Ophthalmic Procedures Research Articles

A custom virtual reality training solution for ophthalmologic surgical clinical trials

We present a summary of the development and clinical use of two custom designed high-fidelity virtual-reality simulator training platforms. This simulator development program began in 2016 to support the phase III clinical trial Archway (ClinicalTrials.gov identifier, NCT03677934) intended to evaluate the Port Delivery System (PDS) developed by Genentech Inc. and has also been used to support additional clinical trials. The two simulators address two specific ophthalmic surgical procedures required for the successful use of PDS and provide state-of-the-art physical simulation models and graphics. The simulators incorporate customized active haptic feedback input devices that approximate different hand pieces including a custom hand piece specifically designed for PDS implantation. We further describe the specific challenges of the procedure and the development of corresponding training strategies realized within the simulation platform.

Prevalence of COVID-19 Infection Among Asymptomatic Ophthalmic Surgical Patients Undergoing Ophthalmic Procedures at University of Abuja Teaching Hospital, Gwagwalada, Abuja

Purpose:The aim of this article is to determine the prevalence of COVID-19 infection among asymptomatic ophthalmic patients undergoing ophthalmic procedures at University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.Materials and Methods:A retrospective review of records of all consecutive ophthalmic patients who had pre-operative reverse transcriptase–polymerase chain reaction testing for COVID-19 screening before an elective surgical procedure between July 2020 and January 2021 was done. A semi-structured questionnaire was used to extract the following information from eligible patients’ case records: age, gender, results of COVID-19 tests, type of ophthalmic surgical procedure done, and ocular examination findings and diagnosis.Results:Out of the 150 patients scheduled for surgical procedures within the study period, only 14 (9.3%) returned a positive test result. These patients had their surgeries postponed and were asked to return with negative results 2 weeks later. No association was found between gender, age, or type of surgical procedure and the prevalence of COVID-19 infection.Conclusion:This study found that 1 in 11 patients scheduled for elective ophthalmic procedure was a carrier of COVID-19 infection, highlighting the need for regular pre-operative testing in order to reduce the risk of spread of infection to healthcare workers and other hospitalized patients.

OPHTHAMIC VISCOSURGICAL DEVICE PROCEDURES : A MIRACLE TOOL FOR SURGICAL CATARACT MANAGEMENT.

Introduction: Ophthalmic viscosurgical devices have remained an indispensable part of the cataract surgery armamentarium now for decades. Their use has been for forming the anterior chamber and protection of the corneal endothelium. Viscodissection and viscodelineation have been described by authors . We designed a study to evaluate the usefulness of ophthalmic viscosurgical device procedures in our phacoemulsication cases . Aim: The study documents the use of ophthalmic viscosurgical device procedures as an added step to facilitate cataract removal. Methods: Twenty ve consecutive cases of cataract with nuclear sclerosis one or two withor without any grade of posterior subcapsular opacication were enrolled. The cases were performed by a single operator. Phacoemulsication was performed as per protocol. Ophthalmic viscosurgical device procedures were performed as an additional step. Subjective and objective assessments were done post operatively. Results: The use of ophthalmic viscosurgical device procedures reduced the total phaco energy used per case. Discussion: Ophthalmic viscosurgical device procedures are advocated as an adjunct to power modulations to reduce the total phaco energy used per case. Conclusion: In the era of increasing sophistication ophthalmic viscosurgical device procedures represent an exciting paradigm shift towards minimalization and efcacy.

Assessing the quality of online information on glaucoma procedures

ObjectiveTo investigate the quality of information related to glaucoma procedures found online using 2 different assessment tools. DesignCross-sectional survey of 100 web sites found via Google search engine. MethodsThe terms “peripheral iridotomy” and “trabeculectomy” along with synonymous keywords were inputted into Google's search engine. The first 50 functional websites for each term were assessed by 2 independent raters using the DISCERN instrument as well as a quality assessment tool by the Journal of the American Medical Association (JAMA). Statistical analysis included an evaluation of intra-rater reproducibility and interclass correlation between the 2 scales. Main outcome measures(i) Quality of web site content based on DISCERN and JAMA scores, (ii) quality of web site based on categorization of web site (iii), intra-rater reproducibility of each scale, and (iv) interclass correlation between the 2 rating scales. ResultsOnly 22% of the web sites for peripheral iridotomy and 34% of the web sites for trabeculectomy met all the criteria for JAMA's quality assessment. The mean DISCERN scores for peripheral iridotomy and trabeculectomy were 44 and 43.7, respectively, indicating poor quality. For the DISCERN scale, level of agreement between raters for each question ranged from κ = 0.550 (95% confidence interval [CI] 0.700–1.026) to κ = 0.884 (95% CI 0.751–1.017). For the JAMA 4 scale, level of agreement for each question ranged from κ = 0.874 (95% CI 0.734–1.01) to κ = 1.00. ConclusionOur study indicates that information found online for two common ophthalmic procedures is of variable and poor quality. Thus, patients may be receiving misinformation online and better measures need to be implemented to avoid the dissemination of low-quality health information.

Microscope integrated optical coherence tomography system combined with augmented reality.

One of the disadvantages in microscope-integrated optical coherence tomography (MI-OCT) systems is that medical images acquired via different modalities are usually displayed independently. Hence, surgeons have to match two-dimensional and three-dimensional images of the same operative region subjectively. In this paper, we propose a simple registration method to overcome this problem by using guided laser points. This method combines augmented reality with an existing MI-OCT system. The basis of our idea is to introduce a guiding laser into the system, which allows us to identify fiducials in microscopic images. At first, the applied voltages of the scanning galvanometer mirror are used to calculate the fiducials' coordinates in an OCT model. After gathering data at the corresponding points' coordinates, the homography matrix and camera parameters are used to superimpose a reconstructed model on microscopic images. After performing experiments with artificial and animal eyes, we successfully obtain two-dimensional microscopic images of scanning regions with depth information. Moreover, the registration error is 0.04 mm, which is within the limits of medical and surgical errors. Our proposed method could have many potential applications in ophthalmic procedures.

Changes in Medicare Reimbursement for Commonly Performed Ophthalmic Procedures

Thirteen of the fifteen most commonly reported procedures in ophthalmology were subject to a statistically significant reduction in inflation-adjusted reimbursement from 2011 to 2020. A sustainable alternative to budget neutrality is critical.

Frequency of Urgent or Emergent Vitreoretinal Surgical Procedures in the United States During the COVID-19 Pandemic

The American Academy of Ophthalmology (AAO) indicated that urgent or emergent vitreoretinal surgical procedures should continue during the coronavirus disease 2019 (COVID-19) pandemic. Although decreases in the frequency of critical procedures have been reported outside the field of ophthalmology, analyses are limited by volume, geography, and time. To evaluate whether the frequency of ophthalmic surgical procedures deemed urgent or emergent by the AAO changed across the United States during the COVID-19 pandemic. Vitreoretinal practices from 17 institutions throughout the US participated in this multicenter cross-sectional study. The frequency of 11 billed vitreoretinal Current Procedural Terminology (CPT) codes across respective weeks was obtained from each practice between January 1, 2019, and May 31, 2020. Data were clustered into intravitreal injections (code 67028), lasers and cryotherapy (codes 67141, 67145, and 67228), retinal detachment (RD) repairs (codes 67107, 67108, 67110, and 67113), and other vitrectomies (codes 67036, 67039, and 67040). Institutions were categorized by region (Northeast, Midwest, South, and West Coast), practice setting (academic [tax-exempt] or private [non-tax-exempt]), and date of respective statewide stay-at-home orders. Nationwide changes in the frequency of billing for urgent or emergent vitreoretinal surgical procedures during the COVID-19 pandemic. A total of 526 536 CPT codes were ascertained: 483 313 injections, 19 257 lasers or cryotherapy, 14 949 RD repairs, and 9017 other vitrectomies. Relative to 2019, a weekly institutional decrease in injections was observed from March 30 to May 2, 2020, with a maximal 38.6% decrease (from a mean [SD] of 437.8 [436.3] to 273.8 [269.0] injections) from April 6 to 12, 2020 (95% CI, -259 to -69 injections; P = .002). A weekly decrease was also identified that spanned a longer interval, at least until study conclusion (March 16 to May 31, 2020), for lasers and cryotherapy, with a maximal 79.6% decrease (from a mean [SD] of 6.6 [7.7] to 1.5 [2.0] procedures) from April 6 to 12, 2020 (95% CI, -6.8 to -3.3 procedures; P < .001), for RD repairs, with a maximal 59.4% decrease (from a mean [SD] of 3.5 [4.0] to 1.6 [2.2] repairs) from April 13 to 19, 2020 (95% CI, -2.7 to -1.4 repairs; P < .001), and for other vitrectomies, with a maximal 84.3% decrease (from a mean [SD] of 3.0 [3.1] to 0.4 [0.8] other vitrectomies) from April 6 to 12, 2020 (95% CI, -3.3 to -1.8 other vitrectomies; P < .001). No differences were identified by region, setting, or state-level stay-at-home order adjustment. Although the AAO endorsed the continued performance of urgent or emergent vitreoretinal surgical procedures, the frequency of such procedures throughout the country experienced a substantial decrease that may persist after the COVID-19 pandemic's initial exponential growth phase. This decrease appears independent of region, setting, and state-level stay-at-home orders. It is unknown to what extent vitreoretinal intervention would have decreased without AAO recommendations, and how the decrease is associated with outcomes. Although safety is paramount during the COVID-19 pandemic, practices should consider prioritizing availability for managing high-acuity conditions until underlying reasons for the reduction are fully appreciated.

A Comparison of Awake Versus Deep Removal of Laryngeal Mask Airway in Children Aged 2 to 8 Years Who Underwent Ophthalmic Procedures at Menilik II Hospital: A Prospective Observational Cohort Study

A Comparison of Awake Versus Deep Removal of Laryngeal Mask Airway in Children Aged 2 to 8 Years Who Underwent Ophthalmic Procedures at Menilik II Hospital: A Prospective Observational Cohort Study

Real-time tool to layer distance estimation for robotic subretinal injection using intraoperative 4D OCT.

The emergence of robotics could enable ophthalmic microsurgical procedures that were previously not feasible due to the precision limits of manual delivery, for example, targeted subretinal injection. Determining the distance between the needle tip, the internal limiting membrane (ILM), and the retinal pigment epithelium (RPE) both precisely and reproducibly is required for safe and successful robotic retinal interventions. Recent advances in intraoperative optical coherence tomography (iOCT) have opened the path for 4D image-guided surgery by providing near video-rate imaging with micron-level resolution to visualize retinal structures, surgical instruments, and tool-tissue interactions. In this work, we present a novel pipeline to precisely estimate the distance between the injection needle and the surface boundaries of two retinal layers, the ILM and the RPE, from iOCT volumes. To achieve high computational efficiency, we reduce the analysis to the relevant area around the needle tip. We employ a convolutional neural network (CNN) to segment the tool surface, as well as the retinal layer boundaries from selected iOCT B-scans within this tip area. This results in the generation and processing of 3D surface point clouds for the tool, ILM and RPE from the B-scan segmentation maps, which in turn allows the estimation of the minimum distance between the resulting tool and layer point clouds. The proposed method is evaluated on iOCT volumes from ex-vivo porcine eyes and achieves an average error of 9.24 µm and 8.61 µm measuring the distance from the needle tip to the ILM and the RPE, respectively. The results demonstrate that this approach is robust to the high levels of noise present in iOCT B-scans and is suitable for the interventional use case by providing distance feedback at an average update rate of 15.66 Hz.

A Modifiable Head Drape Technique for the Oculoplastic Surgeon

Background: Placement of a head drape is an important step in ophthalmic plastic surgery. It must be comfortable for the patient and remain secure throughout the procedure to ensure sterility. Turban head draping is a common technique used amongst ophthalmic surgeons but the ‘turban’ tends to slip back if repositioning is required. Methods: We describe a modifiable technique for head draping in ophthalmic plastic surgery using three cloth drapes. Conclusion: The head drape technique described provides excellent exposure and a secure sterile field for ophthalmic plastic surgery procedures. It can be quickly and easily placed. The technique can be modified depending on available drapes and the procedure to be performed.

Pre-Operative SARS CoV-2 Rapid Antigen Test and Reverse Transcription Polymerase Chain Reaction: A conundrum in surgical decision making.

Purpose:Since the eye is in close proximity to the oro-nasal cavity, transmission of SARS CoV-2 is higher during ophthalmic surgical procedures, it is vital to ensure the safety of the healthcare team by pre-operative Rapid Antigen Test (RAT) and real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for SARS CoV-2 viral RNA of all patients planned for elective or emergency surgery. Hence, understanding the profile of pre-operative RAT and real-time RT-PCR among patients planned for various ophthalmic procedures, will help us make better decisions for future guidelines, for optimal planning of ophthalmic elective or emergency surgeries, keeping in mind the current scenario.Methods:This is a prospective descriptive study conducted on patients planned for elective or emergency ophthalmic surgeries, who had no COVID-19-related symptoms pre-operatively and were subjected to preoperative RAT and real-time RT-PCR of nasopharyngeal and throat swabs for SARS CoV-2 viral RNA. Data was compiled and statistically analysed.Results:204 patients underwent pre-operative RAT and RT-PCR testing; of which, 85 were females and 119 were males. Mean age of the study population was 51.44 ± 16.501 years. Among the 204, 2 tested positive for SARS CoV-2 with Rapid Antigen testing as well as RT-PCR and 10 patients tested positive via RT-PCR after a negative RAT result of the same sample.Conclusion:Pre-operative testing for COVID-19 disease is indispensable as there is a high chance of transmission from patient to healthcare workers. RAT has the advantage of quick results and may play a role in case of emergency procedures. However, it is prudent to perform the more sensitive real-time RT-PCR before any elective, non-emergency procedures or surgeries to avoid any undue risk to the healthcare team.

Swept source intraoperative OCT angiography

To accurately guide surgical instruments during ophthalmic procedures, some necessary intraoperative depth perception is required, which standard surgical microscopes supply limitedly. Intraoperative optical coherence tomography (iOCT), combining optical coherence tomography (OCT) technology and surgical microscope, enables noninvasive, real-time and high-resolution cross-sectional imaging. Currently, though iOCT enables structural imaging, little research has been done on intraoperative angiography. In this work, we presented a swept-source intraoperative OCT angiography (SS-iOCTA) system based on a standard surgical microscope, which provides both structural and angiographic images. The feasibility of the proposed SS-iOCTA was confirmed through deep anterior lamellar keratoplasty (DALK) of ex vivo porcine eyes and blood perfusion imaging of in vivo rat cortex. High-resolution intraoperative feedback, including sub-surface structure and angiogram of biological tissue, can be visualized simultaneously with the SS-iOCTA system, which expand the surgeon’s capabilities and could be widely used in clinical surgery.

Impact of a mobile unit on access to eye care in São Paulo, Brazil.

The goal of this study was to determine the impact of a mobile eye health unit on access to eye care and to generate a profile of the population requiring ophthalmic care by age, nature of their ophthalmic diseases, and optimal management. The study was conducted in 14 cities in the southwest region of São Paulo, Brazil. Subjects included individuals who participate in the Brazilian Unified Health System who were in need of eye care. There were no restrictions on age, gender or socioeconomic status. Data was transferred to an Excel table for statistical analyses. We evaluated 6,878 participants in this survey with mean age of 44 years (range 4 months to 96 years); 65.5% were female. Among the diagnoses, 78.6% presented with refractive errors, 9.6% presented with cataracts and 8.3% presented with pterygium. New corrective lenses were prescribed for 60.9% of the participants; 10% retained their existing lenses, ~28% required counseling only and18.1% of the participants were referred to a tertiary facility for specialized exams and/or surgical procedures. Of the participants who required outside referrals, 36.4% required oculoplastic/external eye surgery and 31.8% required cataract surgery. The vast majority of patients presenting to a mobile eye health unit required prescriptions for corrective lenses. The rate of detection of ocular disorders was relatively high and the mobile unit provided effective treatment of refractive errors and referrals for specialized ophthalmic examinations and procedures. A mobile eye health unit can be an effective alternative method for improving access to basic eye care, for promoting eye health education and preventing blindness.

The value and implementation of routine ophthalmic examination in the era of HAART.

BackgroundThe high prevalence of ocular manifestations (OMs) in patients with human immunodeficiency virus (HIV) infection and chronic diseases such as diabetes has become a global health issue. However, there is still a lack of an appropriate ophthalmic diagnostic procedure for the early detection of OMs in this population, leading to the risk of an irreversible visual impairment that substantially affects the quality of life of these patients.MethodsThe Guangzhou HIV Infection Study was a retrospective study that enrolled hospitalised HIV-infected patients in Guangzhou between January 2005 and December 2016, period corresponding to the highly active antiretroviral therapy (HAART) era in China. We collected data on OMs, systemic diseases, hospitalisation, and demographic characteristics. We classified the patients into 3 groups according to the ophthalmic examination mode they underwent: the non-ophthalmologist examination group (patients hospitalised in 2005–2011 who were only treated by infectious disease physicians), the on-demand ophthalmic examination group (patients hospitalised in 2012–2013 who were referred for a consultation with an ophthalmologist), and the routine ophthalmic examination group (patients hospitalised in 2014–2016 who routinely underwent standard ophthalmic examinations). Binary logistic regression models were used to investigate the factors related to OMs.FindingsA total of 8,743 hospitalised HIV-infected patients were enrolled. The prevalence of detected OMs were 1.5% in the non-ophthalmologist examination group, 1.9% in the on-demand ophthalmic examination group, and 12.8% in the routine ophthalmic examination group. The odds of detection of OMs were highest in the routine ophthalmic examination group (adjusted odds ratio [aOR]=9.24, [95%CI, 6.51–13.12], compared to the non-ophthalmologist examination group). The detection of all types of OMs increased substantially, with keratitis, retinitis and vascular abnormalities increased the most (by 15.8–20.0 times). In the routine examination group, patients who were older than 50 years, males, with medical insurance, and were not resident in Guangzhou, had higher odds to have OMs. Several systemic diseases also increased the odds of OMs, with the highest odds among patients with a cytomegalovirus infection (aOR=5.59, [95%CI, 4.12–7.59]). Patients with retinitis, retinopathy and conjunctivitis had higher odds of having a CD4+ T cell counts less than 200 cells/μL compared to the patients that did not have these referred OMs.InterpretationThe implementation of a routine ophthalmic examination has improved the odds of OM detection by approximately 9 times and increased the diagnosis rates of all types of OMs. Therefore, we encourage all HIV-infected patients to undergo regular ophthalmic examinations. Patients with OMs, especially retinopathy and retinitis, need to be evaluated for immune function (such as CD4+ T cell counts) and systemic diseases.

Comparison of intraocular pressure and hemodynamic responses to insertion of laryngeal mask airway or endotracheal tube in elective paediatric ophthalmic procedures

Introduction: The main objective of the study was to assess the benefits of using laryngeal mask airway in place of endotracheal intubation in reducing the intraocular pressure and hemodynamic response in paediatric patients posted for elective ophthalmic procedures. This prospective randomized study was conducted over a period of six months in the Regional institute of Ophthalmology. Materials and Methods: Sixty paediatric patients aged between 2-12 years, belonging to ASA grade 1 & 2 and posted for elective ophthalmic procedures were allocated into two groups, each of 30 patients, by a closed envelope method. Laryngeal mask airway (LMA) insertion for group I and Endotracheal intubation (ETI) for group II were performed. Intraocular pressure measurements at Baseline, pre-insertion, at 30th second and at 2nd minutes between the groups were compared. Corresponding responses in heart rate (HR), and mean arterial pressure (MAP) were also compared. Results: Statistically significant differences were seen at 30th second of intubation between group I and group II in HR [107.8±13.417in group I and 126.2±10.996 in group II], MAP [84.8±4.637 in group I and 98.4±8.6 in group II] and IOP (11.07+1.9 mmHg in group I and 15.76+2.7 mmHg in group II; P = 0.0001)]. Similarly, significant differences were also observed at 2nd minute of intubation. Conclusion: We found that LMA insertion has less influence on intraocular pressure and hemodynamic response and it is associated with less postoperative complications in children undergoing elective ophthalmic procedures under general anaesthesia. Keywords: Laryngeal mask airway, Intubation, Pressor response, Ophthalmic, Intraocular.

Aqueous Chlorhexidine Compared with Povidone-Iodine as Ocular Antisepsis before Intravitreal Injection: A Randomized Clinical Trial

Topical povidone-iodine (PI) is widely used as an ocular surface antiseptic for intravitreal injections (IVIs). Although PI is generally well tolerated, it can be associated with significant ocular irritation. Aqueous chlorhexidine (AqCHX) has been described as a possibly better tolerated antimicrobial for ophthalmic procedures. We compared patient pain scores, ocular surface characteristics, and antimicrobial efficacy between PI 5% and AqCHX 0.1% during IVIs. Prospective single-center, randomized clinical trial. Patients receiving same-day bilateral intravitreal anti-vascular endothelial growth factor (VEGF) injections. Each patient had 1 eye randomized to PI or AqCHX, and the second eye received the other agent. Both eyes received topical proparacaine 0.5%. After IVIs, participants rated their pain (Wong-Baker, scale 0-10) for each eye 1 minute after PI or AqCHX instillation and 1 day after the procedure. Each eye was assessed using a standardized quantitative grading system of corneal epitheliopathy (ocular staining score). Microbial swab cultures of the conjunctiva both before instillation of topical antisepsis and 10 minutes after IVIs were given. A total of 100 eyes of 50 patients were included. The mean patient age was 68 years (range, 39-92), and 30 of 50 (60%) were male. Compared with AqCHX, eyes receiving PI had a greater mean pain score immediately after injection (1.44 vs. 0.44, P < 0.001) but not on postprocedure day 1 (1.04 vs. 0.48, P= 0.06). Eyes that received PI had a higher ocular staining score indicating worse corneal epitheliopathy (4.22 vs. 3.10, P < 0.001). There was no difference in rates of positive microbial cultures between groups. There was no difference in rates of adverse events between groups (P= 0.99), and no cases of endophthalmitis occurred. Povidone-iodine demonstrated greater ocular surface discomfort and corneal epitheliopathy compared with AqCHX during same-day bilateral IVIs. The 2 agents otherwise demonstrated no difference in positive microbial cultures or adverse events. Aqueous chlorhexidine may be a better tolerated alternative to PI for antimicrobial prophylaxis during IVIs for some patients.

Postoperative Endophthalmitis and Toxic Anterior Segment Syndrome Prophylaxis: 2020 Update.

Improved surgical techniques have led to an increase in the number of outpatient ophthalmic procedures. In spite of decreased surgical times and overall improved outcomes, endophthalmitis remains one of the most severe complications of ophthalmic surgery. Although there are well known risk factors for postoperative endophthalmitis, some prophylaxis strategies remain controversial. A category of noninfectious postoperative inflammation, known as toxic anterior segment syndrome (TASS), is a rare but important complication of cataract surgery. While several worldwide outbreaks of TASS have occurred, it is challenging to identify an etiology in order to reduce the risk of further cases. Endophthalmitis and TASS cannot be prevented completely, but their rates may be decreased through risk reduction strategies supported by peer-reviewed evidence. This review highlights the current evidence in the prevention strategies for postoperative endophthalmitis and TASS.

Anaesthesia for ophthalmic procedures in patients with thyroid eye disease.

Thyroid eye disease is an autoimmune inflammatory disorder of the orbit in adults. It causes inflammation, expansion and fibrosis of orbital fat, muscles and the lacrimal gland, leading to facial disfigurement, functional disability and, in severe cases, blindness. Overall, approximately 20% of affected patients need some form of surgical intervention requiring anaesthesia. This narrative review explores the background of thyroid eye disease, surgical procedures performed and their implications for anaesthesia. General anaesthesia is used for orbital decompression procedures, strabismus correction surgery and complex oculoplastic procedures. Local anaesthetic infiltration or regional anaesthesia under monitored anaesthesia care are the techniques most commonly employed for eyelid retraction surgery. It is important to limit the volume of local anaesthetic agent used during infiltration and continuously monitor the orbital volume and ocular pressure with a ballottement technique. In addition, the contralateral eye should be checked and, if necessary, protected against corneal exposure. Retrobulbar, peribulbar and sub-Tenon's blocks are best avoided. Topical anaesthesia has been used for some strabismus correction surgery but its use is limited to motivated and cooperative patients only.

Spread of Respiratory Droplets in a Simulated Ophthalmic Surgery

Performing ophthalmic surgery safely during the coronavirus 2019 pandemic is important to ophthalmologists, anesthesiologists, nurses, patients, and health policy analysts. Although ophthalmic procedures themselves are not a major source of transmission,1 the upper respiratory tract may harbor high concentrations of severe acute respiratory syndrome coronavirus 2.2 Because concern exists that routine ophthalmic procedures may potentiate the spread of respiratory droplets onto operating room personnel, some centers mandate masks for all operative patients.

A Randomized Controlled Trial: Comparison of 4% Articaine versus 0.5% Bupivacaine for Ambulatory Orthopedic Surgery under Supraclavicular Block.

Background Articaine has been used in many dental and ophthalmic outpatient procedures. In the era of ultrasound-guided regional techniques, we searched for short and potent local anesthetic for patients undergoing ambulatory upper limb procedures. However, studies about articaine efficacy in brachial plexus block are limited. In this study, we compared its safety and efficacy against bupivacaine as a commonly used anesthetic agent for ultrasound-guided supraclavicular brachial plexus block. Methods This randomized prospective study was performed at Ain Shams University Hospital from January to March 2020. A total of 117 patients aged 20 to 60 years, with the American Society of Anesthesiologists physical status I and II, were enrolled in the study. Patients were randomly allocated into two groups: in group A, patients received 30 ml articaine 2%, and in group B, patients received 30 ml of bupivacaine 0.5%. We measured motor and sensory block duration as a primary outcome. Other secondary outcomes such as onset of block, duration of analgesia, patient satisfaction, and time to home discharge readiness were also measured. Results We analyzed data collected from 97 patients. The motor block duration was significantly shorter in group A (165.73 ± 20.33 min) than in group B (220.27 ± 37.73 min). The onset of motor block was faster in group A (8.73 ± 4.33 min), and the postoperative VAS score was lower in group B. Patients in group A achieved an earlier home discharge of 289.67 ± 2.73 min. Conclusion Earlier resolution of articaine block makes it more favorable than bupivacaine for ambulatory surgery. This trial is registered with (NCT04189198).