tissue in the left eye were identified, but the cause of the lesion was not defined, with lagophthalmia, entropion, dystychiasis or ectopic cilia being ruled out. So, it was suggested that the lesion had occurred by a foreign body, such as dust or feed fiber. The contralateral eye showed no changes, Schirmer 15 mm, no changes in sensory and sensory reflexes and negative fluorescein. No signal clinical disease. Due to the severity of the lesion, it was performed a third eyelid flap associated with drug treatment with ciprofloxacin eye drops, every 8 h for 21 days. The animal was placed in the right lateral decubitus position and palpebral akinesia was achieved with the application of 2 mL lidocaine without vasoconstrictor in the region of the auriculopalpebral nerve. This was followed by the routine performance of the third eyelid flap.Discussion: The delay in seeking veterinary care and the application of spray based on oxytetracycline and hydrocortisone aggravated the lesion, since the corticosteroid delays corneal healing and favors the aggravation of the lesion. After desensitization of the cornea, the animal allowed eye manipulation and it was possible to observe the lesion and choose the best treatment, with option for the third eyelid flap because it is a simple and fast technique, does not require special equipment or materials, ideal for performed in the field and is widely used in the treatment of injuries involving the cornea and, besides that, helps to contain corneal perforation and protect the ocular surface. Corneal debridement was also performed to remove necrotic debris and improve drug action, in addition to using broad-spectrum antibiotic eye drops until complete regeneration of the lesion. Twenty-one days after the surgical procedure, the patient had no ocular discomfort, the flap was removed and no changes in the corneal surface were observed. The treatment was considered satisfactory for the healing of the corneal ulcer, guaranteed the esthetics and visual function of the sheep.Keywords: keratitis, surgery, ciprofloxacin, ocular, ruminant.

Clinical features of endophthalmitis clusters after cataract surgery and practical recommendations to mitigate risk: systematic review.

Intraocular transmission of exogenous pathogens in cataract surgery can lead to endophthalmitis. This review evaluates the features of endophthalmitis clusters secondary to pathogen transmission in cataract surgery. Articles reporting on pathogen transmission in cataract surgery were identified via searches of Ovid MEDLINE, EMBASE, and Cochrane CENTRAL, and a total of 268 eyes from 24 studies were included. The most common source of infectious transmission was attributed to a contaminated intraocular solution (ie, irrigation solution, viscoelastic, or diluted antibiotic; n = 10). Visual acuity at presentation with infectious features was 1.89 logMAR (range: 1.35 to 2.58; ∼counting fingers) and 1.33 logMAR (range: 0.04 to 3.00; Snellen: ∼20/430) at last follow-up. Patients with diabetes had worse outcomes compared with patients without diabetes. The most frequently isolated pathogen from the infectious sources was Pseudomonas sp. (50.0%). This review highlights the various routes of pathogen transmission during cataract surgery and summarizes recommendations for the detection, prevention, and management of endophthalmitis clusters.

Self-Report of Severity of Ocular Pain Due to Light as a Predictor of Altered Central Nociceptive System Processing in Individuals With Symptoms of Dry Eye Disease

Dry eye disease (DED) is a diagnosis given to individuals with a heterogeneous combination of symptoms and/or signs, including spontaneous and evoked ocular pain. Our current study evaluated whether and which ocular pain assessments could serve as screening tools for central sensitization in individuals with DED. A cohort of individuals with DED symptoms (n = 235) were evaluated for ocular pain, DED signs (tear production, evaporation), evoked sensitivity to mechanical stimulation at the cornea, and evidence of central sensitization. Central sensitization was defined for this study as the presence of pain 30 seconds after termination of a thermal noxious temporal summation protocol (ie, aftersensations) presented at a site remote from the eye (ventral forearm). We found that combining ratings of average intensity of ocular pain, ratings of average intensity of pain due to light, response to topical anesthetic eye drops, and corneal mechanical pain thresholds produced the best predictive model for central sensitization (area under the curve of .73). When examining ratings of intensity of ocular pain due to light alone (0–10 numerical rating), a cutoff score of 2 maximized sensitivity (85%) and specificity (48%) for the presence of painful aftersensations at the forearm. Self-reported rating of pain sensitivity to light may serve as a quick screening tool indicating the involvement of central nociceptive system dysfunction in individuals with DED. PerspectiveThis study reveals that clinically-relevant variables, including a simple 0 to 10 rating of ocular pain due to light, can be used to predict the contribution of central sensitization mechanisms in a subgroup of individuals with DED symptoms. These findings can potentially improve patient stratification and management for this complex and painful disease.

To study the safety of topical anesthetic eye drops among different patients for month after opening

AbstractPurpose: To find out if we can use topical anesthetic eye drops among different patients for one month after opening the bottle without any risk of causing corneal or conjunctival infections and endophthalmitis.Study Design: Experimental studyPlace and duration of study: Department of Ophthalmology DHQ Teaching Hospital, Gujranwala from 22nd May 2018 to 22nd June 2018.Materials and Methods: This was an experimental study in which topical anesthetic eye drops containing proparacaine hydrochloride 0.5% were tested daily to see if any bacterial/fungal growth occurs in the bottle containing eye drops or not. Same bottle was used in patients presenting in outdoor and indoor departments. Samples taken from the bottle contents were cultured on different media to see growth of fungi or bacteria if any.Results: After 1 month of daily culturing on agar plates, no micro-organism growth was seen.Conclusion: Topical anesthetic eye drops containing proparacaine hydrochloride as the main ingredient and benzalkonium chloride as the preservative (Alcaine®) can be used safely for 1 month after opening in different patients without any risk of causing infectious keratitis, conjunctivitis or endophthalmitis.Keywords: Topical anesthetic, Culture medium, Risk factor, Endophthalmitis

Comparison of the Analgesic Effect of Nepafenac 0.1%, Ketorolac 0.5%, and Diclofenac 0.1% Ophthalmic Solution during Intravitreal Injection

Background: Pain during intravitreal injection (IVT) is inevitable and might reduce the patient’s compliance. Topical anesthetic eye drop usually is administered to reduce pain during IVT. However, severe ocular pain has been reported in some patients. The most effective anesthesia for IVT is still controversy. Objective: To evaluate the analgesic effect of three topical non-steroidal anti-inflammatory drugs (NSAIDs) eye drop, nepafenac 0.1%, ketorolac 0.5%, and diclofenac 0.1%, during IVT. Materials and Methods: The present study was a prospective randomized, double-blinded, placebo-controlled study. Patients undergoing intravitreal bevacizumab injections were randomly divided into four groups. Group 1, group 2, group 3, and group 4 received topical nepafenac 0.1%, topical ketorolac 0.5%, diclofenac 0.1%, and artificial tear (placebo), respectively. One hour after receiving the eye drops, all patients underwent IVT with topical anesthetic eye drop. Pain assessment was performed immediately after IVT using the Thai version of Short-Form McGill Pain Questionnaire (SF-MPQ). The SF-MPQ consists of the main component of the SF-MPQ, the visual analogue scale (VAS), and the present pain intensity (PPI). Results: Eighty patients voluntarily enrolled in the present study. Median of VAS scores were 1.5 (0.8 to 4.6), 2.3 (1.5 to 4.6), 1.5 (1 to 3.2), and 2.4 (1.4 to 3.6) in nepafenac group, ketorolac group, diclofenac group, and placebo group, respectively (p=0.159). Median of the main component of the SF-MPQ scores were 4 (1.25 to 5.75), 5 (2.25 to 11.5), 5 (1.25 to 9.5), and 5 (3 to 13), in nepafenac group, ketorolac group, diclofenac group and placebo group, respectively (p=0.409). Median of the PPI scores were 1 (1 to 1.75), 1 (1 to 2), 1 (1 to 1), and 1 (1 to 2), in nepafenac group, ketorolac group, diclofenac group, and placebo group, respectively (p=0.529). Conclusion: There were no significant differences in analgesic effect during IVT between topical NSAIDs, nepafenac 0.1%, ketorolac 0.5%, diclofenac 0.1%, and placebo. Keywords: Intravitreal injection; Analgesic effect; Topical NSAIDs eye drop; SF-MPQ

Efficacy of 25% Glucose in Pain Alleviation During Retinopathy of Prematurity (ROP) Screening: A Randomized Controlled Trial

Retinopathy of prematurity (ROP) remains a painful examination, despite the common application of local anesthetic eye drops. This study aimed at examining the analgesic effects of 25% glucose in a premature infant pain profile (PIPP) in the first eye examination of infants with ROP. This three-group, randomized clinical trial was conducted from March to February 2017. One oral dose of 25% glucose solution (1 cc/kg) was administered one minute before the first examination of ROP. Mydriatic and anesthetic eye drops were locally instilled in the eyes before the examination for each group. Then, comparisons were made with the control group, which did not receive oral glucose (B), as well as the group which received 1 ml/kg of distilled water (C). The main investigator, who was blinded to the groups, evaluated pain using PIPP at one minute before, during, and one and five minutes after the procedure (ethics code: IR.TUMS.MEDICINE.REC.1396.3130). The baseline characteristics were comparable between the groups. During the procedure, the group receiving oral 20% glucose showed significantly lower PIPP scores (13.8±1.39) compared to the other groups (group B: 15.95±1.27 and group C: 15.10±1.19) (P=0.001). The positive effects persisted for five minutes in this group after the procedure (7.6±1.26), compared to the other groups (P=0.034). During and after ROP screening, oral 25% glucose in combination with local anesthetic eye drops can cause a significant reduction in pain.

Ocular Biometry and its Relationship with Body Size and Head in French Bulldog Dogs

Background: Ocular biometrics is an easy to perform, safe, non-invasive and low-cost exam that provides immediate results with excellent definition. Brachycephalic dogs have a high risk of developing eye problems, and the early appearance is frequent due to factors linked to anatomical conformation. The aim of the present study was to perform eye biometrics in French Bulldog dogs through ultrasound, correlating with body and head size.Materials, Methods &amp; Results: Clinical examination, ophthalmic examination and ocular biometrics were performed using B-mode ultrasonography, using a 10 megahertz frequency transducer in 30 French Bulldog dogs, aged 1-6 years old, male and females from the Br Lord's Staff kennel and the Radiovet - Rio de Janeiro veterinary clinic. A drop of anesthetic eye drops containing 1% tetracaine hydrochloride and 0.1% phenylephrine hydrochloride was instilled and the direct contact technique was performed with the cornea with the help of sterile water-soluble lubricating acoustic gel between the transducer and the examined eye. These measurements were correlated with cephalic measurements (frontal-occipital distance, skull circumference, distance between the zygomatic arches and frontal-nasal distance) and with body measurements (length of the dog from the cranial end of the sternum to the ischial tuberosity and height of the withers from the cranial angle of the scapula to the ground). No chemical restraint was necessary. Dogs were positioned seated or in sternal decubitus, with slight physical restraint. All measurements were performed by the same examiner. There was no significant difference between the parameters of male and female eye biometrics and there was no difference between the measurements of the right and left eyes. The mean value of axial bulb length was 19.51 ± 0.58 mm, for the thickness of the lens, 6.71 ± 0.66 mm, for depth of the anterior chamber, 2.36 ± 0.89 mm and for the depth of the vitreous chamber, 10.44 ± 1.32 mm, showing the same pattern as other studies with brachycephalic dogs. The size of the dog or skull did not interfere with the measurements of eye biometrics.Discussion: The French Bulldog breed was selected for this study due to the scarcity of publications on ocular biometrics in brachycephalic breeds.The knowledge of ocular biometrics is extremely important for the understanding and early diagnosis of some anomalies related to the growth of ocular structures. It is an essential method of exploration and diagnosis of diseases of the eye bulb and orbit, being indicated to evaluate variations in size, shape and position of the eye bulb. The casuistry of these dogs with eye diseases in the ophthalmological clinical routine is large, since they have a high risk of developing eye problems. Ultrasonography is an easy to access and safe, non-invasive exam and the direct corneal contact technique allows clearer images. As there was no significant difference in measurements of intraocular structures between the right and left eyes, the normal eye can be a reliable parameter to establish the prosthetic eye bulb for the injured or enucleated eye. In the present study, there were 21 females and 9 males, which may have generated interference in these values since there was no sex ratio. The measurements of axial length, lenticular thickness, depth of the anterior chamber and the vitreous chamber had values similar to other studies with brachycephalic dogs.

Anesthesia for Intravitreal Injection: A Systematic Review.

BackgroundThe intravitreal injection has become one of the most commonly performed procedures in ophthalmology; however, there is no standardized approach to anesthesia during the procedure. The goal of this systematic review is to review approaches to anesthesia for intravitreal injection and look at comparative efficacy between these different anesthetics.MethodsA systematic review of literature was performed in the MEDLINE, PubMed, Cochrane Library, and Clinicaltrials.gov databases using the key words “anesthesia”, “pain management”, and “intravitreal injection”. Of the initial 239 search matches, 30 articles were found to be relevant to the topic. 18 studies were excluded as they did not include primary data or did not include the visual analog scale as a primary outcome. The remaining 12 articles were assessed to look at the comparative efficacy of anesthesia and adverse events.ResultsThe anesthesia techniques reported include topical methods such as anesthetic eyedrops, anesthetic gels, and anesthetic-soaked pledgets as well as subconjunctival injection of anesthetic. Ultimately, no single anesthetic or delivery mechanism was shown to be superior to the others in a statistically significant way and adverse events were largely insignificant. Limitations of these studies include relatively small sizes of the studies, as well as the lack of masking which may introduce bias.ConclusionIn the current literature, no type of anesthetic method was found to be superior to another for intravitreal injection. Future studies in this area may lead to new insights into the efficacy of different forms of intravitreal anesthesia.

Bullous Keratopathy in a dog treated with Third Eyelid Flap and Autologous Serum Eye Drops

Background: Bullous Keratopathy (BK) is characterized by decompensation of the corneal stroma resulting in visual impairment by corneal opacity, discomfort, excessive tearing, blepharospasm and pain. The aim of this study was to report a case of BK in a dog and the complete recovery of the ocular structure and visual function, with a third eyelid flap associated with the use of autologous blood serum topically.Case: A 2-year-old Shih Tzu male dog, weighing 4.3 kg, with recurrent bilateral eye discomfort was brought to Ophthalmologist Veterinarian Assistance. The patient had already been seen by other veterinarians, but the signs returned in a short period of time after the prescription was suspended. During physical examination it was observed moderate blepharospasm in the right eye, epiphora in the left eye, and in both eyes was noted exophthalmos, medial corneal entropion, caruncle trichiasis and ectopic cilia in the upper and lower eyelids. Fluorescein test was positive in both eyes, and a large bullous, opaque and gelatinous lesion with irregular appearance was observed occupying a large part of the cornea of the right eye. Superficial corneal ulcer was diagnosed in left eye and BK in right eye, both probably in consequence of ectopic cilia presence. Surgical intervention was made, with the cauterization and excision of the ectopic cilia and third eyelid flap in the right eye. The cauterization of caruncle trichiasis was not authorized by the owner. Moxifloxacin eye drops in the dose of one drop four times a day in both eyes, lubricant based on hyaluronic acid in the dose of one drop four times a day in both eyes, and autogenous blood serum, obtained from the centrifugation of a blood sample of the dog itself, in the dose of one drop every hour in the right eye for 24 hours, and meloxicam in the dose of 0.1 mg/kg every 24 h for 3 days were prescribed. Elizabethan collar was recommended until removal of the third eye flap. During the surgery, a sample of eye secretion was collected and sent for culture and antibiogram and did not show growth of microorganisms. After seven days of the procedure, the animal did not show eye discomfort and corneal ulcer in the left eye was healed. The third eye flap remained stable until the return of 28 days and after removal of the capton, adhesions were identified, which were removed with Castroviejo scissors after application of topical anesthetic proxymetacaine hydrochloride eye drops. A fluorescein test was performed and the absence of corneal keratitis was confirmed. Discrete corneal scars (macula) were identified.Discussion: The patient in this report had several changes in ocular morphology that favored the formation of recurrent injuries which contributed to the formation of BK. The use of topical medications as unique treatment was not performed due to the severity of the lesion and the presence of alterations such as medial entropion, caruncle trichiasis and ectopic cilia that needed surgical corrections to resolve the causes of the lesions. In order to protect the cornea and provide compression of its epithelium, a third eyelid flap was performed, a low-invasive procedure that is quick and easy to perform. Ectopic cilia were cauterized to eliminate one of the causes of the corneal injuries, however, the other changes could not be corrected because they were not authorized by the owner. The adjuvant uses of ocular lubricant based on hyaluronic acid, a broad-spectrum topical antibiotic and mainly autogenous blood serum favored the epithelial reconstruction of the cornea by providing protection, vitamins, growth factors, immunoglobulins, anti-collagenolytic and bacteriostatic substances. The protocol used it enabled a rapid reduction in patient discomfort, reversal of injuries and recovery of visual function.

Topical anaesthetic in the treatment of corneal epithelial defects: What are the risks?

Recent publications have suggested that topical anaesthetic eye drops can be used safely and are effective in providing pain relief for the treatment of corneal abrasions. Complications resulting from the injudicious prescribing of topical anaesthetic eye drops are seen with some frequency inthe Royal Victorian Eye and Ear Hospital's (RVEEH's) emergency department. The aim of this article is to review theliterature and provide a clinical perspective to challenge the safety oftopical anaesthetic eye drops for corneal abrasions. The literature relevant to this clinical question is reviewed, with an emphasis on a critical evaluation of the publications in question. Cases from the RVEEH areused for illustrative purpose. An alternative option for analgesia is suggested.

To Study the Safety of Multi-dose Topical Anaesthetic Eye Drops One Month after Opening

Purpose: To determine the risk of ocular infections due to topical multi-dose anaesthetic eye drops in patients one month after opening the bottle. Study Design: Quasi experimental study. Place and duration of study: Department of Ophthalmology DHQ Teaching Hospital, Gujranwala from 22nd May 2018 to 22nd June 2018. Materials and Methods: In this study topical anaesthetic eye drops containing proparacaine hydrochloride 0.5% as main ingredient and benzalkonium choride as preservative (Alcaine�) were tested daily to see if any bacterial/fungal growth occurs in the bottle containing eye drops or not. Same bottle was used in patients presenting in outdoor and indoor departments. Samples taken from the bottle contents were cultured on different media to see growth of fungi or bacteria. Patients who already had keratitis, conjunctivitis, corneal opacities, thin corneas and having dry eyes which were prone to get infected were excluded from this study. Results: There were 60 patients included in our study and they were divided in two groups. Group A included those who presented in the outdoor department and group B comprised of those admitted for various operative procedures. There were 30 patients in each group. All patients were adults (18-60 years). After 1 month of daily culturing on agar plates, no micro-organism growth was seen in both groups. Conclusion: Topical anaesthetic eye drops can be used safely for 1 month in different patients after opening the bottle without any risk of causing infectious keratitis, conjunctivitis or endophthalmitis. Keywords: Proparacaine, Culture medium, Endophthalmitis.