Non-steroidal Anti-inflammatory Drops Research Articles

FULL-THICKNESS MACULAR HOLE CLOSURE WITH TOPICAL MEDICAL THERAPY.

To examine the efficacy and clinical characteristics of successful full-thickness macular hole closure with topical therapy. Retrospective case series of full-thickness macular holes managed by a single retinal physician (DS) diagnosed and treated from 2017 to 22. Of 168 patients with full-thickness macular holes, 71 patients were started on steroid, carbonic anhydrase inhibitor, and nonsteroidal antiinflammatory (NSAID) drops. 49 patients (mean 67 years, 59% women) were included in the analysis, and 22 patients were excluded for poor follow-up. In total, 7/49 were secondary post-PPV holes and 42/49 were idiopathic. In addition, 18/49 eyes (36.7%) achieved closure on topical therapy, of which 13 were idiopathic. Hole size was directly correlated with odds of closure: for every 10 μm decrease in size and odds of closure increased by 1.2× ( P = 0.001, CI 1.1-1.4). Average time to closure was 107.2 days (range 20-512 days) and was not correlated with hole size ( P = 0.217, CI -0.478 to +1.938). The presence of VMT was found to be inversely related to successful closure (OR 6.1, P = 0.029, CI 1.2-31.3). There was no significant difference in final best-corrected visual acuity for eyes undergoing primary pars plana vitrectomy versus those trialing drops before undergoing pars plana vitrectomy ( P = 0.318, CI -0.094 to +0.112). In the first study to date to report the overall efficacy and clinical characteristics of successful macular hole closure with topical therapy, drops achieved an overall closure rate of 36.7%, with higher efficacy in smaller holes and those without VMT. Rates of MH narrowing and reduction in central foveal thickness acted as predictors of effectiveness of drop therapy.

The effects of non-prostaglandin hypotensive drops with preservative on central retinal thickness after phacoemulsification

BACKGROUND: Primary open angle glaucoma is often associated with cataract. The correlation between the use hypotensive drops, in particular non-prostaglandin hypotensive drops with preservative, and the change in central retinal thickness after phacoemulsification with intraocular lens implantation continues to be relevant.
 AIM: To evaluate central retinal thickness and pseudophakic cystoid macular edema incidence after phacoemulsification with intraocular lens implantation in patients with primary open-angle glaucoma using non-prostaglandin hypotensive drops with preservatives.
 MATERIALS AND METHODS: 94 patients (108 eyes) with cataract were enrolled in the study, divided into 3 groups: the first group 21 patients (27 eyes), and the second group 21 patients (23 eyes) with primary open-angle glaucoma using non-prostaglandin hypotensive drops with preservative; the third (control) group included 52 patients (58 eyes) without ocular comorbidities. All patients underwent uncomplicated phacoemulsification with intraocular lens implantation. In the post-op period, patients of the first group received topical antibiotics and steroids, patients of the second and the third groups received the same treatment and non-steroidal anti-inflammatory drops as well. Central retinal thickness was measured using optical coherence tomography before surgery, 2 weeks, 2 and 6 months after surgery.
 RESULTS: The central retinal thickness increase in comparison with baseline values was more significant in the first group than in the second and the third groups, and the time of recovery to baseline values during 6 months after surgery was longer. Pseudophakic cystoid macular edema was not identified in any group.
 CONCLUSIONS: The use non-prostaglandin drops with preservative in patients with primary open-angle glaucoma does not affect pseudophakic cystoid macular edema development after uncomplicated phacoemulsification. Instillations of non-steroidal anti-inflammatory drops in the post-op period reduce the time of central retinal thickness recovery to baseline value.

Real-world treatment patterns and economic burden of post-cataract macular edema

BackgroundPost-cataract macular edema (PCME) is a condition that can occur in patients following cataract surgery without risk factors and complications. Although 80% of patients experience spontaneous resolution after 3 to 12 months, in persistent cases, it can lead to permanent vision loss if left untreated. There are currently no standardized treatment guidelines for PCME, and there have been limited studies showing the impact of PCME on annual Medicare spending and ophthalmology-related outpatient visits per case compared to those without the complication. This study aims to evaluate real-world treatment patterns and the economic burden of patients with PCME.MethodsThis retrospective claims analysis identified patients from the IBM® MarketScan® Commercial and Medicare Supplemental databases. Patients with (n = 2430) and without (n = 7290) PCME 1 year post cataract surgery were propensity score matched 1:3 based on age, geographic region, diabetes presence, cataract surgery type, and Charlson Comorbidity Index. Treatment pattern analysis for each PCME patient summarized the distribution of medications across lines of therapy. Economic burden analysis compared the mean number and costs of eye-related outpatient visits, optical coherence tomography imaging scans, and ophthalmic medications between the 2 groups using linear regression models.ResultsTreatment pattern analysis found 27 different treatment combinations across 6 treatment lines. The most common first-line treatments were topical steroid drops (372 [30%]), topical nonsteroidal anti-inflammatory drug drops (321 [27%]), and intraocular or periocular injectable steroids (189 [15%]). Compared to match controls, PCME patients averaged 6 additional eye-related outpatient office visits (95% CI: 5.7–6.2) resulting in an additional $3,897 (95% CI: $3,475 - $4,319) in total costs. Patients filled 3 more ophthalmology-related outpatient prescription medications (95% CI: 2.8–3.2), adding $371 in total cost (95% CI: $332 – $410).ConclusionsPCME treatment patterns showed wide clinical variability in treatments and time, specifically regarding injectable treatments and combination therapy. Additionally, significantly higher healthcare resource use and economic burden were found for both patients and payers when comparing PCME patients to non-PMCE controls. These results highlight the need for treatment standardization and demonstrate that interventions targeted at preventing PCME may be valuable.

Diagnostic difficulties in a very rare case of mycoplasma pneumoniae uveitis

Abstract Introduction: Mycoplasma pneumoniae is known as a common cause of respiratory tract infections, especially in children. Regarding extrapulmonary manifestations, many dysfunctions have been linked to circulating IgM antibodies, including eye diseases and disorders. In this report, we aim to highlight the importance of considering Mycoplasma pneumoniae a potential etiological agent that can cause significant eye structures inflammation. Case presentation: We present a case of a 22-year-old male patient who arrived at the Emergency Department complaining of visual acuity decrement. Fundoscopic examination outlined a pale optic nerve, covered by pre-papillary infiltrates and peripheric inflammatory infiltrates, accompanied by signs of vasculitis. Investigations were performed and a multidisciplinary assessment was conducted. General antibiotic and antimycotic treatment and topical non-steroidal anti-inflammatory drops were administrated but his symptoms were aggravating, although it was continuously upgraded. Antibodies for Mycoplasma pneumoniae were determined with positive IgM and macrolide antibiotherapy was administrated, with favorable evolution. Conclusions: Mycoplasma pneumoniae should not be excluded as a possible cause of severe ocular inflammations, even in asymptomatic patients. The patient’s management should include multidisciplinary assessment for an easier diagnosis in cases of uncertainty.

The effect of topical steroids and non-steroidal anti inflammatory drugs on epiphora of unknown cause: Optical coherence tomography study.

The aim of this study is to evaluate using topical non-steroidal antiinflammatory and low-potency steroid drugs for the treatment of epiphora without an underlying cause using anterior segment-optical coherence tomography (AS-OCT) and Munk epiphora grading system. Thirty patients with epiphora who had no underlying cause were evaluated prospectively.A detailed ophthalmological examination, tear meniscus height on slit-lamp, fluorescein tear break-up time, schirmer test, lisamin green conjonctival staining, lacrimal syringing of the upper and lower canaliculus were done in all patients. The patients with contact lens wear,punctal stenosis, lacrimal system disorders, dry eye disease, eyelid malpositions, pterygium, conjunctivochalasis, conjunctivitis, blepharitis, ocular infection, and corneal disease, used topical anti-glaucomatous drugs were excluded. All patients were treated with a combination of topical low-potency drug (loteprednol etabonate 0.5%) twice daily for ten days and topical non-steroidal anti-inflammatory drug (nepafenac 0.3%)once a day for 1 month. Before and after the medical treatment protocol, tear meniscus area (TMA) and tear meniscus height (TMH) were measured by AS-OCT and patients were asked to subjectively rate their epiphora according to the Munk epiphora grading system. The effectiveness of treatment were evaluated by AS-OCT measurements and the Munk epiphora grading system. Fourteen males and sixteen females were included. The mean age at presentation was 60.1±7.35 years and duration of symptoms was 10.03±5.08 months. The mean duration of follow-up was 8.7±3.2 months. Munk epiphora grading system was significantly decreased from 2.5 to 1.6 after treatment (p: 0.004). TMH and TMA were significantly decreased on AS-OCT (TMH:402vs 309µm, p:0.001, TMA:0.797vs 0.347 mm2, p=0.006).Six of thirty patients subjectively reported that their symptoms had not improved but TMH and TMA were significantly decreased on AS-OCT. The combined use of topical non-steroidal anti-inflammatory and low-potency steroid drops may be a good option in patients with epiphora who does not have an underlying cause.

Predictive Factors and Management of Macular Edema after Retropupillary Iris-Claw Intraocular Lens Implantation in Aphakia: National Multicenter Audit-Report 2.

The aim of this multicenter, national clinical audit is to evaluate the predictive factors and management of postoperative macular edema (ME) after retropupillary iris-claw intraocular lens (RICI) implantation and pars plana vitrectomy (PPV). Preoperative, surgical and postoperative data were collected. Number and type of intravitreal injections (IT) administered (anti-VEGF or dexamethasone implant), visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) assessed by OCT were collected at 1, 3, 6 and 12 months. From 325 eyes (325 patients), 11.7% (38/325) developed postoperative ME. Previous complicated cataract surgery with no capsular support was the only significant predictive factor for developing postoperative ME (OR 2.27, 95% CI 1.38-4.52, p = 0.02) after RICI implant. Mean time to ME development was 11.4 ± 10.7 weeks, and mean CRT peaked at 3 months follow-up. Different treatment options were non-steroidal anti-inflammatory (NSAIDs) drops (31.6%, 12/38), dexamethasone (DEX) implant (50%, 19/38), anti-VEGF (7.9%, 3/38) or combined IT (10.5%, 4/38). Cumulative probability of ME resolution was higher in the group treated with IT than in the group treated with topical NSAIDs (85.2% vs. 58.3%, p = 0.9). Performing RICI implantation after complicated cataract surgery is a risk factor for the development of postoperative ME. DEX implants may be an effective treatment for postoperative ME in these cases.

Multimodal imaging findings in Purtscher-like retinopathy after retrobulbar anesthesia

Introduction: This is a case of Purtscher-like retinopathy with an unusual etiology of retrobulbar anesthesia, evidenced by optical coherence tomography-angiography (OCT-A) images. Patient and Clinical Findings: After cataract surgery with a retrobulbar block, a 65-year-old woman experienced sudden dramatic visual reduction with superficial white retinal patches on fundus examination and corresponding capillary bed infarcts on fluorescein angiography and OCT-A. Diagnosis, Intervention, and Outcomes: Using advanced OCT-A, fluorescein angiography imaging, and fundus photography, the patient was diagnosed with Purtscher-like retinopathy. The patient was treated with topical steroids, nonsteroidal anti-inflammatory drops, and antibiotic drops, with gradual and nearly complete resolution of visual acuity. Conclusions: This case represents a rare but possible complication of retrobulbar anesthesia associated with cataract surgery. Despite dramatic changes on OCT-A, and in contrast to other reports with similar characteristic findings, our patient regained significant vision.

A Comparison of Efficacy of Nepafenac 0.1% with Nepafenac 0.3% Drops for the Management of Post-Operative Inflammation and CME in Uneventful Phacoemulsification

Aim: To compare the efficacy of two topical nonsteroidal anti-inflammatory drops (NSAIDs) used in isolation in controlling inflammation and preventing cystoid macular edema (CME) after uneventful phacoemulsification. Design: Single armed randomized prospective study Methods: 200 patients who underwent uneventful phacoemulsification from December 2020 to March 2021 by a single surgeon were randomly assigned to be given one of the two NSAID drops. Among the 200 individuals those were included in the study, 192 patients completed follow up visits at 1 and 6 weeks and were included for analysis of the results. The efficacy of the drugs was evaluated by comparing the grade of pain score, conjunctival hyperemia, anterior chamber (AC) cells, along with best corrected visual acuity (BCVA), central macular thickness (CMT) and intraocular pressure (IOP) recorded at 1 and 6 weeks after surgery. Results: Between the two NSAID groups, there was no significant difference in pain ratings, AC cell grade, or visual acuity. There was no significant difference in the number of patients experiencing CME at 6 weeks. At 1 and 6 weeks, however, the mean rise in central macular thickness and conjunctival hyperemia in nepafenac 0.3 percent was much smaller. Conclusion: The efficacy of both the topical NSAIDs was found to be comparable in terms of pain score, AC cells grade and visual acuity. Though occurrence of CME after surgery was similar in both the NSAID’s, subclinical CME was less in Nepafenac 0.3% group both at 1st and 6th week follow up. Keywords: non-steroidal anti-inflammatory drugs, visual acuity, central macular thickness, cystoid macular edema, phacoemulsification.

Evaluation of retinal thickness and of pseudophakic cystoid macular edema incidence in patients with primary open-angle glaucoma treated with prostaglandin analogues

Background. Cataract is often associated with primary glaucoma. Prostaglandin analogues use is considered to be a risk factor for pseudophakic cystoid macular edema.
 Purpose. To evaluate the effect of prostaglandin analogues and non-steroidal anti-inflammatory drops on the central retinal thickness and the incidence of pseudophakic cystoid macular edema after phacoemulsification with intraocular lens implantation in patients with primary open-angle glaucoma.
 Materials and methods. 91 patients were enrolled in the study. 22 patients (22 eyes) were included in the first main group and 22 patients (22 eyes) were included in the second main groups. All patients in main groups had glaucoma and used prostaglandin analogues. 47 patients (57 eyes) without glaucoma were included in the control group. All patients were treated with topical antibiotics and steroids after phacoemulsification. Patients in the main second and in the control groups also received non-steroidal anti-inflammatory drops. The retinal thickness was measured by optical coherence tomography 2 weeks, 2 months and 6 months after the operation.
 Results. After the operation, the foveal thickness in patients of the first and the second groups was increased, but it had returned to the preoperative level after 6 months in the first group and after 2 months in the second group. The retinal thickness in the fovea in the control group decreased after the surgery and it has been increasing gradually but did not achieve the preoperative value.
 Conclusion. Prostaglandin analogues use after phacoemulsification with intraocular lens implantation does not affect the incidence of pseudophakic cystoid macular edema. Prescribing non-steroidal anti-inflammatory drops after the surgery helps to achieve faster normalization of the central retinal thickness.

Modified inexpensive needle for suprachoroidal triamcinolone acetonide injections in pseudophakic cystoid macular edema.

Pseudophakic cystoid macular edema (PCME) is one of the leading causes of reduced vision, after cataract surgery. Topical steroids and nonsteroidal anti-inflammatory drops are frequently used in the management; however, intravitreal injections may be required for chronic cases. Suprachoroidal injection of preservative free Triamcinolone acetonide is a recent addition to the therapeutic armamentarium of ophthalmologists for treatment of cystoid macular edema of varied etiology. Though the drug is commercially available at a reasonable cost, the microneedle is not commonly available. We modified a 26 G needle for safe and cost-effective delivery of preservative-free suprachoroidal triamcinolone acetonide (SCT). In the current series of three patients with non-resolving PCME, macular edema resolved and vision improved over 3 months.

MACULAR BURNS AS A RESULT OF EXPOSURE TO GREEN LASER POINTER OF III B CLASS

We present a clinical case of macular burn as a result of the effect of laser pointer observed in our 14-year-old patient. The laser pointer wasaclass IIIBlaser according to the classification of laser power (based on the wavelength and output power of the laser). The patient focused the laser beam on his eyes for a few seconds and then noticed a black spot on both eyes. Examinations revealed decreased visual acuity in both eyes, and spectral-domain optical coherent tomography (SD-OCT) and fluorescent angiography (FAQ) revealed defects in the outer lamellar layers of the retina. Topical corticosteroids and non-steroidal anti-inflammatory drops were used for treatment. Re-examination after 3 months showed some clinical improvement, but there were persistent effects

Control of Pain in Intravitreal Injections: Evaluation of Combination Topical Anesthetics and Non-steroidal Anti-inflammatory Drops: A Randomized, Placebo-Controlled Clinical Trial

Abstract Our randomized, double-blind, placebo-controlled trial investigated the utility of NSAID drops in pain control following intravitreal injection. The addition of topical NSAID to proparacaine drops and lidocaine ophthalmic gel had negligible effect on subjective pain.

Review of the Evidence for Topical Nonsteroidal Anti-inflammatory Drugs Post-cataract Surgery

In this article, we review the recent literature surrounding the use of topical nonsteroidal anti-inflammatory drops for prophylaxis of cystoid macular edema following uncomplicated cataract surgery. As has been found with past research, most recent studies suggest that topical NSAIDs may help reduce the incidence of postoperative cystoid macular edema. The effect may be minimal in patients at low risk for macular edema, and more pronounced in those at high risk. The evidence suggests that the effect is maximized when used in combination with topical corticosteroids. Although there remain several limitations to the research on this topic that restrict our ability to draw firm conclusions, the bulk of the evidence supports the use of postoperative topical NSAIDs for cataract surgery in patients at high risk for macular edema. However there is no consensus regarding the ideal choice of NSAID, or the ideal dosing regimen following surgery.

Effect on Gel Formation Time of Adding Topical Ophthalmic Medications to ReSure Sealant, an In Situ Hydrogel.

The purpose of this study was to describe the gel formation times of ReSure(®) Sealant, an in situ hydrogel approved to seal cataract surgery incisions, when commercially available topical medications are mixed with the sealant. In this experimental laboratory study, the commercial product, ReSure Sealant, was used as per the product insert. Two drops of diluent were mixed with the polymer and time to gel formation was measured. Following this, various commercial antibiotic, nonsteroidal anti-inflammatory drug and steroid drops were used in substitution of one of the drops of the diluent. Combinations of 2 medications were also tested. Each condition was performed in triplicate and the mean gel time was calculated. The addition of bromfenac slightly reduced mean gel time from 19 s (ReSure alone) to 13 s. All other medications, including moxifloxacin, gatifloxacin, ofloxacin, ciprofloxacin, loteprednol etabonate, prednisolone acetate, dexamethasone, ketorolac, and nepafenac, increased mean gel time, ranging from 49 s to >120 s. The addition of bromfenac to moxifloxacin, ofloxacin, or gatifloxacin reduced their mean gel times from ≥105 s to 18-29 s. Certain medications, specifically bromfenac, may not substantially alter time to gel formation of ReSure Sealant when added to the hydrogel. In fact, bromfenac added to moxifloxacin, ofloxacin, or gatifloxacin reduced gel formation time to acceptable levels. All other medications and combinations of medications added to ReSure Sealant produced unacceptably long gel times to be used routinely. Clinical studies may be considered based on these results to assess the safety and efficacy of this strategy.

Traitement de l’œdème maculaire postopératoire (syndrome d’Irvine-Gass) par implant intravitréen de dexaméthasone 700 μg

To evaluate the efficacy of dexamethasone 0.7 mg intravitreal implant in patients with postoperative cystoid macular edema. Fourteen patients' charts with postoperative cystoid macular edema were retrospectively reviewed. The main outcome measures were best-corrected visual acuity (BCVA) and mean central retinal thickness (CRT). Patients' mean age was 72.1 years old. Five patients were diabetic. All patients had previously been treated with non-steroidal anti-inflammatory drops. Four patients had received a previous treatment with intravitreal ranibizumab. The mean follow-up period was 8.7 months. Mean BCVA before intravitreal dexamethasone was 0.72 logMAR. After injection, it improved to 0.50 at month 1, was 0.47 at month 3, and 0.60 logMAR at month 12. The pre-injection mean CRT was 598 μm. It improved to 286 μm at month 1, 338 μm at month 3, and was 441 μm at month 12. Eight patients received 2 intravitreal injections of dexamethasone. Five patients presented with elevated intraocular pressure during follow-up, which was treated with drops. Intravitreal dexamethasone injection improved visual acuity and macular thickness at month 1 and month 3 in patients with postoperative cystoid macular edema. A second injection was necessary after a mean period of 5 months.

Phakic Cystoid Macular Edema Secondary to Idiopathic Macular Telangiectasia Type 1 Responsive to Topical Anti-Inflammatory Agents

ABSTRACTPurpose: To report a 65-year-old male patient with bilateral phakic cystoid macular edema secondary to idiopathic macular telangiectasia type 1, with robust response to topical steroidal and non-steroidal agents.Methods: Retrospective interventional case report. Chart review.Results: Snellen visual acuity was 20/40 bilaterally. Color fundus photographs showing golden crystalline deposits temporal to the fovea; fluorescein angiography demonstrating telangiectasias with late leakage; and spectral-domain optical coherence tomography revealing intraretinal and subretinal fluid demonstrated findings consistent with idiopathic macular telangiectasia type 1 with bilateral cystoid macular edema. The patient was treated with steroidal and non-steroidal anti-inflammatory drops with complete resolution of edema within two months and improved visual acuity. Over the next two years, edema recurred whenever the drops were stopped and disappeared with reinstitution of topical therapy.Conclusion: Topical steroidal and non-steroidal anti-inflammatory agents may lead to long-term resolution of cystoid macular edema secondary to idiopathic macular telangiectasia type 1.

Corneal densitometry evaluation in archipelago keratitis

To report a case of archipelago keratitis and its improvement as evaluated by corneal densitometry. A review of the patient's record and relevant literature. A 57-year-old man presented with blurred vision associated with photophobia and halos around lights. Slit-lamp examination revealed multiple confluent, nummular subepithelial infiltrates. The infiltrates were unresponsive to topical nonsteroidal anti-inflammatory drops. The treatment was changed to topical steroids and oral acyclovir and a diagnosis of archipelago keratitis was made. The patient showed quick response to the treatment and the infiltrates disappeared within 5weeks. However, no clear changes were observed initially by slit-lamp but corneal densitometry allowed us to evaluate improvement as the density value decreased from 96.5 to 38.6. After 10days of treatment all the symptoms were resolved. Archipelago keratitis responded well to topical steroids and oral acyclovir. We describe the use of corneal densitometry complementary to slit-lamp examination in the clinical observation of archipelago keratitis.

Self-medication in Ophthalmology: A Questionnaire-based Study in an Argentinean Population

Purpose: The aim of this study was to identify practices of self-medication in the treatment of ocular conditions and to identify a profile of patients who self-medicate.Methods: We conducted a cross-sectional descriptive survey of patients, over the age of 17 years seen in our ophthalmology practice in Cordoba, Argentina. Self-medication was defined as the use of ophthalmic medicines which had not been prescribed by a health care specialist in the previous year.Results: The sample included 379 subjects, 162 males (43%) and 217 females (57%); mean age 46.8 years. Prior to looking for medical attention in our institution, 97 patients (25.6%) reported self-medicating. The most frequently employed products included non-steroidal anti-inflammatory drops in combination with a vasoconstrictive agent (32%) followed by a combination of antibiotics and steroids (9%), however, 14% of patients did not remember the name or type of medication applied. A total of 31% of patients used drugs recommended by a pharmacist; 25% used drugs of their own choosing and 24% followed suggestions from a friend or family member. Only 12% of patients knew the drug’s components and only 3% were aware of any possible side effects. There was no difference in behavior patterns related to educational level or age, however, there was a significant difference related to gender, with males misusing ophthalmic drops more frequently than women (P = 0.004).Conclusions: Patients commonly attempt to treat conditions that require ophthalmologic care by self-medicating with over-the-counter eye drops. Educational efforts to inform patients of the consequences of self-medication are necessary.

Prophylactic treatment for cytosine arabinoside-induced keratoconjunctivitis

High-dose cytosine arabinoside (Ara-C) is known to cause keratoconjunctivitis in a large proportion of patients. Topical steroids are a popular choice of prophylactic treatment. The objective of this survey was to evaluate the type, dose, frequency and duration of drops used in all centres (n=117) participating in the acute myeloid leukaemia trial 15 (AML 15), and to assess adherence to the trial protocol prescribed guidelines. All centres used prophylactic treatment; however, the dose of Ara-C at which it was initiated varied from 100 to 6000mg/m(2)/day. All centres used some form of steroid prophylaxis with prednisolone 0.5% being the most commonly used (98/117), but only 6 of the 117 centres initiated treatment at doses recommended in the trial protocol. Ten centres used lubricants in addition to steroids. No centre reported the use of non-steroidal anti-inflammatory drops. The duration of treatment ranged from 2days prior to commencing Ara-C to 28days post-treatment. Twenty-two centres reported complications of which preservative allergy was the commonest. There is a large variation in prophylactic treatment practice in the UK. Clear guidance on the use of prophylaxis and further studies are required to ascertain the most effective prophylactic treatment and regimen.

Prise en charge de l’anesthésie pour une chirurgie du strabisme chez l’enfant

Strabismus surgery is one of the most common pediatric ophthalmic procedures. The purpose of this continuing professional development module is to update physicians on the anesthetic considerations of pediatric patients undergoing strabismus surgery. The preoperative assessment is important, as patients undergoing strabismus surgery may have an associated neuromuscular disorder, congenital syndrome, or cardiac disease. Malignant hyperthermia is no longer considered as being an issue associated with strabismus. The laryngeal mask airway is used frequently and has been shown as being associated with a low incidence of complications in strabismus surgery. The anesthesia technique can be adapted to decrease the incidence of the oculocardiac reflex and the oculorespiratory reflex, and the use of anticholinergic prophylaxis remains debatable. Since patients are at high risk for postoperative nausea and vomiting (PONV), combination anti-emetic therapy is recommended using dexamethasone and ondansetron. Metoclopramide was not found to provide additional benefit when combined with other anti-emetics. Droperidol is effective, but there remains a black box warning for dysrhythmias. Effective analgesics in this patient population include acetaminophen, nonsteroidal anti-inflammatory drugs, peribulbar blocks, and subtenon blocks. Topical tetracaine drops have demonstrated mixed results, and topical nonsteroidal anti-inflammatory drops were found not to be effective. The use of opioids should be minimized due to the increased incidence of PONV. To provide optimal care for the pediatric patient undergoing strabismus surgery, it is important to understand the unique anesthetic considerations for strabismus surgery and to appreciate how each decision regarding the anesthetic technique can alter these considerations.