Ophthalmic Procedures Research Articles

Factors associated with postoperative complications in healthy horses after general anesthesia for ophthalmic versus non-ophthalmic procedures: 556 cases (2012-2014).

OBJECTIVE To compare complications between healthy horses undergoing general anesthesia for ophthalmic versus non-ophthalmic procedures and identify potential risk factors for the development of complications. DESIGN Retrospective case series. ANIMALS 502 horses (556 anesthetic procedures). PROCEDURES Medical records from January 2012 through December 2014 were reviewed to identify horses undergoing general anesthesia. Signalment, body weight, drugs administered, patient positioning, procedure type (ophthalmic, orthopedic, soft tissue, or diagnostic imaging), specific procedure, procedure time, anesthesia time, recovery time, recovery quality, and postoperative complications were recorded. RESULTS Patients underwent general anesthesia for ophthalmic (n = 106), orthopedic (246), soft tissue (84), diagnostic imaging (110), or combined (10) procedures. Mean procedure, anesthesia, and recovery times were significantly longer for patients undergoing ophthalmic versus non-ophthalmic procedures. Excluding diagnostic imaging procedures, there was a significant positive correlation between surgery time and recovery time. Within ophthalmic procedures, surgery time, anesthesia time, and recovery time were significantly greater for penetrating keratoplasty versus other ophthalmic procedures. There was a significantly higher rate of postoperative colic following penetrating keratoplasty, compared with all other ophthalmic procedures. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that in healthy horses, duration of general anesthesia should be minimized to decrease the risk of postanesthetic complications. Judicious use of orally administered fluconazole is recommended for horses undergoing general anesthesia. For horses undergoing a retrobulbar nerve block during general anesthesia, use of the lowest effective volume is suggested.

Physiology and Role of Intraocular Pressure in Contemporary Anesthesia.

More than 26 million Americans suffer with cataracts, and with 3.6 million cataract extractions performed annually in the United States, it is the most common surgical procedure. The integrity of the delicate structures of the eye that mediate vision is dependent on the intraocular pressure (IOP). Yet, IOP acts to compress the vessels within the globe-akin to a Starling resistor-and is a key component that determines the ocular perfusion pressure, defined as the difference between arterial pressure and IOP. The retina is one of the most metabolically active tissues in the body, and its functional integrity is dependent on an adequate blood supply, with retinal function linearly related to the ocular perfusion pressure. Retinal cell death has been demonstrated at low perfusion pressures (below 50 mm Hg). Modern ophthalmic surgery involves globe irrigation, manipulation, and instrumentation, resulting in dynamic pressure fluxes within the eye. Marked elevations of IOP (up to 4-5 times the normal value) with consequent borderline retinal and optic disk perfusion pressures occur for prolonged periods during many ophthalmic procedures. General surgeries, including laparoscopic, spinal, and cardiac procedures, especially, with their demand for steep Trendelenburg or prolonged prone positioning and/or hypotensive anesthesia, can induce IOP changes and ocular perfusion imbalance. These rapid fluctuations in IOP, and so in perfusion, play a role in the pathogenesis of the visual field defects and associated ocular morbidity that frequently complicate otherwise uneventful surgeries. The exact etiology of such outcomes is multifactorial, but ocular hypoperfusion plays a significant and frequently avoidable role. Those with preexisting compromised ocular blood flow are especially vulnerable to intraoperative ischemia, including those with hypertension, diabetes, atherosclerosis, or glaucoma. However, overly aggressive management of arterial pressure and IOP may not be possible given a patient's comorbidity status, and it potentially exposes the patient to risk of catastrophic choroidal hemorrhage. Anesthetic management significantly influences the pressure changes in the eye throughout the perioperative period. Strategies to safeguard retinal perfusion, reduce the ischemic risk, and minimize the potential for expulsive bleeding must be central to the anesthetic techniques selected. This review outlines: important physiological principles; ophthalmic and general procedures most likely to develop damaging IOP levels and their causative factors; the effect of anesthetic agents and techniques on IOP; recent scientific evidence highlighting the significance of perfusion changes during surgery; and key aspects of postoperative visual loss and management approaches for high-risk patients presenting for surgery.

Inhibition of Mitochondrial Fission Preserves Photoreceptors after Retinal Detachment

Photoreceptor degeneration is a leading cause of visual impairment worldwide. Separation of neurosensory retina from the underlying retinal pigment epithelium is a prominent feature preceding photoreceptor degeneration in a variety of retinal diseases. Although ophthalmic surgical procedures have been well developed to restore retinal structures, postoperative patients usually experience progressive photoreceptor degeneration and irreversible vision loss that is incurable at present. Previous studies point to a critical role of mitochondria-mediated apoptotic pathway in photoreceptor degeneration, but the upstream triggers remain largely unexplored. In this study, we show that after experimental retinal detachment induction, photoreceptors activate dynamin-related protein 1 (Drp1)-dependent mitochondrial fission pathway and subsequent apoptotic cascades. Mechanistically, endogenous reactive oxygen species (ROS) are necessary for Drp1 activation invivo, and exogenous ROS insult is sufficient to activate Drp1-dependent mitochondrial fission in cultured photoreceptors. Accordingly, inhibition of Drp1 activity effectively preserves mitochondrial integrity and rescues photoreceptors. Collectively, our data delineate an ROS-Drp1-mitochondria axis that promotes photoreceptor degeneration in retinal diseased models.

Operacija sive mrene pri bolnikih s sladkorno boleznijo

Ophthalmic complications of diabetes are one of the leading causes of visual loss and blindness in the working population worldwide. Globally, an estimated 422 million adults were living with diabetes in 2014. According to the World Health Organisation, this number will rise to an estimated 592 million by 2035. Cataract is a clouding of the eye lens. Surgery is indicated when cataract causes significant visual impairment. Several clinical studies have shown that cataract development occurs more frequently and at an earlier age in diabetic compared to nondiabetic patients. Cataract surgery is the most frequent ophthalmic surgical procedure and has an excellent outcome. However, diabetic patients may have more complications and a poor visual outcome. They are prone to ocular surface disease, intraoperative complications, corneal oedema in the early postoperative period and an increased incidence of cystoid macular oedema in patients with retinopathy. Anterior capsular contraction is also more frequent. A good prognosis is expected in patients with good systemic and ophthalmological preoperative, operative and postoperative management.

Prion Deposition in the Retina of Sporadic Cruetzfeldt‐Jakob Disease

IntroductionHuman spongiform encephalopathies, also known as prion diseases, are a rare group of infectious, heritable, and acquired diseases leading to rapid cognitive decline. Prion diseases are considered a serious public health threat due to the high level of infectivity and delayed presentation. Up to 50% of patients with prion disease develop visual symptoms during their clinical course, possibly secondary to abnormal prion protein (PrPSc) accumulation within the eye or within the visual pathway in the brain. Few studies, however, have investigated the presence and deposition pattern of PrPSc within the eye of patients with sporadic Creutzfeldt‐Jakob disease (sCJD). Knowing the presence or levels of PrPSc in the eye is important to assess the potential risk of transmission from common ophthalmic surgical procedures (cornea transplantations and cataract extractions). Additionally, the current gold standard of diagnosis for prion disease remains brain autopsy. If PrPSc expression is present consistently in the eye, ocular imaging modalities with PrPSc‐binding compounds may potentially enable earlier diagnosis. Here, we investigate the expression of PrPSc within retinas of confirmed prion disease cases collected from post‐mortem enucleations.MethodsFrom December 2015 to May 2017, 28 eyes were collected from 14 autopsies of clinically suspected prion disease and 6 of non‐prion disease at a single institution. sCJD was confirmed in all cases by brain autopsy and genetic analysis of the PRNP gene. Immunohistochemistry was performed with antibodies against PrP and PrP deposition within the retina was evaluated and compared with normal controls. Subjects included both male and female patients with ages ranging from 51–80 years old. The clinical disease course ranged from 2–24 months.ResultsIn twelve of the fourteen prion disease cases, PrPSc deposits were observed in the retina by immunohistochemistry. PrPScwas limited to the outer and inner plexiform layers of the retina and was most prominent in the outer plexiform layer, with the majority of cases exhibiting a coarse, 5–10 um well‐aligned ovoid deposits. Controls showed no PrPSc staining in any retinal layers. In the sclera, cornea, lens, and optic nerve, no deposits were observed.ConclusionPrPSc deposits were present in a majority of retinas of patients with confirmed prion disease, primarily within the outer plexiform layer, and these deposits can be detected immunohistochemically. Our findings confirm previous isolated reports of retinal PrPSc deposition in the largest series of documented prion cases to date. We suggest that the retina potentially serves as a diagnostic target in clinically suspected prion disease. Additionally, retinal involvement may contribute to visual symptoms commonly associated with prion disease.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Prophylactic antibiotics prescription in ear, nose, throat and ophthalmologic procedures; an Iranian university hospital situational analysis

Introduction:Different prophylactic methods are introduced to prevent surgical site Infection. This study was conducted to evaluatesituation of prophylactic antibiotics (PA) usage in an Iranian university hospital.Aims:A cross sectional study.Methods:This study obtained data from 1010 patients’ medical files in 2015. These patients were admitted to a university otolaryngology (ENT) and ophthalmology hospital in north of Iran. Data from ordered prophylactic antibiotics considering induction time, type of antibiotic, duration of use, dosage amount and intervals was obtained to compare with international and national guidelines. Data analysis was performed by using Chi-square test at significance level of 95%.Results:402 (39.8%) patients were male and 608 (60.2%) ones were female. Mean age and standard deviation was 41.8±22.3 years old, and most participants were in 20-39 years of age. Ophthalmic and ENT related procedure was respectively conducted for 41.7% and 58.3% of patients. Septorhinoplasty and phacoemulsification were the commonest procedures. Totally 999 (98.9%) people received prophylactic antibiotics. Intravenous Cefazolin (for ENT procedures) and topical eye drop of Chloramphenicol 0.5% were prescribed mostly. We found poor accommodation between antibiotic use and guidelines for prophylaxis, mostly in case of duration of apply.Conclusion:Ordered prophylactic antibiotics is not as need as prescribed. Also, accommodation between prescription of antibiotics and available scientific guidelines was improper in this study.

Return to the Operating Room after Macular Surgery: IRIS Registry Analysis

To investigate the rate of return to the operating room after vitrectomy surgery to treat macular hole or epiretinal membrane. A retrospective registry cohort. Individuals receiving care in ophthalmology practices participating in the Academy IRIS (Intelligent Research in Sight) Registry. Data from the IRIS Registry were analyzed for patients who underwent vitrectomy for macular holes or epiretinal membranes. Cases were identified by the combination of International Classification of Diseases, 9th revision code (362.54, 362.56) and a current procedural terminology (CPT) code for vitrectomy surgery between January 1, 2013 and June 30,2017. The eyes that underwent additional eye surgery within 1 year after initial vitrectomy for macular hole or epiretinal membrane were identified, as was the nature of the additional procedures per CPT code. A total of 41 475 eyes underwent vitrectomy for macular hole and 73 219 eyes underwent vitrectomy for epiretinal membrane during the study period. In the macular hole group, 7573 had a second surgery within 1 year, and 2827 (6.8%) had a second surgery that was not cataract related. In the epiretinal membrane group, 12 433 had a second surgery within 1 year, 4022 (5.5%) of which were not cataract related. In the macular hole group, 4.6% of eyes returned to the operating room for another macular hole repair surgery, and 2.0% returned for retinal detachment repair. In the epiretinal membrane group, 1.4% returned for a second vitrectomy with membrane stripping, and 2.5% returned for retinal detachment repair. This registry-based study encompassed a large number of patients but was limited by the inaccessibility of some information and the potential for inaccurate medical records or coding, as it obtained data from multiple electronic health records entities. Excluding cataract surgery, approximately 6% of eyes that underwent vitrectomy to address macular hole or epiretinal membrane returned for a second ophthalmic procedure within a year. In the macular hole group, most secondary non-cataract surgeries were for another macular hole repair procedure. For both macular holes and epiretinal membranes, approximately 2% of eyes required retinal detachment repair surgery within 1 year.

The Ophthalmology Surgical Competency Assessment Rubric (OSCAR) for anterior approach ptosis surgery

ABSTRACTPurpose: The International Council of Ophthalmology (ICO) is currently developing a series of standardized, internationally validated, teaching tools for key ophthalmic surgical procedures called the Ophthalmology Surgical Competency Assessment Rubrics (OSCARs). This study aims to develop an OSCAR for anterior approach ptosis surgery.Methods: An international panel of content experts, representing Australia, India, Iran, Italy, Turkey, UK, and the USA was established and worked to develop the rubric using a range of online collaboration tools. The team used the standardised OSCAR template as a baseline, developing explicit behavioural descriptors (the behaviour and performance expected for each step) that were reviewed and modified with successive models. Learners were scored a modified 4-point Dreyfus scale of skill acquisition (novice, beginner, advanced beginner, competent) with the removal of the expert domain.Results: The final OSCAR ptosis tool was developed in alignment with the ICO-OSCAR standard. Seventeen agreed and weighted stems were produced. Domains such as communication and postoperative complications were removed from this rubric as they are evaluated in other spheres of residency training. Specific comments with regard to the parameters and wording were incorporated to formulate the final rubric, which was internationally agreed and demonstrated face and content validity.Conclusions: The OSCAR for anterior approach ptosis is skill and behaviour-based, has ICO agreed standards for assessment and provides learners with specific targets for improvement. Although the OSCAR ptosis tool has face and content validity, further development could better elucidate its precise role.

Simulation of wave propagation inside a human eye: acoustic eye model (AEM)

The design and development of the acoustic eye model (AEM) is reported. The model consists of a computer-based simulation that describes the propagation of mechanical disturbance inside a simplified model of a human eye. The capabilities of the model are illustrated with examples, using different laser-induced initial loading conditions in different geometrical configurations typically occurring in ophthalmic medical procedures. The potential of the AEM is to predict the mechanical response of the treated eye tissue in advance, thus complementing other preliminary procedures preceding medical treatments.

Complications of Intravitreous Injections in Patients with Diabetes

ABSTRACT Intravitreous injections are presently the second most frequently performed ophthalmic procedure and the most common vitreoretinal procedure. In diabetic patients, intravitreous injections are frequently performed for the treatment of center-involved diabetic macular edema, proliferative diabetic retinopathy, or other co-existing retinal vascular disease. Diabetic patients may be at higher risk of adverse events compared to non-diabetic individuals, given frequent systemic comorbidities, such as cardiovascular and renal disease and increased susceptibility to infection. This review highlights the potential complications and safety considerations in intravitreous injections in patients with diabetes.

Monitored anesthesia care in ophthalmic surgeries

Monitored anesthesia care (MAC) is a specific anesthesia service for diagnostic and therapeutic procedures. It includes safe conscious sedation, adequate pain relief, and measures to allay anxiety. Even though it involves minimal anesthetic intervention, it is essential for an anesthetist to know about the patient history. Many ophthalmic drugs have significant anesthetic implications, and many anesthetic drugs cause significant intraocular pressure changes. In this article, we have highlighted the importance of MAC in ophthalmic procedures and implications of various anesthetic agents in eye surgeries. The various ophthalmic blocks and their complications and the toxicity which can occur with the use of local anesthetics have also been touched upon.

The use of povidone-iodine in ophthalmology.

Povidone-iodine (PVI) is a disinfectant and antiseptic agent used for preoperative preparation of the skin and mucous membranes, as well as for the treatment of contaminated wounds. Currently regimens for prophylaxis against postsurgical endophthalmitis are being modified, including a total withdrawal of antibiotics in intravitreal injections. The aim of this study was to evaluate the use of PVI in ophthalmology. As a result of its broad spectrum of microbicidal activity, PVI is routinely used in ophthalmic surgery. However, various protocols are applied worldwide and within different procedures. Additional indications include prophylaxis against ophthalmia neonatorum, acute conjunctivitis, adenoviral conjunctivitis, bacterial keratitis or corneal ulcer, endophthalmitis, giant fornix syndrome, and antimicrobial prophylaxis in patients with Boston type I keratoprosthesis. Despite the introduction of new antiseptics in surgery, PVI is still the preeminent antiseptic measure in ophthalmology. Its use is economically reasonable. There have been no reports of resistance to PVI or anaphylaxis with topical ophthalmic use. Furthermore, it does not induce resistance or cross-grztance to antibiotics. With these advantages the range of indications for topical use of antibiotics might decrease, with PVI as the sole perioperative antiseptic measure. Additional studies are required to assess the optimal timing, concentration and exposure time within different ophthalmic procedures.

Ophthalmic Complications Following Acoustic Neuroma Resection.

Past studies have shown high rates of ocular complications with the need for ophthalmic surgery following acoustic neuroma resection (ANR). To determine the rates of ophthalmic complications, referrals, and surgery following ANR, and the factors associated with poor outcomes. A retrospective study of ophthalmic outcomes in patients who underwent ANR was conducted, following institutional review board approval. Surgical approach, tumor size, tumor characteristics, completeness of resection, postoperative House-Brackmann grades, ocular complications, referrals to ophthalmology, and ophthalmic treatments were recorded. Between 2007 and 2012, 174 patients underwent ANR. There were 3 surgical groups: retrosigmoid (n = 97), translabyrinthine (n = 59), and combined retrosigmoid and translabyrinthine (n = 18). Median tumor size was 2.2 cm. Postoperatively, 30% of patients had facial nerve dysfunction (House-Brackmann ≥3), which recovered to 19% by 1 mo and 8.6% by 1 yr following ANR. Fifty-six (32.9%) patients experienced ocular complications postoperatively, with lagophthalmos, dry eye, and blurry vision as the most common complications. Thirty-six (67.9%) of the patients who required ophthalmic treatment were managed nonsurgically, with just 13 (7.6%) patients requiring referral to an ophthalmologist. In total, only 9 (5.3%) patients received an ophthalmic procedure. Patients with tumors >2 cm, those undergoing combined retrosigmoid and translabyrinthine resection, and those with severe facial nerve dysfunction which did not improve in the first month following surgery were more likely to have poor ophthalmic outcomes. We present lower rates of ophthalmic complications following ANR than previously reported. Improved surgical technique, better postoperative eye care, and facial nerve monitoring most likely accounted for the improved ocular outcomes.

The Eyes Have It: Eyelid Swelling and Rash in a 79-year-old Woman With Macular Degeneration.

IntroductionA 79-year-old woman with macular degeneration was referred to the Allergy/Immunology clinic for the evaluation of a potential allergy to anti-vascular endothelial growth factor (anti-VEGF) treatments. The patient developed urticaria and eyelid swelling immediately following a retinal injection of aflibercept, which she had previously tolerated. She previously had allergic reactions following ranibizumab and bevacizumab injections. Injections of anti-VEGF treatments were discontinued given concern for allergy with progression of the patient’s disease.ObjectiveTo assess the culprit medication(s) responsible for hypersensitivity reactions following anti-VEGF injections for macular degeneration.MethodsMedication records were reviewed for each retinal injection. All medications used in each procedure, including the anti-VEGF therapy (aflibercept), topical anesthetics (tetracaine and proparacaine hydrochloride), and antiseptic (povidine), were evaluated with skin testing. She was additionally tested for alternative anti-VEGF therapies (ranibizumab and bevacizumab) as she was thought to have allergies to these agents by prior history. A test dose challenge was completed for aflibercept, ranibizumab, and bevacizumab.ResultsSkin prick and intradermal testing were negative to aflibercept, ranibizumab, bevacizumab, and povidine. Intradermal testing was positive to tetracaine and proparacaine hydrochloride. The patient passed test dose challenges to aflibercept, ranibizumab, and bevacizumab. Due to her positive hypersensitivity testing to 2 ester anesthetics, the patient underwent skin prick and intradermal testing to the amide anesthetic, lidocaine. This was negative and the patient tolerated a graded challenge to lidocaine. She was deemed to have an immunoglobulin E (IgE)-mediated hypersensitivity to ester-type local anesthetics. She successfully resumed anti-VEGF therapy with an amide local anesthetic.ConclusionsThe reason for this consult was the concern for hypersensitivity to a biologic anti-VEGF medication. The culprit allergen, the local anesthetic, could have been overlooked without an assessment of all medications used during the procedure. This case highlights the importance of a thorough allergy evaluation of all medications used during procedures to determine the causative agent.Chief Complaint: Eyelid swelling and rash after ophthalmic procedures for macular degeneration.

A STUDY OF MICROBIAL AIR QUALITY BEFORE AND AFTER HYDROGEN PEROXIDE FUMIGATION OF OPHTHALMIC OPERATIVE THEATRE IN THE RESEARCH INSTITUTE OF OPHTHALMOLOGY IN EGYPT

This study aimed to assess air quality in operating rooms (OR) , expressed as colony forming units (CFU)/m3, during ophthalmic surgeries; exploring the effect of hydrogen peroxide vapor HPV fogging of OR and number of attending personnel on air contamination in the vicinity of the operated eye. Data collection by active air samplingand observations was performed during 452 ophthalmic procedures. The results showed median total viable count (TVC) at rest was 27.5 CFU/m3 range (0-275) and 30 CFU/m3 range (0-170) pre HPV and post HPV samplings respectively. The median TVC in operational was 60 CFU/m3 (range = 0-500) pre-HPV and 75 CFU/m3 (range = 20-270) post HPV. Results showed a non-significant correlation between the total CFU/m3 per operation and prior application of HPV (P = 0.077, n = 452). However, air samples exceeding the maximum CFU/m3 acceptable levels pre- and post-fogging was decreased from 42% to 40.3% (P= 0.8) at rest and from 15.5% to 12.8% (P= 0.6) at operation. A significant weak positive correlation was also found between TVC in CFU/m3 and the number of persons attending the operation (r = 0.159, P = 0.006, n =296). Conclusion: Air fumigation with HPV disinfectant and traffic flow has a positive impact on the OR environment.

A Handbook of Ophthalmic Standards and Procedures (second edition)

A Handbook of Ophthalmic Standards and Procedures (second edition)

Epidemiology of Primary Ophthalmic Inpatient Admissions in the United States

To determine the national estimates, demographics, and costs of inpatient eye care in the United States (US). Retrospective cross-sectional study. National Inpatient Sample (NIS), a representative sample of all US community hospitals, was used to analyze inpatient admissions with a primary ophthalmic diagnosis from 2001 to 2014. National estimates of the most prevalent diagnoses were determined, and descriptive statistics were calculated for demographics and costs. From 2001 to 2014, there were an estimated 671 324 inpatient admissions (male patients, 51.6%; mean [standard deviation] age, 44.5 [27.3] years) in the US owing to an ophthalmic disorder-an annual rate of 16 per 100 000 population. The Mid-Atlantic region had the highest rate. Most admissions were owing to nontraumatic disorders (75.3%), classified as emergencies (41.8%), and covered by public insurance (48.9%). The median length of stay was 2days and mortality was 0.2%. The total inflation-adjusted cost over the 14-year period was $5.9 billion. The most prevalent diagnosis was orbital cellulitis (14.5%), followed by orbital floor fracture (9.6%) and eyelid abscess (6.0%). Most diagnoses were infectious (28.0%) and the majority were attributed to external disease (24.3%). A total of 31.1% of all patients had an ophthalmic procedure, pars plana vitrectomy (4.8%) being the most common one. There were around 48 000 ophthalmic inpatient admissions in the US costing $421 million every year. Orbital pathology, namely infection and trauma, was the leading cause of admissions. Implementing interventions to decrease the incidence of these conditions may significantly reduce the burden of inpatient ophthalmic care.

Light scattering measurements in electron-beam sterilized corneas stored in recombinant human serum albumin

Irradiated corneal tissues have been used for a variety of ophthalmic procedures including glaucoma drainage device covers and lamellar grafts. The maintenance of corneal clarity is important, as light obstructions resulting from processing or long-term storage of irradiated corneas may negatively affect vision and postoperative cosmesis. It has been reported that corneal tissues can be preserved in human serum albumin (HSA), however, the clarity of corneas after long-term storage in HSA has not been well described. Furthermore, the use of donor-pooled serum increases the risk for transmission of blood-borne diseases and may induce an immune response in the recipient. Here, we examined changes in corneal clarity due to electron-beam (e-beam) irradiation and storage in a recombinant human serum albumin (rHSA). Dark-field microscopy was employed to examine the light scattering effects of fresh and irradiated corneas. Compared to measurements taken prior to tissue preparation and e-beam treatment, irradiated corneas showed an average 2.6% increase in light scattering (P=0.002). Irradiated corneas stored in rHSA at room-temperature for 20months showed an average increase of 11.6% light scattering compared to fresh corneas (P≪0.01), but did not negatively affect the visualization of printed text, and were deemed suitable for transplant use. Therefore, the slight increase in cornea light scattering, and resulting reduction in corneal clarity, after e-beam treatment and long-term storage in rHSA may not be clinically significant.These results suggest that e-beam sterilizedcorneal grafts may be used as an alternative to fresh tissue for certain ophthalmic applications.

Analysis of Ophthalmic Plastic Procedures in a Tertiary Centre

Orbito-oculoplastics diseases and deformities tend to impact negatively on the psycho-social, economic as well as the educational achievement of affected persons. Ophthalmic plastic procedures are performed to improve the appearance and function of the eyelids and face of the affected person. Purpose: To determine the prevalence and indications of oculoplastic procedures in oculopastic subspecialty in order to provide data base for management of ophthalmic plastic conditions in our centre. Method: The clinic and theatre records of all patients that had oculoplastic procedures done from January 2015 – July 2017 were retrieved to obtain demographic characteristics, duration of symptoms, presenting visual acuity and oculoplastic procedures and histo-pathological diagnosis from the records. Results: One hundred and eighty (180) patients had oculo-plastic surgery. This constituted (12.1%) of all surgeries done in this centre. There were 95(52.8%) males and 85 (48.2%) females with a male to female ratio of 1.1:1. Conjunctival disorders 106(58.9%) were the most frequent with two third occurring at 40 years and above. This was followed by disorders arising from trauma with greater than 2/3 occurring at younger age group. Most of the ophthalmic cosmetic procedures were performed in the elderly females while the destructive procedures resulting from trauma were performed in the young males. Conclusion: The incidence of ophthalmic plastic procedure was low. There is need fortraining of more staff with adequate and relevant skill in more advance cosmetic oculoplastic surgery and provision of up to date equipments required for various procedures in order to improve the practice of this subspecialty in this centre.

The incidence of hyperthermia during cochlear implant surgery in children.

Inadvertent hyperthermia during anaesthesia is a rare but life-threatening complication. We have encountered several cases of severe hyperthermia in paediatric patients undergoing anaesthesia for cochlear implantation. This study aimed to describe the clinical characteristics of children who developed hyperthermia while undergoing cochlear implantation, and to explore possible mechanisms and predisposing factors. The anaesthetic charts of all patients aged under 18 years who underwent cochlear implantation, or mastoid or ophthalmic surgery, between 1 January 2006 and 31 December 2009, at Soroka Medical Center in Beer Sheva, Israel, were reviewed. Patients undergoing mastoid and ophthalmic surgical procedures were used as controls. A larger percentage of patients who underwent cochlear implant surgery (10 per cent) developed hyperthermia compared to controls (0.7 per cent, p < 0.05). In five of the seven cases, hyperthermia appeared in combination with tachycardia and hypercapnia, adhering to the clinical triad of malignant hyperthermia. Patients undergoing cochlear implantation are susceptible to developing intra-operative hyperthermia. This article describes the hyperthermic events that occur during paediatric cochlear implantation, and attempts to identify potential triggers of hyperthermia.