Ophthalmic Procedures Research Articles

Sustainable practices in ophthalmology-steps towards environmental stewardship in healthcare.

The healthcare sector, responsible for approximately 4-5% of global carbon dioxide equivalent (CO2eq) emissions, significantly impacts the environment due to its high energy consumption and waste generation. As aspecialty, ophthalmology has adisproportionately large environmental impact because of the high annual volume of ophthalmic surgeries. In recent years, significant organized efforts have focused on reducing ophthalmology's carbon footprint while maintaining quality patient care. As one example, EyeSustain is acoalition of 50global ophthalmology societies collaborating to advance sustainability in the delivery of eye care through education, research, and advocacy. Education and advocacy are critical to raising awareness and promoting the implementation of sustainable practices among physicians. Many of these practices can and should be applied throughout the broader healthcare system, and EyeSustain is amodel of how other specialties can organize education and advocacy efforts through medical societies. We review current initiatives, advocacy efforts, and waste-reduction strategies aimed at reducing the environmental footprint of ophthalmic procedures.

Insights from an online survey: Veterinary surgeons' antibiotic practices in ophthalmic surgery in Germany.

To investigate antibiotic usage practices in ophthalmic surgeries in Germany. An online questionnaire was sent to veterinary surgeons (general veterinarians and veterinarians with additional qualification in ophthalmology) inquiring about their antibiotic preferences, administration methods, and factors affecting antibiotic usage in ophthalmic surgical procedures. A total of 417 questionnaires were analyzed. Postoperative antibiotics (systemic/topical in percent when used) were used all or most of the time by 69% of veterinarians following enucleation (99/6), by 62% after eyelid surgery (54/69), by 68% after third eyelid (TEL) surgery (19/92) and by 80% after keratectomy (6/99). The most commonly used systemic antibiotic was amoxicillin with clavulanic acid and the most commonly used topical antibiotic was chloramphenicol. WHO "watch-group" antibiotics were infrequently administered systemically but frequently utilized topically; including in 13% of eyelid surgery, 15% of TEL surgery, and 35% of keratectomies. Factors influencing antibiotic use included fear of complications (67%), personal experience (63%), diagnostic uncertainty (21%), and owner expectations (9%). Participants following institutional guidelines used fewer antibiotics in enucleations (p = .002) and were less likely to choose fluoroquinolones post-eyelid surgery (p = .044). The potential for reducing antibiotic use following ophthalmic soft tissue surgery is significant. Addressing barriers such as concerns about postoperative complications and the reliance on individual clinical experience, the implementation of standardized guidelines could facilitate a shift toward more judicious antibiotic practices.

Peribulbar anesthesia decreases corneal and periocular sensation and can improve rat welfare during ophthalmic procedures

Peribulbar anesthesia decreases corneal and periocular sensation and can improve rat welfare during ophthalmic procedures

Influence of surgeon learning on outcomes in new ophthalmic procedures: quantified nationwide evidence in endothelial corneal transplantation

AimsTo investigate the impact of surgeon learning on endothelial keratoplasty (EK) procedure outcomes.MethodsA prospective nationwide registry study of EK grafts in patients aged at least 21 years with Fuchs endothelial...

A novel supraorbital surgical approach for enucleation in dromedary camels (Camelus dromedaries): cadaveric study

BackgroundEnucleation and exenteration are widely utilized ophthalmic procedures in veterinary practice, involving the complete removal of the eye and comprehensive extraction of orbital contents, respectively. These procedures are indicated for pain relief, excision, and management of neoplasia metastases, and addressing severe medically untreatable conditions.AimThis study aimed to develop an orbital enucleation surgical approach. The study evaluated the applicability of the new approach and investigated the impact of the surgical procedure.MethodsAnatomical dissection of three cadaveric heads and surgical orbital enucleation in four cadaveric heads were performed. Anatomical data was collected, and feasibility, safety and applicability of the procedure were assessed.ResultsAnatomical dissection showed a distinctive large orbital fossa, providing a suitable surgical window to access orbital structures. The procedure was found to be feasible, facilitating the complete removal of the orbital content. Notably, the preservation of intact eyelids was prioritized to enhance cosmetic appearance.ConclusionThe presented orbital enucleation technique proved to be feasible, safe, reproducible, and required basic surgical skills to perform.

Comparison of the effectiveness of 0.5% and 0.25% proparacaine hydrochloride eye drops as topical anesthetics in routine ocular investigations and procedures.

To compare the effectiveness of 0.5% and 0.25% proparacaine eye drops in providing topical anesthesia for routine ocular procedures. 137 patients (274 eyes) were included in this study. They were categorized into two groups. Group A patients received 0.5% and Group B received 0.25% proparacaine drops. A single surgeon performed all the procedures. Intraprocedural and postprocedural pain scores, surgeon comfort, supplemental anesthesia, and vital parameters, were noted. The mean age of the participants was 69.42 years (±12.05). An equal number of procedures were performed (n = 30) for applanation tonometry, lacrimal sac syringing, and A-scan biometry. The other procedures performed were removal of the conjunctiva (n = 5) and corneal foreign bodies (n = 16 per group), corneal scraping (n = 8 per group), and corneal suture removal (n = 18 per group).The mean visual analog pain score during the procedure was 6.9663 in Group A and 8.0803 in Group B (P = 0.66). The mean postprocedural pain score was not significant (P = 0.21). None of the patients required any additional anesthesia during or after the procedure. The average surgeon's experience was 0.152±0.507 in Group A and 0.111±0.402 in Group B (P = 0.07).In Group A, 133 of 137 patients (97.08%), and in Group B, 132 out of 137 patients (96.35%) preferred to use the same anesthetic for future procedures. None of the patients experienced a vasovagal attack or any change in vital parameters. The present study aimed to establish equivalence between two concentrations of proparacaine hydrochloride in which false positive and false negative errors were expected. This is the inherent challenge in the equivalence and inferiority trials. To mitigate these risks, the present study was carefully designed with specific statistical methods, sample size calculation, and rigorous methodology. Nevertheless, it is crucial to recognize that the risk of false positive errors remains, and the results should be interpreted with this in mind. These findings indicated that 0.25% proparacaine is a viable alternative to the standard 0.5% concentration in routine ophthalmic procedures, with the potential for improved patient comfort.

Fusional Vergence amplitude measurement among students of ISRA School of optometry, Isra University, Karachi campus

Purpose: To determine mean fusional vergence amplitudes FVA and the effect age and gender on FVA. Methodology: A cross sectional descriptive study was conducted among Isra School of optometry, Isra University, Karachi campus students from August 2023 to December 2023. A total of 120 students consisting of 43 males (35.8%) and 77 females (64.1%) were recruited using a convenient sampling technique. Inclusion criteria included subjects with 6/6 vision, no any ocular disease, strabismus and subjects with exophoria or esophoria. The age ranged from 18-27 years. Patients underwent ophthalmic procedure i.e. visual acuity for both distance and near and ophthalmoscopy was performed to check the clarity of the patient’s media. After assessing the ocular media, cover test was used to check the type of phoria. By using horizontal prism bars, Positive Fusion Vergence (PFV) and Negative Fusion Vergence (NFV) were recorded as break, and recovery points at near and distance. All the information was recorded in self-made Performa. Data was analyzed using SPSS. Result: Students were categorized into three age groups: Group 1 (18-21 years), Group 2 (22-24 years), and Group 3 (25-27 years). The data showed negative fusional divergence break-up and recovery points at distance and near, with mean values of 10.06±4.8 Δ and 7.3±4.7 Δ, respectively. Positive fusional convergence break-up and recovery points at distance and near had mean values of 10.95±6.11 Δ and 8.1±5.57 Δ, respectively. The result for negative divergence break and recovery point at distance were significant with p-value of 0.021 and 0.026, respectively Conclusion: This study concluded that the mean fusional vergence amplitudes FVA at near and distance are reduced while distance and near FV revealed no effects of age and gender. However, negative fusional break point and positive fusional recovery point were significantly affected by age.

Novel supraglottic airway device for ophthalmic procedures.

Novel supraglottic airway device for ophthalmic procedures.

Short-Cycle Autoclave Sterilization of Instruments in Same-Day Ophthalmic Surgeries

What Is the Issue? The volume of ophthalmic surgeries is increasingly high, with cataract surgery being 1 of the most performed surgeries in Canada. Infections following ophthalmic surgeries, while rare, can cause severe complications that may lead to irreversible vision loss. Reducing postsurgery infections is a high priority in clinical practice. Running a full wrapped, terminal steam sterilization cycle for ophthalmic instruments in autoclaves may be inefficient for ophthalmic surgeries and may cause unnecessary heavy economic and environmental burdens due to high surgical volumes. Using instruments sterilized on a short cycle between sequential same-day ophthalmic surgeries may help improve efficiency and reduce resources used. These instruments are generally processed using autoclaves (i.e., steam sterilizers); the effectiveness of a shorter-cycle method of sterilization is unclear. What Did We Do? To inform decisions regarding the use of autoclaves for short-cycle sterilization for sequential same-day instrument use in ophthalmic surgery, we sought to identify and summarize evidence comparing this method to full-cycle sterilization of wrapped instruments and identify any relevant recommendations. We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2012. One reviewer screened articles for inclusion based on predefined criteria. What Did We Find? In a laboratory setting to simulate sequential same-day procedures, short-cycle sterilization with interrupted dry time for unwrapped ophthalmic instruments is feasibly as effective as full-cycle sterilization for wrapped instruments using the STATIM autoclave. Similarly, short-cycle sterilization with interrupted dry time for contained ophthalmic instruments is feasibly as effective as full-cycle sterilization for contained instruments using the AMSCO autoclave. For sequential same-day ophthalmic procedures, wet instruments sterilized by a short-cycle process with an interrupted dry time can remain sterile for at least 3 minutes if kept in a covered sterilizer containment device. One guideline recommends that wrapped or unwrapped ophthalmic instruments sterilized by a short-cycle process without full drying should be stored in a covered containment device until retrieved by staff wearing sterile gloves and gowns in the operating room for the subsequent surgery after a short delay. Phaco handpieces should be immediately primed with a balanced salt solution and remain wet as they sit on the sterile instrument table. We did not identify any clinical setting evidence from studies or autoclave manufacturers. It is unclear if clinical outcomes differ between patients undergoing sequential same-day ophthalmic surgeries using short-cycle sterilized instruments and those undergoing surgery using full-cycle sterilized instruments. What Does This Mean? Preliminary laboratory evidence and guideline recommendations supporting the use of autoclaves for short-cycle sterilization of instruments for sequential same-day ophthalmic surgeries are available. However, there is no clinical effectiveness evidence available on this process in patient settings. Future research is necessary to understand the clinical safety of using instruments sterilized by short cycles for sequential same-day use for patients undergoing ophthalmic surgeries. In addition to the evidence and recommendations identified, other factors, such as environmental influence, may be useful considerations when making decisions about short-cycle sterilization for sequential same-day instrument use for ophthalmic surgery.

Diagnosis and Surgical Removal of a Corneal Dermoid in a Red-eyed Tree Frog, Agalychnis callidryas (Anura, Hylidae), From the Tenorio Volcano, Costa Rica

Abstract A male, red-eyed frog (Agalychnis callidryas) was collected from the Tenorio Volcano region in Costa Rica due to the presence of a unilateral ocular abnormality affecting its left eye. Approximately 70% of the cornea was replaced by a well demarcated, 5.0 mm in diameter, opaque, bright green and roughened tissue compatible with skin. The affected eye was enucleated under established ophthalmic surgical procedures. A dermoid was confirmed by histopathology based on the finding of amphibian cutaneous (epidermal and dermal) tissue replacing the cornea and characterized by the presence of keratinized epidermis, spongy dermis, and integumentary glands. After a successful post-operative recovery period the frog was released back to the wild, demonstrating the viability of medical intervention and surgery in wild amphibians. Dermoids are congenital lesions that result from a failure in the differentiation of the superficial ectoderm to generate normal corneal epithelium and the subsequent development of epidermis and dermal tissues in the area. Corneal dermoids have been reported in horses, cattle, sheep, wildebeest, pigs, rats, dogs, cats, birds, and humans, this being the first case reported in amphibians. In the locality where the frog was found, several other ophthalmic abnormalities have been documented in other amphibians. Active monitoring of wild amphibians is ongoing, and possible causes of ophthalmic abnormalities in the area are being investigated.

Trends in Medicare Charges, Reimbursements, and Utilization for Ophthalmic Versus Non-Ophthalmic Procedures: Medicare Charges in Ophthalmic Procedures

ObjectiveTo investigate trends in Medicare charges, reimbursements, and utilization for ophthalmic and non-ophthalmic procedures. MethodsWe examined all ophthalmic, non-ophthalmic, and the 15 most performed ophthalmic medical/surgical procedures in Medicare Provider Utilization and Payment Data from 2013 to 2019. Monetary values were adjusted for inflation based on the 2019 United States (US) dollar using the Bureau of Labor Statistics Consumer Price Index. We calculated annual procedural utilization by adjusting service counts per million Medicare beneficiaries and examined trends for ophthalmic and non-ophthalmic procedures from 2013-2019 using descriptive statistics. ResultsFrom 2013-2019, Medicare inflation-adjusted charges and reimbursements changed by -14% and -23%, respectively, for ophthalmic procedures compared to +14% and +5%, for non-ophthalmic procedures, and -24% and -31% for the 15 most common ophthalmic procedures. Utilization of ophthalmic, non-ophthalmic, and common ophthalmic procedures changed by +2%, -15%, and +17%, respectively. ConclusionsLower reimbursements likely compensate for higher utilization in ophthalmology, especially since the magnitude of change in charges and reimbursements was larger for the 15 most performed ophthalmic procedures. In future reimbursement deliberations, policymakers should consider the declining reimbursements for procedures in ophthalmology relative to other medical specialties. Public Interest SummaryMedicare reimbursement rates for common ophthalmic procedures decreased by 31% from 2011-2020. These reductions may lead to lower hospital revenue and, subsequently, higher prices. This shifts the financial burden onto uninsured and underinsured patients and is a potential barrier to care. Additionally, as there are not enough ophthalmologists in the US to adequately meet demand, further reimbursement reductions may influence student interest and contribute to earlier retirements in the existing ophthalmic workforce. This study identifies a decline in charges and reimbursements as utilization concurrently increased for ophthalmic procedures. In contrast, there has been an increase in charges and reimbursements with a decrease in utilization for non-ophthalmic procedures. Policymakers should take these findings into consideration in future decisions on reimbursement changes for ophthalmology.

Anaesthesia Concepts in Patients with Chronic Progressive External Ophthalmoplegia Undergoing Ophthalmic Surgery-A Retrospective Cohort Analysis.

Chronic progressive external ophthalmoplegia (CPEO) belongs to the group of mitochondrial encephalomyopathies. Anaesthesia for patients with CPEO may be associated with an increased risk due to known drug effects on mitochondrial metabolism. Therefore, the aim of this analysis was to evaluate anaesthesiological concepts in patients with CPEO requiring ophthalmic surgery. This is a retrospective, monocentric cohort analysis of eleven patients with CPEO undergoing ophthalmic surgery either with general anaesthesia or local anaesthesia in a German university hospital from January 2012 to February 2022. A total of twelve ophthalmic surgery procedures were performed in eleven adult patients with CPEO. Six patients underwent surgery after receiving local anaesthesia (LA cohort). Five patients underwent six surgical procedures under general anaesthesia (GA cohort). In five cases within the GA cohort, propofol and remifentanil were used for the maintenance of anaesthesia. In one case, balanced anaesthesia with desflurane and remifentanil was used. The median duration of general anaesthesia was 37.5 min (range, 25-65 min). Patients stayed in the recovery room for a median of 48.5 min (range, 35-70 min). All patients were discharged on the first postoperative day. No relevant complications occurred in either the LA or GA cohort. Both local and general anaesthesia are feasible concepts for patients with CPEO undergoing ophthalmic surgery. Propofol, at least with a short duration (less than one hour) of use, appears to be a feasible hypnotic drug in CPEO patients.

Value for money of reusable versus disposable ophthalmic instruments for intravitreal injections

aim: The aim of this study was to follow the instruments’ pathways and cost each segment to calculate whether reusable or disposable ophthalmic instruments offer better value for money for intravitreal injections. methods: The cycles and costs of reusable and single-use disposable instruments used for intravitreal injections were mapped out, including purchase costs, transport to and from the place of use, opening and disposal, sterilisation, replacement, salary costs of staff involved, etc. results: The cost of using reusable instruments for intravitreal injections (NZ$29.00) was lower than the cost of using disposable instruments ($30.51) by $1.51 per patient. conclusions: Intravitreal injections performed with reusable instruments offer better value for money than when performed with disposable instruments. This equates to a beneficial financial saving just for this one low-complexity case. Such savings can multiply significantly when considering the instruments used in a wider variety of ophthalmic procedures. There are of course trade-offs between safety, quality, cost and sustainability.

Incidence and outcomes of post-operative endophthalmitis following elective phacoemulsification cataract surgery, between 2015 and 2022.

Cataract surgery remains the commonest ophthalmic surgical procedure in the UK. Post-operative endophthalmitis (POE) is a sight-threatening complication. This study presents the incidence and outcomes of POE within Moorfields Eye Hospital NHS Foundation Trust (MEH) in London, UK. We conducted a retrospective, tertiary-centre study of the incidence and outcomes of POE following elective phacoemulsification cataract surgery between 2015 and 2022. We report a rate of 18 out of 154 826 (0.012%) cases of POE within seven weeks of cataract surgery. The age range was 43-87 years (mean age 67.1 years), and the male-to-female ratio was 1:1. Two cases were associated with intraoperative vitreous loss, one with anterior capsular tear extending to posterior capsular tear and the other with posterior capsular tear and dropped fragment. Two cases had a concomitant intravitreal injection, one of Triamcinolone Acetonide and the other of Dexamethasone implant (Ozurdex®), to manage chronic uveitic macular oedema. The majority of samples (89.9%) resulted in Gram-positive species. A final best corrected visual acuity (BCVA) of Snellen 6/36 or better was achieved in 12/18 (66.67%). The time from cataract surgery to suspicion of POE ranged from 3 to 44 days (mean 15.8 days). Eight cases (44.4%) required pars plana vitrectomy (PPV). We demonstrate an incidence of POE of 0.012% following phacoemulsification at MEH from January 2015 to December 2022. Such results are a testament to high-quality surgery, training supervision and post-operative care whilst adhering to local and international standards.

Influence of COVID-19 pandemic on the cataract services in a district hospital

Purpose: In March 2020, COVID-19 was declared a pandemic by the World Health Organization. The COVID-19 pandemic significantly disrupted the healthcare system, including the number of elective ophthalmic procedures conducted worldwide, resulting in a large-scale deferment of cataract surgeries after the Malaysian government recommended to postpone all nonessential elective surgeries to minimise the virus transmission and to augment the hospital resources to cope with a surge in COVID-19 cases. This study assessed the influence and impact of the COVID-19 pandemic on the cataract services in a district hospital. Study design: Retrospective descriptive analysis. Methods: This study analysed cataract surgery services in the period between January 1, 2017 and 31 December 31, 2021. Data were extracted from the electronic medical records. The study population was further divided into 3 groups according to the COVID-19 pandemic status: pre-pandemic, lockdown and recovery phase. Results: A total of 8,125 eyes were included in this study. During the lockdown phase, there was a 42% decline in the number of surgeries done compared to the pre-COVID-19 phase. A higher number of patients (53.5%) presented with severe visual impairment or blindness during the lockdown phase as compared to 40.2% during the pre-COVID-19 phase. The number of lens-related complications was markedly higher (2.58%) during the lockdown phase, as compared to the pre-COVID-19 phase (0.64%). During the end of the recovery phase studied, there was an early increment in the number of surgeries done, surpassing that of the pre-COVID-19 phases. Conclusion: The COVID-19 pandemic caused a drastic reduction in the number of cataract surgeries performed during the lockdown phase, causing more patients to suffer from avoidable blindness due to cataract, and leading to a higher rate of lens-related complications. An intuitive approach and reorganisation of ophthalmic care services are essential in order to lessen the backlog without causing burnout among healthcare workers.

Robot-Assisted Eye Surgery: A Systematic Review of Effectiveness, Safety, and Practicality in Clinical Settings.

Surgical innovation in ophthalmology is impeded by the physiological limits of human motion, and robotic assistance may facilitate an expansion of the surgical repertoire. We conducted a systematic review to identify ophthalmic procedures in which robotic systems have been trialled, evaluate their performance, and explore future directions for research and development of robotic techniques. The Cochrane Library, Embase, MEDLINE, Scopus, and Web of Science were searched. Screening adhered to five criteria: (1) English language; (2) primary research article; (3) human patients; (4) ophthalmological surgery; and (5) robot-assisted surgery. Quality assessment was conducted with Joanna Briggs Institute Tools for Critical Appraisal. The study protocol was registered prospectively (PROSPERO ID CRD42023449793). Twelve studies were included. In comparative studies, there was no difference in the occurrence of ocular harms in robot-assisted procedures and conventional surgery. However, robotic assistance did not demonstrate consistent benefits over manual surgery in terms of effectiveness or practicality, likely reflecting the learning curve associated with these systems. Single studies indicated the potential of robotic assistance to improve the consistency of subretinal drug infusion and efficiency of instrument manipulation in vitreoretinal surgery. Proof-of-concept studies have demonstrated the potential of robotic assistance to facilitate procedures otherwise infeasible or impractical, and may broaden access to surgery. However, robot-assisted surgery has not yet demonstrated any significant benefits over standard surgical practice. Improving the speed and reducing perioperative requirements of robot-assisted surgery are particular priorities for research and innovation to improve the practicality of these novel techniques. This systematic review summarizes the potential and limitations of robotic systems for assisting eye surgery and outlines what is required for these systems to benefit patients and surgeons.

A Health-Related Quality of Life Measure for Patients Who Undergo Minimally Invasive Glaucoma Surgery

PurposeTo develop a standardized patient-reported outcome measure to assess the impact of glaucoma and treatment, including minimally invasive glaucoma surgery (MIGS), on health-related quality of life (HRQOL). DesignObservational study before and after concomitant cataract and FDA-approved implantable MIGS device surgery to provide information on the measure's performance in assessing HRQOL. Methods SettingSurvey administration was done by electronic patient-reported outcomes (ePRO) application to patients at multiple sites on a computer, iPad, or similar device. Patient PopulationOne hundred eighty-four adults completed a baseline survey, 124 completed a survey 3 months after surgery, and 106 completed the 1-month test-retest reliability survey. The age range was 37-89, and the average age was 72. Most of the respondents were female (57%), non-Hispanic White (81%), and had a college degree (56%). Main Outcome MeasuresThe Glaucoma Outcomes Survey (GOS) includes 42 questions assessing functional limitations (27 items), vision-related symptoms (7 items), psychosocial issues (7 items) and satisfaction with microinvasive glaucoma surgery (1 item). The three multiple-item scales were scored on a 0-100 range, with a higher score indicating worse health. ResultsInternal consistency reliability estimates ranged from 0.75 (vision-related symptoms) to 0.93 (functional limitations) and one-month test-retest intraclass correlations ranged from 0.65 (PROMIS global mental health) to 0.92 (functional limitations). Product-moment correlations among the GOS scales ranged from 0.56 to 0.60. Improvement in visual acuity in the study eye from baseline to the 3-month follow-up was significantly related to improvements in GOS functional limitations (r =0.18, p =0.0485), vision-related symptoms (r = 0.19, p = 0.0386), and psychosocial concerns (r = 0.18, p =0.0503). The highest proportion of responders to treatment was seen for the GOS functional limitations scale (48%), followed by GOS psychosocial issues (21%) and GOS vision-related symptoms (17%). ConclusionsThis study provides initial support for using the GOS instrument in ophthalmic procedures such as MIGS. Further evaluation of the GOS in other samples, including different patient subgroups and clinical settings, will be valuable. The instrument may be useful for evaluations of other treatments for glaucoma.

807-P: GLP-1 Agonists and the Risk of Delayed Gastric Emptying in Elective Ophthalmic Procedures

807-P: GLP-1 Agonists and the Risk of Delayed Gastric Emptying in Elective Ophthalmic Procedures

Anesthesia Applications In Experimental Neurological Disease Modeling

Neuroscience, which covers the molecular mechanisms employed by the brain to cause neurological diseases and how they can be treated, remains current as the subject of high-budget investigations to develop early diagnosis and new treatment modalities with multidisciplinary approaches. For this purpose, creating the appropriate model with the correct modality and anesthesia in neurological in vivo experimental models is the most important phase to obtain accurate results and ensure animal welfare. To manage anesthesia in rodents, knowing the physiological characteristics of anesthetics and their risks will strengthen experimental procedures. Among the injectable anesthetics, ketamine, xylazine, and pentobarbital are the most frequently preferred agents for general anesthesia in short surgical procedures. Isoflurane and sevoflurane are inhaler anesthetics that are administered through a vaporizer because they are liquids. Important advantages of inhaled anesthetics, such as rapid induction and rapid withdrawal, make inhaled anesthetics stand out in neuroscience studies. In this review, the properties of frequently used anesthetic agents in rodents, their usage methods, and which model they are preferred will be discussed. For this purpose, the selection of appropriate anesthetics in animal models such as epilepsy, Alzheimer's disease, ischemia-reperfusion injury, traumatic brain injury, ischemic stroke, experimental autoimmune encephalomyelitis, and ophthalmic surgical procedures and their side effects will be reviewed.

Celastrol alleviates subconjunctival fibrosis induced by silicone implants mimicking glaucoma surgery

Subconjunctival fibrosis is critical to the outcomes of several ophthalmic conditions or procedures, such as glaucoma filtering surgery. This study aimed to investigate the anti-fibrotic effect of celastrol on subconjunctival fibrosis and to further reveal the underlying mechanisms. We used celastrol-loaded nanomicelles hydrogel hybrid as a sustained-release drug. A rabbit model of subconjunctival fibrosis following silicone implantation was used for in vivo study, and TGF-β1-induced human pterygium fibroblast (HPF) activation as an in vitro model. The effects of celastrol on inhibiting TGF-β1-induced migration and proliferation of HPFs were evaluated by scratch wound assay and CCK-8, respectively. Immunofluorescence and western blotting were used to examine the effect of celastrol on the expression of α-SMA, collagen I, fibronectin, and the targets of the Hippo signaling pathway. We found that in vivo celastrol treatment reduced the expression of YAP and TAZ in subconjunctival tissue. Moreover, celastrol alleviated collagen deposition and subconjunctival fibrosis at 8 weeks. No obvious tissue toxicity was observed in the rabbit models. Mechanistically, celastrol significantly inhibited TGF-β1-induced proliferation and migration of HPFs. Pretreatment of HPFs with celastrol also suppressed the TGF-β1-induced protein expression of α-SMA, collagen I, fibronectin, TGF-βRII, phosphorylated Smad2/3, YAP, TAZ, and TEAD1. In conclusion, celastrol effectively prevented subconjunctival fibrosis through inhibiting TGF-β1/Smad2/3-YAP/TAZ pathway. Celastrol could serve as a promising therapy for subconjunctival fibrosis.