Anesthetic Eye Drops Research Articles

Effect of breast milk and sucrose on pain and perfusion index during examination for retinopathy of prematurity

Objective The objective of this study is to investigate the effect of breast milk and sucrose on pain scores and perfusion index (PI) and to evaluate the alteration in pain and PI during retinopathy of prematurity (ROP) examination. Methods This prospective randomized controlled study was conducted with preterm infants who were born in our hospital, hospitalized in the neonatal intensive care unit and whose gestational week was <32 weeks and birth weight was <1500 g. The preterm infants who would undergo ROP examination were allocated to three groups according to simple randomization method as follows: group 1: only local anesthetic eye drops, proparacaine HCl ophthalmic solution 0.5%, group 2: proparacaine HCl ophthalmic solution 0.5% plus breast milk, and group 3: proparacaine HCl ophthalmic solution 0.5% plus sucrose 24%. Postductal PI, transcutaneous oxygen saturation and heart rate (HR) values were measured before the eye examination (0), at the 30th, 60th, and 90th seconds (s) of the eye examination and 30 s after lasting of the examination in all infants. Pain was evaluated using Neonatal Infant Pain Scale (NIPS) during the examination. Results Fifty-one preterm neonates were prospectively enrolled into the study. The HR was higher during and after the examination in all infants according to before the examination (p < .001). Transcutaneous oxygen saturation values significantly decreased during the examination in breast milk and sucrose groups (p = .001 and <.001, respectively). While PI was found to be lower at the 60th s compared to the 30th s of the examination in the proparacaine HCl group, no difference was found between the values before and after the examination. Perfusion index was found to significantly decrease during and after the examination compared to the values before the examination in the breast milk group. Perfusion index values were determined to significantly decrease at the 30th and 60th s of the examination in the sucrose group. The NIPS scores during the examination were determined to be higher compared to the NIPS scores before the examination in all groups (p< .001). In the intergroup comparisons, the NIPS scores were found to be higher in the sucrose group compared to the proparacaine HCl group at the 60th s of the examination and higher than that in the breast milk group at the 90th s of the examination (p = .02 and p = .01, respectively). Conclusions The present study indicates that alterations may be seen in PI during the ROP examination; in other words, peripheral tissue perfusion could be affected. We consider that eye examination is a very painful procedure, and administering breast milk, sucrose or local anesthetic is not sufficient for reducing pain.

Modification of the Neuropathic Pain Symptom Inventory for use in eye pain (NPSI-Eye).

Chronic eye pain, which has previously been assumed to be due to ocular surface abnormalities (ie, "dry eye [DE] disease"), has recently garnered attention as a potential indicator of neuropathic ocular pain in some patients. The purpose of this study was to evaluate the psychometric properties of a modified version of the Neuropathic Pain Symptom Inventory in individuals with eye pain (NPSI-Eye). Enrolled participants (n = 397) completed the NPSI-Eye, general pain severity questionnaires, DE symptom report, and psychological health indices. Participants also underwent mechanical pain sensitivity testing of the cornea, tear film assessment, and evaluation of the efficacy of anesthetic eye drops to relieve pain. Short-term test-retest reliability of the NPSI-Eye was excellent (intraclass correlation coefficient = 0.98, P < 0.001). Correlations between the NPSI-Eye and indicators of general eye pain were ≥0.65 (P < 0.001), whereas correlations between the NPSI-Eye and DE symptom severity and psychological health indices were lower (rho = 0.56, 0.32, 0.37; all P < 0.001). Individuals who reported little or no decrease in pain after anesthetic eye drops (hypothesized to indicate eye pain with at least partial central involvement) had significantly higher NPSI-Eye scores than participants whose eye pain was completely relieved by anesthetic (P < 0.05). Overall, our results support preliminary validation of the NPSI-Eye, yielding similar metrics to those reported in Bouhassira et al.'s original NPSI publication (2004). However, additional evaluation and refinement of some questions may be desirable, including the potential elimination of items that were not highly endorsed.

Avaliação do tempo de ruptura lacrimal não invasivo e da altura do menisco lacrimal após a instilação de três diferentes formulações de colírio anestésico por Oculus Keratograph 5M

Abstract Purpose: To assess the non-invasive tear break-up time (NITBUT) and tear meniscus height (TMH) after instilling the three different types of anesthetic eye drops by Oculus Keratograph 5M. Methods: In this prospective study, 85 healthy subjects (85 eyes) were randomly divided into three groups. The groups were randomly received lidocaine hydrochloride 2%, proparacaine hydrochloride 0.5%, and tetracaine hydrochloride 0.5%. The qualitative and quantitative parameters of tear film were assessed using NITBUT and TMH, respectively. In all groups, the quantity of tear film using TMH was measured in the right eye of subjects, while the quality of tear film using NITBUT was assessed in the left eye. The analysis of variance (ANOVA) was used to compare the difference between before and after the intervention. A P-value 0.05). The mean values of NITBUT and TMH after the instillation of proparacaine hydrochloride 0.5% showed a significant decrease than before the intervention (P < 0.05). Also, after the use of tetracaine hydrochloride 0.5%, the mean value of NITBUT was significantly increased (P < 0.05), but the mean value of TMH was significantly decreased than before the intervention (P < 0.05). Conclusion: Our study showed that lidocaine hydrochloride 2% as an anesthetic eye drops can be an appropriate choice for eye examinations due to a lack of significant effect on the quantity and quality of tear film.

Comparison of surgeon comfort assessment during phacoemulsification using bilateral topical anesthesia versus ipsilateral topical anesthesia: a randomized controlled study.

To evaluate the effectiveness of bilateral use of topical anesthetic eye drops during phacoemulsification procedure as compared to use in one eye only. This is a prospective double-blind randomized case study of 180 cases undergoing phacoemulsification under topical anesthesia using 0.5% proparacaine: Group 1 consisting of patients who had topical anesthetic eye drop instilled into the operating eye only and Group 2 consisting of patients who had both their eyes anesthetized using topical anesthetic eye drops. Phacoemulsification was done using standard surgical technique. Main parameters evaluated included number of intra-operative patient counseling score (IPCS), surgical comfort score (SCS), total phacoemulsification procedure time (TPPT) and total operation time (TOPT). A comparison of mean value of various variables between Group 1 (60; 33.3% cases) and Group 2 (120; 66.7% cases) using "t" test revealed that there was a statistically significant difference for mean SCS (78.38±10.31 vs. 85.05±8.70; p=0.00), mean IPCS (12.60±3.11 vs. 6.63±1.74; p=0.00) and mean TOPT (418.88±89.59 vs. 341.64±79.51; p=0.00), respectively. However, no statistically significant difference existed for mean TPPT (143.57±87.96 vs. 152.96±78.99; p=0.48). Simultaneous instillation of topical anesthetic eye drops in both the eyes, i.e., operating eye and the fellow eye as against practice of instilling topical anesthetic eye drop in the operating eye only, helps in decreasing the total surgical time by primarily shortening the durations of pre- and post-ultrasonic periods of surgery where effective globe stabilization is wanted. This is achieved by better patient compliance, which in turn enhances surgeon's comfort during phacoemulsification surgery.

Topical Anesthetic Misuse in Patients Admitted to Sabzevar Eye Clinic in Iran

Abstract Topical anesthetic eye drops are used extensively for ophthalmic examinations but self-treatment and non-technical removal of foreign bodies using tetracaine drops can be hazardous. The present study intended to determine the inadmissible uses of anesthetic tetracaine eye drops, manner of drug obtaining and likelihood of the ocular complications in the patients. This cross-sectional study was conducted on 162 patients with ocular pain and foreign body sensation, red eye or lid edema admitted to the Eye clinic in Sabzevar, Iran. Variables included age, sex, chief compliant, job, site of foreign bodies, diagnosis of problem, use of tetracaine drops, drug provision, times patients referred to the eye clinic, and kinds of treatment. The most common chief complaint for admission to the Eye clinic was lacrimation (55.6%), followed by ocular pain, and foreign body sensation (35.8%). Some patients (30.9%) (mostly welders) inadmissibly used topical tetracaine eye drops; 21.6% of cases obtained tetracaine eye drops from drugstores without doctor’s prescription, and only 3.7% provided drugs by prescription. Corneal site (81.5%) was the most common location of foreign body; metallic foreign body (63%) was the most common. One patient was admitted in hospital for management. Topical inadmissible tetracaine (0.5%) is commonly used by welders, who obtain it from drugstores without prescriptions due to its simple usage and short acting pain relief. Supervision is required over drugstores for denying it if demanded without a prescription. Enhancing clients’ awareness is also suggested.

Can topical anesthetic eye drops prevent pain in preterm infants undergoing screening for retinopathy?

Can topical anesthetic eye drops prevent pain in preterm infants undergoing screening for retinopathy?

Selected Antimicrobial Activity of Topical Ophthalmic Anesthetics.

PurposeEndophthalmitis is a rare complication of intravitreal injection (IVI). It is recommended that povidone-iodine be the last agent applied before IVI. Patients have reported povidone-iodine application to be the most bothersome part of IVIs. Topical anesthetics have been demonstrated to have antibacterial effects. This study compared the minimum inhibitory concentration (MIC) of topical anesthetic eye drops (proparacaine 0.5%, tetracaine 0.5%, lidocaine 2.0%) and the antiseptic, 5.0% povidone-iodine, against two organisms causing endophthalmitis after IVI.MethodsMinimum inhibitory concentration values of topical anesthetics, povidone-iodine, preservative benzalkonium chloride (0.01%), and saline control were determined using five isolates of each Staphylococcus epidermidis and viridans group Streptococcus species (VGS). A broth microdilution technique was used with serial dilutions.ResultsLidocaine (8.53 × 10−5mol/mL) had MICs of 4.27 to 8.53 × 10−5 mol/mL, and tetracaine (1.89 × 10−5 mol/mL) had MICs of 9.45 × 10−6 mol/mL for all isolates. Proparacaine (1.7 × 10−5 mol/mL) had MICs of 1.32 to 5.3 × 10−7 and 4.25 × 10−6 mol/mL for S. epidermidis and VGS, respectively). Benzalkonium chloride (3.52 × 10−7 mol/mL) had MICs of 1.86 × 10−9 to 1.1 × 10−8 and 4.40 × 10−8 mol/mL for S. epidermidis and VGS, respectively. Povidone-iodine (1.37 × 10−4 mol/mL) had MICs of 2.14 to 4.28 × 10−6 and 8.56 × 10−6 mol/mL for S. epidermidis and VGS, respectively.ConclusionProparacaine was the anesthetic with the lowest MICs, lower than that of povidone-iodine. Benzalkonium chloride had lower MICs than proparacaine. All tested anesthetics and povidone-iodine inhibited growth of S. epidermidis and VGS at commercially available concentrations.Translational RelevanceFor certain patients, it could be possible to use topical anesthetic after povidone-iodine for comfort without inhibiting and perhaps contributing additional antimicrobial benefit.

Changes in the Eye Microbiota Associated with Contact Lens Wearing.

ABSTRACTWearing contact lenses has been identified as a risk factor for the development of eye conditions such as giant papillary conjunctivitis and keratitis. We hypothesized that wearing contact lenses is associated with changes in the ocular microbiota. We compared the bacterial communities of the conjunctiva and skin under the eye from 58 subjects and analyzed samples from 20 subjects (9 lens wearers and 11 non-lens wearers) taken at 3 time points using a 16S rRNA gene-based sequencing technique (V4 region; Illumina MiSeq). We found that using anesthetic eye drops before sampling decreases the detected ocular microbiota diversity. Compared to those from non-lens wearers, dry conjunctival swabs from lens wearers had more variable and skin-like bacterial community structures (UniFrac; P value = <0.001), with higher abundances of Methylobacterium, Lactobacillus, Acinetobacter, and Pseudomonas and lower abundances of Haemophilus, Streptococcus, Staphylococcus, and Corynebacterium (linear discriminant analysis [LDA] score = >3.0). The results indicate that wearing contact lenses alters the microbial structure of the ocular conjunctiva, making it more similar to that of the skin microbiota. Further research is needed to determine whether the microbiome structure provides less protection from ocular infections.

Does patient comfort influence the choice of tonometer for the measurement of intraocular pressure?

The purpose of this study was to compare patient comfort and preference between the use of Icare tonometer and Goldmann applanation tonometer for the measurement of intraocular pressure (IOP). This was a prospective study carried out at the Eye clinic of the University College Hospital, Ibadan on volunteers aged 18years and above. Demographic information of the participants was collected using a proforma. All participants had Icare tonometry and Goldmann applanation tonometry (GAT) performed on them in sequence within a 15-min period. After the measurements, participants were asked to report their assessment of the level of comfort with each method and to state their preferred choice for IOP measurement. One hundred subjects participated in the study; 45 (45%) were males, and the mean age was 47.1 (±17.4) years. Forty-three subjects (43%) reported that Icare was either much more comfortable or more comfortable than GAT, while 31 (31%) stated that Goldmann applanation was either much more or more comfortable. Twenty-six participants (26%) reported that the level of comfort was the same with the two instruments. With regard to which of the instruments will be preferred for IOP check at another clinic visit, 53 (53%) of the respondents preferred the Goldmann applanation tonometer. Some of the participants preferred GAT because they believed it was more sophisticated, while the main reported reason for preferring Icare was the stinging sensation of the anesthetic eye drop when using GAT. Although more participants reported the Icare tonometer to be more comfortable, the Goldmann tonometer was preferred by majority of the respondents.

Quantifying and qualifying the use of topical anesthetics in retinopathy of prematurity examinations: a survey

Use of topical anesthetic eye drops during retinopathy of prematurity examinations is a common practice, but many ophthalmologists believe it is unnecessary. No data exists to quantify the practice of topical anesthetic use or physicians’ reasons for using or not using anesthetics.

Survey: technique of performing intravitreal injection among members of the Brazilian Retina and Vitreous Society (SBRV).

To evaluate and describe the precautions involved in the technique of intravitreal injection of antiangiogenic drugs adopted by the ophthalmologists who are members of the Brazilian Society of Retina and Vitreous (SBRV). A questionnaire containing 22 questions related to precautions taken before, during, and after intravitreal injection was sent electronically to 920 members of SBRV between November 15, 2013 and April 31, 2014. 352 responses (38%) were obtained. There was a predominance of men (76%) from the southwest region of Brazil (51%). The professional experience varied between 6 and 15 years after medical specialization (50%). Most professionals (76%) performed an average of 1 to 10 intravitreal injections a week, and 88% of the procedures were performed in the operating room using povidone iodine (99%), sterile gloves, and blepharostat (94%). For inducing topical anesthesia, usage of anesthetic eye drops was the most used technique (65%). Ranibizumab (Lucentis®) was the most common drug (55%), and age-related macular degeneration (AMD) was the most treated disease (57%). Regarding the complications treated, 6% of the ophthalmologists had treated at least one case of retinal detachment, 20% had treated cases of endophthalmitis, 9% had treated cases of vitreous hemorrhage, and 12% had encountered cases of crystalline lens touch. Intravitreal injection is a procedure routinely performed by retina specialists and has a low incidence of complications. Performing the procedure in the operating room using an aseptic technique was preferred by most of the respondents. Ranibizumab was the most used drug, and AMD was the most treated disease.

Ecobiometria ocular de cães glaucomatosos

Foram estudados olhos glaucomatosos de cães referidos no serviço de diagnóstico por imagem. Os pacientes foram submetidos à ultrassonografia em modo B de alta resolução para realização de biometria ocular, por meio da qual foram realizadas as seguintes medidas: espessura central da córnea, profundidade da câmara anterior, espessura da lente e profundidade da câmara vítrea. Para tal, foi realizada contenção física e instilado colírio anestésico. Foram aferidas a PIO e a paquimetria da córnea e, em seguida, foi realizada a ultrassonografia em modo B nos dois olhos. Além da diferença óbvia de PIO, maior nos bulbos glaucomatosos, os resultados mostraram-se estatisticamente significativos em dois parâmetros: aumento da profundidade da câmara vítrea nos casos de glaucoma crônico (1,24±0,26cm; P=0,01) quando se comparou aos olhos controle e aumento da espessura da córnea também nos casos de glaucoma agudo (0,987±0,28cm; P=0,027), quando se comparou aos olhos controle e aos olhos com glaucoma crônico. Observou-se que a câmara vítrea é a estrutura intraocular que mais contribui no processo de expansão de volume do bulbo (buftalmia) durante o glaucoma.

Postoperative endophthalmitis due to Burkholderia cepacia complex from contaminated anaesthetic eye drops

ObjectiveTo report the clinical presentation and outcomes of cluster postcataract Burkholderia cepacia complex endophthalmitis, the source of infection and clonal relatedness of the isolates.MethodsThis was a retrospective study on 13...

Transepithelial corneal collagen cross‐linking by iontophoresis of riboflavin

To evaluate the effectiveness of transepithelial cornea impregnation with riboflavin 0.1% by iontophoresis for collagen cross-linking. Transepithelial collagen cross-linking by iontophoresis of riboflavin was performed in a series of 22 eyes of 19 patients with progressive keratoconus I-II of Amsler classification. The riboflavin solution was administered by iontophoresis for 10 min in total, after which standard surface UVA irradiation (370 nm, 3 mW/cm(2) ) was performed at a 5-cm distance for 30 min. The riboflavin/UVA treatment resulted in a decrease in the average keratometry level from 46.47 ± 1.03 to 44.12 ± 1.12 D 1 year after the procedure. Corneal astigmatism decreased from 3.44 ± 0.48 to 2.95 ± 0.23 D. Uncorrected distance visual acuity improved from 0.61 ± 0.44 up to 0.48 ± 0.41 (LogMAR). Preoperative and postoperative endothelial cell density remained unchanged at 2765 ± 21.15 cells/mm(2) . Transepithelial collagen cross-linking by iontophoresis might become an effective method for riboflavin impregnation of the corneal stroma reducing the duration of the procedure and being more comfortable for the patients. Further long-term studies are necessary to complete the evaluation of the efficacy and risk spectrum of the modified cross-linking technique.

The Effect of Anesthetic Eye Drop Instillation on the Distribution of Corneal Thickness

To address the effect of topical instillation of oxybuprocaine on the relative distribution of corneal thickness (CT) in young healthy subjects. Prospective study involving 30 eyes of 30 emmetropic subjects (24 ± 3 years). Corneal thickness measurements were carried out before and 3 minutes after the instillation of oxybuprocaine 4% using slit-scanning corneal topography (Orbscan topography system II). No acoustic correction factor was applied. The mean of 5 consecutive Orbscan measurements was obtained at the center and 3 mm from the visual axis in the temporal, superior, nasal, and inferior hemimeridians. No significant mean differences were found at any corneal location after anesthesia (P > 0.05). The difference between the baseline values obtained of the central, superior, inferior, nasal, and temporal cornea and those obtained after anesthesia ranged from -15 to 16 μm, from -19 to 32 μm, from -14 to 24 μm, from -20 to 33 μm, and from -31 to 18 μm, respectively. The maximum paracentral CT was never found at the temporal location before anesthesia, whereas it was never found at the inferior location after anesthesia. The minimum paracentral CT was never found in the superior location after anesthesia. Topical anesthetic eye drops induce CT increases and decreases at each corneal location; however, the differences are not significant. Nevertheless, a change in the location of the minimum and maximum paracentral thickness occurs in some individuals after corneal anesthesia.

Effects of topical anaesthetics and repeated tonometry on intraocular pressure

To investigate the effects of repeated measurements of intraocular pressure (IOP) using Goldmann applanation tonometry (GAT) and applanation resonance tonometry (ART) to identify mechanisms contributing to the expected IOP reduction. A prospective, single-centre study with six healthy volunteers. Consecutive repeated series (six measurements/serie/method) were made alternately on both eyes for 1 hr with oxybuprocaine/fluorescein in the right eye and tetracaine in the left. The left eye was Pentacam(®) photographed before and repeatedly for 20 min after the IOP measurements. On a separate occasion, the same volunteers received the same amount of anaesthetic drops for 1 hr but without repeated IOP measurements. A significant IOP reduction occurred with both ART and GAT in the oxybuprocaine-treated eye, -4.4 mmHg and -3.8 mmHg, respectively and with ART in the tetracaine eye, -2.1 mmHg. There was a significant difference in IOP reduction between the oxybuprocaine and tetracaine eyes with ART. There was a significant drop in anterior chamber volume (ACV) immediately after the IOP measurements, -12.6 μl that returned to pretrial level after 2 min. After 1 hr of receiving anaesthetic eye drops (without IOP measurements), the IOP decreased significantly in the oxybuprocaine eye for both ART and GAT, -3.1 and -1.7 mmHg, respectively, but not in the tetracaine eye (p = 0.72). The IOP reduction cannot be explained solely by aqueous humor being pressed out of the anterior chamber. While significant IOP reduction occurred with both tetracaine and oxybuprocaine after repeated mechanical applanation, the IOP reduction was significantly greater with oxybuprocaine.

Estudo clínico e histológico das pálpebras e conjuntiva hígidas submetidas ao tratamento tópico com soluções anestésicas em coelhos

Avaliaram-se as apresentações comerciais de colírios anestésicos aplicados em 63 coelhos da raça Nova Zelândia, distribuídos em três grupos (G1, G2 e G3) de 21 animais cada e que receberam instilação de uma gota em cada olho seis vezes ao dia. Os animais do G1 foram tratados com colírio de cloridrato de proparacaína a 0,5%; os do G2, com colírio de cloridrato de tetracaína a 1% associado à fenilefrina a 0,1%; e os do G3, com solução fisiológica. Cada grupo foi subdividido em três subgrupos com sete animais cada, os quais foram tratados por três, sete e 15 dias. No final de cada tratamento, dois animais de cada subgrupo foram sacrificados para exame histológico de fragmentos retirados da conjuntiva, da terceira pálpebra e das pálpebras. Observou-se, ao exame clínico, episclerite em graus diversos em 100% dos animais do G1, no terceiro, sétimo e 15º dia, e em apenas 17,8% nos do G2, nestes mesmos dias. Ao exame microscópico, observaram-se aumento do número de células califormes, proliferação de folículos linfoides, aumento do número de eosinófilos e aumento do espaço intersticial nas pálpebras dos animais do G1. Pôde-se concluir que o colírio de tetracaína a 1% associado à fenilefrina a 0,1% promoveu maior toxicidade à conjuntiva ocular e às pálpebras de coelhos quando comparado ao colírio de proparacaína a 0,5%.

Peritopic anesthesia: a new alternative in cataract surgery

Correspondence: Jose A Abreu Ophthalmology Department, University Hospital of the Canary Islands, Ctra. Ofra S/N La Cuesta, 38320 La Laguna, Tenerife, Canary Islands, Spain Email jaabreureyes@gmail.com Dear editor We read with interest the recently published article “Superior subconjunctival anesthesia versus retrobulbar anesthesia for manual small-incision cataract surgery in a residency training program: a randomized controlled trial” by Pipat Kongsap, where the author studied possible differences in the clinical outcomes of superior subconjunctival anesthesia and retrobulbar anesthesia, in a residency training program. Nowadays, two options are the most accepted in phacoemulsification anesthesia: topical anesthesia and regional anesthesia (retrobulbar and peribulbar). However, being strict with the concepts, if we talk about topical anesthesia, we should refer only to use of anesthetic eyedrops, whereas when we add intracameral lidocaine and/or sedation, we should be talking about a “combined form.” When topical anesthesia alone is not possible, rather than perform a classical retrobulbar or peribulbar anesthesia, we could choose an intermediate approach that would supplement the topical anesthesia with a “limited” peribulbar anesthesia, to provide their benefits without the associated drawbacks. We would like to mention that for the last 5 years, we have added a new option to the anesthetic techniques discussed: peritopic anesthesia. Peritopic anesthesia, as defined by our group, is a combination of topical anesthesia and a single-injection peribulbar anesthesia, without sedation. The patient’s eye is first instilled with a drop of a commercial mixture of tetracaine hydrochloride 0.1% and oxybuprocaine hydrochloride 0.4%. A second and a third drop, instilled once the patient is in the operating room, contain a mixture of tetracaine hydrochloride 0.5% and naphazoline. Peribulbar anesthesia then involves an injection, at the inferotemporal quadrant, of 2–4 mL of a 50% mixture of lidocaine 2% and bupivacaine 0.5%. This anesthetic combination has the effect that after surgery, any limited induced akinesia has virtually disappeared, leaving a comfortable analgesia so that the patient will not feel the urge to rub the eye or tighten the eyelid in an antalgic maneuver – these would be dangerous occurrences in sutureless cataract surgery because they could lead to some degree of aqueous humor leakage, secondary hypotonia, intraocular lens malposition, increased risk of endophthalmitis, etc. Peritopic anesthesia doesn’t produce postoperative ptosis, and eye occlusion is usually not needed, and both the patient and the surgeon are comfortable during the surgery. This new anesthesia technique in cataract surgery may be useful when topical anesthesia is insufficient, as may occur in: uncooperative patients (anxiety, deafness, Dovepress

Protocole simplifié de prise en charge anesthésique chez les patients opérés de cataracte sous topique : étude rétrospective sur un an

The reduced supply of anesthesiologists in the hospital setting calls for a reconsideration of anesthesia management for ophthalmology patients. Therefore, a simplified management protocol has been designed through close collaboration between the involved specialists for cataract surgery under topical anesthesia (anesthetic eye drops or sub-Tenon's injection). At the conclusion of the visit confirming the need for surgery, the surgeon completes a questionnaire designed to elicit a history of the presence of diabetes mellitus (type I or II), prior organ transplantation, chronic renal insufficiency requiring dialysis, communication difficulties, psychiatric disorders, allergy and/or a complex cataract. If one of the items is positive, the patient is scheduled for a preoperative anesthesia consult. If all the items are negative, this anesthesia evaluation is waived. The surgeon explains the fasting requirement and how to take the patient's usual medications on the morning of surgery. The patient continues his/her medications. No lab tests or chest X-ray are performed. If necessary, the surgeon prescribes preoperative antibiotic prophylaxis and any other preparation. During the surgery, the patient receives IV fluids and is monitored via EKG, non-invasive blood pressure and pulse oxymetry by a certified nurse anesthetist. The anesthesiologist on duty (one per every four rooms) is immediately available for the slightest problem. The surgeon signs the postoperative anesthesia note and discharge order. This procedure was assessed by one surgeon over a one year period, including 145 patients (60% of the patients recruited for this surgery), primarily outpatient (77%) under topical anesthesia (Oxybuprocaine(®)+Visthesia(®), Zeiss) or under sub-Tenon's injection (Xylocaïne(®)). No major complications were observed. Seven cases of arterial hypertension, treated with calcium channel blockers (nicardipine), and three episodes of brief anxiety were observed. This simplified anesthesia protocol appears to be safe and effective but requires more demanding involvement of the surgeon, whose scope of competence and responsibility must naturally increase. This is the only way by which cataract surgery can remain competitive.

Comparison of EyeCam and anterior segment optical coherence tomography in detecting angle closure

To compare the diagnostic performance of EyeCam (Clarity Medical Systems, Pleasanton, CA, USA) and anterior segment optical coherence tomography (ASOCT, Visante; Carl Zeiss Meditec, Dublin, CA, USA) in detecting angle closure, using gonioscopy as the reference standard. Ninety-eight phakic patients, recruited from a glaucoma clinic, underwent gonioscopy by a single examiner, and EyeCam and ASOCT imaging by another examiner. Another observer, masked to gonioscopy findings, graded EyeCam and ASOCT images. For both gonioscopy and EyeCam, a closed angle in a particular quadrant was defined if the posterior trabecular meshwork was not visible. For ASOCT, angle closure was defined by any contact between the iris and angle anterior to the scleral spur. An eye was diagnosed as having angle closure if ≥2 quadrants were closed. Agreement and area under the receiver operating characteristic curves (AUC) were evaluated. The majority of subjects were Chinese (69/98, 70.4%) with a mean age of 60.6 years. Angle closure was diagnosed in 39/98 (39.8%) eyes with gonioscopy, 40/98 (40.8%) with EyeCam and 56/97 (57.7%) with ASOCT. The agreement (kappa statistic) for angle closure diagnosis for gonioscopy versus EyeCam was 0.89; gonioscopy versus ASOCT and EyeCam versus ASOCT were both 0.56. The AUC for detecting eyes with gonioscopic angle closure with EyeCam was 0.978 (95% CI: 0.93-1.0) and 0.847 (95% CI: 0.76-0.92, p < 0.01) for ASOCT. The diagnostic performance of EyeCam was better than ASOCT in detecting angle closure when gonioscopic grading was used as the reference standard. The agreement between the two imaging modalities was moderate.