Use Of Balanced Salt Solution Research Articles

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

Macular Toxicity of Low-Concentration Cefuroxime during Cataract Surgery in Vitrectomized Eyes

Introduction: The objective of this study was to determine the toxic effect and clinical characteristics of 1 mg/mL cefuroxime sodium on retinas after phacoemulsification in vitrectomized eyes. Methods: Cataract patients with vitrectomized eyes were studied retrospectively. Phacoemulsification combined with intraocular lens implantation was performed uneventfully. Best-corrected visual acuity, intraocular pressure, fundus photography, macular central thickness, and angiography were collected and analyzed. They were studied in patients with macular edema to evaluate macular toxicity. Results: Ninety two cases (92 eyes) were enrolled, including 44 eyes of males and 48 eyes of females with an average age of 55.35 ± 12.32 years. Univariate analysis showed that the intraoperative use of balanced salt solution containing 1 mg/mL cefuroxime sodium compound electrolyte and macular involvement in primary vitrectomy were important risk factors for macular edema on the first day after cataract surgery (p < 0.05). In addition, the characteristics of this kind of macular edema were studied; the thickness of macular fovea was significantly high at 1-day follow-up (p < 0.05), but there was no difference between pre-operation and 1-week post-operation (p > 0.05). Conclusion: Low-concentration cefuroxime sodium can cause acute macular edema in vitrectomized eyes, which can heal within 1 week after surgery.

Bimanual Microincision Cataract Surgery versus Coaxial Microincision Cataract Surgery: A Meta-Analysis of Randomized Controlled Trials and Cohort Studies.

Purpose This meta-analysis was conducted to compare the intraoperative and postoperative outcomes of bimanual microincision cataract surgery (B-MICS) and coaxial microincision cataract surgery (C-MICS). Methods Three databases were searched for papers that compared B-MICS and C-MICS from inception to June 2016. The following intraoperative and postoperative outcomes were included in the final meta-analysis: ultrasound time (UST), effective phacoemulsification time (EPT), balanced salt solution use (BSS use), mean surgery time, best-corrected visual acuity (BCVA), central corneal thickness (CCT), and increased CCT. Results There were no statistically significant differences in mean surgery time, UST, BSS use, BCVA, CCT, or increased CCT (one subgroup at postoperative day 7-8 and another subgroup at postoperative day 30). However, there was less EPT needed during surgery (p < 0.01) and lower levels of increased CCT at postoperative day 1 (p = 0.02) in the B-MICS group compared with the C-MICS group. Conclusions The EPT was shorter and increased CCT was less at postoperative day 1 in the B-MICS group. There were no statistically significant differences in other intraoperative and postoperative outcomes between the B-MICS group and the C-MICS group. B-MICS is an efficient and safe cataract surgery procedure.

Changes in corneal endothelium cell characteristics after cataract surgery with and without use of viscoelastic substances during intraocular lens implantation.

PurposeTo evaluate whether the use of balanced salt solution (BSS) or an ophthalmic viscoelastic device (OVD) during hydrophilic acrylic intraocular lens (IOL) implantation variously impacts corneal endothelial cell characteristics in eyes undergoing uneventful phacoemulsifications.MethodsProspective nonrandomized observational clinical trial. Patients were assigned either to the BSS plus® or to the OVD Z-Celcoat™ group depending on the substance used during IOL implantation. Corneal endothelium cell characteristics were obtained before, 1 week, and 6 weeks after surgery. Intraoperative parameters (eg, surgery time, phacoemulsification energy) were recorded.ResultsNinety-seven eyes were assigned to the BSS plus and 86 eyes to the Z-Celcoat group. Preoperative corneal endothelium cell density (ECD) and endothelium cell size were 2,506±310 cells/mm2/2,433±261 cells/mm2 and 406±47 µm2/416±50 µm2 (P=0.107/P=0.09). After 1 and 6 weeks, ECD decreased and endothelium cell size increased significantly in both groups (each P<0.001) without significant differences between both groups (each P>0.05). Irrigation–aspiration suction time (30.3±16.6 versus 36.3±14.5 seconds) and overall surgical time (7.2±1.2 versus 8.0±1.4 minutes) were significantly longer in the OVD Z-Celcoat group (each P<0.001). No complications or serious side effects occurred.ConclusionImplantation of a hydrophilic acrylic IOL under BSS infusion seems to be a useful and faster alternative in experienced hands without generating higher ECD loss rates.

Transverse vs torsional ultrasound: prospective randomized contralaterally controlled study comparing two phacoemulsification-system handpieces.

PurposeTo compare surgical efficiency and multiple early clinical outcome variables in eyes undergoing phacoemulsification using either transversal or torsional ultrasound systems.SettingAssil Eye Institute, Beverly Hills, CA, USA.DesignProspective, randomized, clinician-masked, contralaterally controlled single-center evaluation.Patients and methodsPatients seeking cataract removal in both eyes with implantation of multifocal intraocular lenses were randomly assigned to one of two treatment rooms for phacoemulsification with either a transverse ultrasound system or torsional handpiece system. The contralateral eye was treated at a later date with the alternate device. A total of 54 eyes of 27 patients having similar degrees of cataract, astigmatism, and visual potential were included. All operative data were collected for analysis, and patients were followed for 3 months after surgery.ResultsSimilar visual acuity was reported at all postoperative visits between the two groups. Mean phacoemulsification time and total power required were both significantly lower with the transverse system than with the torsional technique (P<0.05 for both). Similarly, mean total balanced salt solution used was significantly less with the transverse system vs torsional (P<0.05). Postoperative safety demonstrated significantly lower endothelial cell loss at 1 day and 1 month (P<0.05) with transverse vs torsional. Macular swelling was less at 1 week, 1 month, and 3 months with transverse vs torsional, although the difference did not achieve significance (P=0.1) at any single time point. Clinically detectable corneal edema was reported less frequently at all postoperative time points with the transverse system.ConclusionThe transverse ultrasound system was found to be possibly associated with less balanced salt-solution use, less phacoemulsification time, and less power required than the torsional phaco system. Postoperative data suggested that improved phaco efficiency may translate to a better overall safety profile for the patient.

Choice of fluid in acute illness: what should be given? An international consensus

Fluid management during critical illness is a dynamic process that may be conceptualized as occurring in four phases: rescue, optimization, stabilization, and de-escalation (mobilization). The selection and administration of resuscitation fluids is one component of this complex physiological sequence directed at restoring depleted intravascular volume. Presently, the selection of i.v. fluid is usually dictated more by local practice patterns than by evidence. The debate on fluid choice has primarily focused on evaluating outcome differences between 'crystalloids vs colloids'. More recently, however, there is interest in examining outcome differences based on the chloride content of crystalloid solutions. New insights into the conventional Starling model of microvascular fluid exchange may explain that the efficacy of colloids in restoring and maintaining depleted intravascular volume is only moderately better than crystalloids. A number of investigator-initiated, high-quality, randomized controlled trials have demonstrated that modest improvements in short-term physiological endpoints with colloids have not translated into better patient-centred outcomes. In addition, there is substantial evidence that certain types of fluids may independently worsen patient-centred outcomes. These include hydroxyethyl starch and albumin solutions in selected patient populations. There is no evidence to support the use of other colloids. The use of balanced salt solutions in preference to 0.9% saline is supported by the absence of harm in large observational studies. However, there is no compelling randomized trial-based evidence demonstrating improved clinical outcomes with the use of balanced salt solutions compared with 0.9% saline at this time.

Predictive factors for anterior chamber fibrin formation after vitreoretinal surgery

Objetivo: Avaliar os possíveis fatores relacionados à formação de fibrina na câmara anterior após cirurgia vitreorretiniana em uma grande série de casos. Métodos: Foi realizado um estudo retrospectivo, observacional, caso-controle, onde os dados de 185 olhos de 185 pacientes submetidos à cirurgia vitreorretiniana foram avaliados. Os seguintes dados foram analisados: presença ou não de fibrina na câmara anterior na primeira semana de pós-operatório, idade, presença ou não de diabetes mellitus, calibre do sistema de vitrectomia utilizado (20,23 ou 25 gauge), [...]

Comparison of phaco-chop, divide-and-conquer, and stop-and-chop phaco techniques in microincision coaxial cataract surgery

To compare the outcomes of coaxial microincision cataract surgery (MICS) performed with 3 phacoemulsification techniques (phaco-chop, divide-and-conquer, and stop-and-chop) according to cataract density. Bucheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea. Prospective randomized clinical trial. Eyes with nuclear density from grade 2 to 4 were randomly subdivided into 3 groups (phaco-chop, divide-and-conquer, and stop-and-chop). Intraoperative measurements included ultrasound time (UST), mean cumulative dissipated energy (CDE), and balanced salt solution use. Clinical measurements included preoperative and 1 day, 1 month, and 2 month postoperative corrected distance visual acuity, central corneal thickness, and endothelial cell count. Intraoperative measurements showed significantly less UST, CDE, and balanced salt solution use with the phaco-chop technique than with the divide-and-conquer and stop-and-chop techniques in the grade 4 cataract density group (P<.05). The percentage of endothelial cell loss was significantly lower in the phaco-chop group than in the divide-and-conquer and stop-and-chop groups in the grade 4 cataract density group 2 months after cataract surgery (P<.05). All 3 techniques may be effective for coaxial MICS in mild and moderate cataracts. However, in eyes with hard cataract having coaxial MICS, the phaco-chop technique can be more effective for lens removal, with less corneal endothelial damage, than the divide-and-conquer and stop-and-chop techniques. No author has a financial or proprietary interest in any material or method mentioned.

Comparison of tips in coaxial microincision cataract surgery with the bevel-down technique

To compare clinical and intraoperative parameters of 3 phaco tip designs in torsional phacoemulsification using the bevel-down technique. Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea. Clinical trials. Consecutive cases were randomly assigned to have coaxial microincision cataract surgery using the mini-flared 30-degree Kelman tip, mini-flared 45-degree Kelman tip, or reverse mini-flared 30-degree Kelman tip. Clinical measurements included preoperative and 2-month postoperative uncorrected distance visual acuity, endothelial cell counts, and anterior segment optical coherence tomography and preoperative and 1-day postoperative central corneal thickness. Intraoperative measurements included cumulative dissipated energy (CDE) and balanced salt solution use. Intraoperative video recording was used to visualize tip movements in the anterior chamber. The study enrolled 302 eyes of 297 patients. Intraoperatively, there was less CDE use with the 45-degree Kelman tip and reverse 30-degree Kelman tip than with the 30-degree Kelman tip (P<.05). There were no statistically significant differences in any clinical parameter between the 3 tips. Intraoperative films showed that the opening of the reverse 30-degree Kelman tip approached the nucleus more easily than the opening of the other 2 tips. In torsional phacoemulsification through microincisions with the bevel-down technique, the reverse mini-flared 0.9 mm 30-degree Kelman tip was as effective as the mini-flared 0.9 mm 45-degree Kelman tip with regard to intraoperative characteristics, such as total energy use. No author has a financial or proprietary interest in any material or method mentioned.

Length and frequency of intraoperative occlusive events with new torsional phacoemulsification software

To evaluate the efficiency profile of new torsional phacoemulsification software. Eye Institute of Utah, Salt Lake City, Utah, USA. Comparative case series. Routine cataract surgeries were performed using standard torsional (Ozil) and new torsional (Ozil IP) software. The new software uses occasional pulses of longitudinal energy that are operator specified and system controlled to manage potential occlusion. The new software was compared with the previous standard software, which did not include this option. The video monitor system was recorded in high definition. Measurement of cumulative dissipated energy, balanced salt solution use, and amount of time spent in occlusion were measured in a frame-by-frame review of the recorded videos. Data were categorized for analysis by software group and cataract grade (1 to 4). The study comprised 59 eyes that had cataract removal using the new torsional software and 59 eyes using the standard torsional software. Cumulative dissipated energy was not statistically significantly different between the 2 groups. Balanced salt solution use, time spent in occlusion, and the mean longest continuous occlusion were significantly lower with the new torsional software; these differences were greater as the cataract grade increased. The new torsional software significantly decreased occlusion time and balanced salt solution use over standard torsional software, particularly with denser cataracts. The net result was a relatively better safety cataract surgery profile. No author has a financial or proprietary interest in any material or method mentioned.

Comparison of a torsional handpiece through microincision versus standard clear corneal cataract wounds

To directly compare intraoperative and clinical parameters using a torsional handpiece through microincision and standard clear corneal cataract wounds with appropriately configured tips and sleeves. Duke University Eye Center, Durham, North Carolina, USA. Cataracts in both eyes of 32 patients needing bilateral surgery were extracted using the OZil torsional handpiece. Tips and sleeve selections were optimized for the incision chosen. Right eyes had cataract surgery using a standard method consisting of a 2.8 mm incision with a 0.9 mm tapered 30-degree bevel Kelman configuration tip with a Microsleeve. Left eyes had cataract surgery through a 2.2 mm microincision using a 0.9 mm miniflared 45-degree bevel Kelman configuration tip with an Ultrasleeve. Intraoperative measurements included cumulative dissipated energy (CDE) and balanced salt solution use. Clinical measurements included preoperative and 1-day postoperative central corneal thickness (CCT), preoperative and 6-month postoperative endothelial cell count (ECC), and preoperative and postoperative anterior segment optical coherence tomography (AS-OCT). Intraoperatively, the microincision (2.2 mm) group had less CDE use than the standard incision (2.8 mm) group (P= .001). Clinical measurements showed less ECC loss at 6 months in the microincision group (P<.05). No difference in CCT or AS-OCT findings was detected between groups. Phacoemulsification using the OZil torsional handpiece through a microincision with an Ultrasleeve and a 45-degree miniflared tip showed favorable clinical and intraoperative characteristics such as less total energy use and less endothelial cell loss at 6 months. Further studies are warranted to substantiate these preliminary findings.

M.T. Pepper Jenkins introduces Ringer's lactate to treat shock

M.T. Pepper Jenkins was one of the team that introduced balanced salt solutions (in those days, Ringer's Lactate) to the resuscitation of traumatic shock. The revolutionary proposal is one of the most important innovations in the modern care of the surgical patient. Before 1950, surgeons and physiologists felt that salt solutions were contraindicated in surgical patients because they did not excrete a sodium load. Anesthetized patients were given small amounts of D5W, and if blood loss was excessive, they were given transfusions of whole blood. The turning point came in 1950 when Jenkins reported a series of critical patients in hemorrhagic shock, who received D5W and whole blood for resuscitation. They developed high hematocrits, stiff lungs and pulmonary failure, called “congestive atelectasis.” Jenkins theorized that congestive atelectasis could be prevented if Ringer's Lactate was given with the blood. Over the next 30 years, Shires demonstrated the deficit of extracellular fluid, which occurs in hemorrhagic shock in dogs and humans, and the acute sequestered edema space that results from trauma. This work established the efficacy for the use of balanced salt solutions in shock. Salt solutions were not contraindicated, rather they are indicated and, in fact, life saving. Salt solutions are now used all over the world for the treatment of shock and have saved millions of lives. Our understanding of surgical fluid therapy has changed forever; and Jenkins could be compared to Copernicus who suggested that the earth and other planets rotate around the sun, changing the way we think about the universe.

Toxic endothelial cell destruction from intraocular benzalkonium chloride

Purpose: To present a cluster of cases of corneal edema occurring after phacoemulsification. Setting: Regional hospital in rural Australia. Methods: This retrospective case series comprised 12 patients from a single surgical list comprising 19 cases who developed persistent corneal edema after having phacoemulsification. Results: After 6 months, the edema improved in 1 patient. Inadvertent intraocular use of balanced salt solution (BSS®) preserved with benzalkonium chloride was found to be the cause of this serious complication. Conclusions: Benzalkonium chloride in concentrations commonly used extraocularly is highly toxic to the corneal endothelium. Every possible safeguard should be taken to prevent inadvertent intraocular use of such preserved solutions.

Suitability of enhanced green fluorescent protein as a reporter component for bioassays

Evaluation of enhanced green fluorescent protein (EGFP) for use in gene expression studies was done by transfection of several EGFP variants into mammalian cell lines followed by measurement of fluorescence intensities using a microplate reader. Fluorescent excitation and emission spectra of EGFP expressing living cells were arithmetically folded with excitation and emission filter transmission data allowing the calculation of fluorescence yields for different filter combinations. FITC (fluorescein-5-isothiocyanate) filter sets used for EGFP measurement do not meet the EGFP optimum. Microplate readers equipped with custom made filters may lead to higher fluorescence readings, but to exclude the contribution of excitation wavelengths in the emission wavelength range of EGFP excitation filters with a maximum at 460–470 nm instead of 480–490 nm should be used for red-shifted EGFP variants. For stably transfected cell lines where nearly all cells express EGFP a nearly linear dependence of fluorescence on cell numbers was observed, the lower limit of detection being 11,400 adherent cells per well (96-well plate). For strong EGFP expression of transiently transfected cells >7% positive cells in a confluent cell lawn can be distinguished from nonfluorescent controls (24-well plate). For weak EGFP expression from inducible promoters it is of great importance to consider the background from cells and media components. The use of balanced salt solution instead of media and special microplates designed for fluorescence readings of mammalian cells can reduce the contribution of background fluorescence. For kinetic measurements which consider the modulation of gene expression (up/down regulation) and which result in less fluorescence recorded, especially when d2EGFP is used, the above mentioned constraints have to be more strictly inspected.

PLASMA-VOLUME DEFICITS AND SALT AND WATER EXCRETION AFTER SURGERY

Plasma-volume deficits have been de Summary scribed after major surgery but their significance is uncertain, as is their relation to postoperative salt and water excretion. Two groups of patients undergoing large-bowel surgery were studied. One group was given balanced salt solution during and after surgery, whereas the other group was treated conventionally by salt and water restriction. There was a significant plasma-volume deficit after operation in patients managed by salt and water restriction, and this was associated with antidiuresis and sodium conservation. Cases given balanced salt solution had no plasma-volume deficit and no reduction in postoperative urine flow and urinary sodium excretion, although antidiuretic-hormone activity was also observed in such patients. These results support the hypothesis that circulatory-volume deficits account for postoperative sodium conservation and suggest that the use of balanced salt solutions in moderation during and after major surgery may be justifiable.

Physiological response to crystalloid resuscitation of severe burns.

SummaryThe use of balanced salt solutions in the resuscitation of burn shock has been evaluated in experimental animals and clinical burns utilizing the maintenance of functional ECF volume and circulatory response as the criteria of effectiveness. In both animal and clinical burns restoration of the functional ECF required greater quantities administered at a faster rate than was anticipated.In the first 24–30 hr post‐burn, circulatory hemodynamics appear to be closely correlated with functional ECF volume maintenance. After this time, changes in the circulatory status seem to be unrelated to fluid administration.

Rationale for the use of balanced salt solutions during anæsthesia and surgery

Rationale for the use of balanced salt solutions during anæsthesia and surgery