Ophthalmic Procedures Research Articles

Balanced Anaesthesia for paediatric Ophthalmic Procedures

Balanced Anaesthesia for paediatric Ophthalmic Procedures

Emergency laparotomy in infants born at

ObjectiveIdentify the proportion of infants born at <26 completed weeks’ gestation who require emergency laparotomy, and review the surgical pathology, incidence of subsequent surgical procedures and outcome.DesignRetrospective cohort review.SettingTertiary neonatal...

Safety and Efficacy of Chloral Hydrate Sedation in Paediatric Sedation for Ophthalmic Procedures

Chloral hydrate (CH) sedation is routinely used in paediatric ophthalmic examination in Singapore as an alternative to examination under general anaesthesia. Despite CH's traditionally high success rates and relatively low rate of adverse events, there is little data on its safety and efficacy as a sedative for ophthalmic procedures in an Asian population. A retrospective chart review was performed, including children who underwent CH sedation at the Singapore National Eye Centre from January 2012 to January 2015. Participants were given an initial dose of CH and a top-up dose if required. Univariate and multivariate analyses were performed on data collected. CH sedation was successful in 144 of 153 children (94.1%). Of the 20 (13.0%) who required a top-up dose, 4 failed to sedate. The mean sedation onset was 29.4 minutes (SD: 24.3) and mean sedation duration was 56.5 minutes (SD: 24.0), with more than a third lasting more than 1 hour. The age of children, rather than initial dose of CH, was more relevant in determining success of sedation. Children who were >6 years old were 20.3 times more likely to fail sedation than those aged <2 years. During sedation, depression in the heart rate and a transient reduction of oxygen saturation was documented. All children recovered well post-sedation. CH is a very useful sedative for paediatric ophthalmic procedures, especially in younger children. Children over 4 years old were more likely to fail sedation and require top-up doses. Alternative means of sedation may need to be considered in these cases.

Development of Absorbable, Antibiotic-Eluting Sutures for Ophthalmic Surgery.

PurposeTo develop and evaluate an antibiotic-eluting suture for ophthalmic surgery.MethodsWet electrospinning was used to manufacture sutures composed of poly(L-lactide), polyethylene glycol (PEG), and levofloxacin. Size, morphology, and mechanical strength were evaluated via scanning electron microscopy and tensile strength, respectively. In vitro drug release was quantified using high performance liquid chromatography. In vitro suture activity against Staphylococcus epidermidis was investigated through bacterial inhibition studies. Biocompatibility was determined via histological analysis of tissue sections surrounding sutures implanted into Sprague-Dawley rat corneas.ResultsSutures manufactured via wet electrospinning were 45.1 ± 7.7 μm in diameter and 0.099 ± 0.007 newtons (N) in breaking strength. The antibiotic release profile demonstrated a burst followed by sustained release for greater than 60 days. Increasing PEG in the polymer formulation, from 1% to 4% by weight, improved drug release without negatively affecting tensile strength. Sutures maintained a bacterial zone of inhibition for at least 1 week in vitro and elicited an in vivo tissue reaction comparable to a nylon suture.ConclusionsThere is a need for local, postoperative delivery of antibiotics following ophthalmic procedures. Wet electrospinning provides a suitable platform for the development of sutures that meet size requirements for ophthalmic surgery and are capable of sustained drug release; however, tensile strength must be improved prior to clinical use.Translational RelevanceNo antibiotic-eluting suture exists for ophthalmic surgery. A biocompatible, high strength suture capable of sustained antibiotic release could prevent ocular infection and preclude compliance issues with topical eye drops.

Design and Validation of a Training Simulator for Laser Capsulotomy, Peripheral Iridotomy, and Retinopexy.

Ophthalmology trainees commonly learn laser procedures on live patients. A simulator for learning peripheral iridotomy (PI), posterior capsulotomy, and retinopexy may improve patient outcomes. A model eye with artificial tissues was designed. The tissues reacted to laser similarly to human tissues. Inexperienced (n = 6; first- to third-year residents) and experienced (n = 7; fourth- to fifth-year residents and staff) ophthalmic personal were compared on performance of the above laser procedures. The inexperienced group required more shots (P = .04) and caused more lens markings (P = .04) during capsulotomy and had more incomplete retinopexy results (P = .04) than the experienced group. The groups did not differ in total shots for PI, average power for retinopexy, or the total time required for any of the procedures. Our model effectively simulates common ophthalmic laser procedures and is practical for the training of ophthalmology residents. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:56-61.].

Role of Diagnostic Endoscopy in Posterior Segment Evaluation for Definitive Prognostication in Eyes With Corneal Opacification

Direct visualization of the posterior segment is not possible with conventional imaging techniques in eyes with corneal opacification. This study evaluated the efficacy of videoendoscopy in visualizing and hence prognosticating the visual outcomes in such eyes. Prospective, noncomparative, consecutive interventional case series. This study included 64 eyes of 64 patients with corneal opacification who underwent a diagnostic ophthalmic endoscopy procedure from March 2014 to May 2016. All eyes also underwent conventional B-scan ultrasonography as part of their comprehensive ocular examination. The findings that were noted during endoscopy included the optic disc characteristics, anatomic integrity of the retina, and condition of the retinal blood vessels. The principal outcome measure was the determination of whether the results of the videoendoscopy helped in establishment of or brought a change in the management plan; accordingly, they were classified as either "contributory" or "noncontributory." The videoendoscopy findings were classified as contributory in 62 of 64 eyes. The remaining 2 eyes had vitreous hemorrhage; endoscopic vitrectomy was done in them to detect an inoperable retinal detachment in 1 eye. With the help of the stereoscopic picture of the fundus provided by the endoscope, a poor visual prognosis in 17 eyes with retinal detachment and 22 eyes with attached retina was determined. Additionally, in eyes that had an attached retina on ultrasound B-scan, the endoscope helped in detecting a glaucomatous disc in 10 of those eyes; 7 of them had glaucomatous optic atrophy. In 3 patients ultrasound did not detect a retinal detachment (false-negative). One eye with detached retina on ultrasound did not actually have a retinal detachment (false-positive). Thus ultrasound had a sensitivity of 88.4% and a specificity of 97.3% in detecting RD as compared with an endoscopic evaluation. Based on the endoscopic findings, 34 of 64 (53%) eyes were identified as having a better visual prognosis and underwent subsequent vision-restoring procedures. This included 10 (16%) patients who directly underwent a corneal procedure and 24 (37.5%) patients who had endoscopic vitreoretinal procedures initially before undergoing a corneal procedure. Endoscopy helped in identifying poor prognosis in 30 of 64 (46.8%) eyes; thus, further invasive procedures could be avoided. The endoscopy procedure in itself did not lead to any complications. Diagnostic endoscopy provided invaluable supplemental information about the posterior segment in eyes with corneal opacification. This helped in better prognostication and in reserving corneal reconstructive procedures for eyes with a favorable visual prognosis.

A strategy for measuring patient preferences to incorporate in benefit-risk assessment of new ophthalmic devices and procedures

The U.S. Food and Drug Administration recently released guidance documents explaining that measurement of patient preferences should be considered during the pre-market approval process to specify patients’ tolerances for risk and perspectives on benefit when assessing the benefit-risk profile of new medical devices. For ophthalmological patients, the typical primary clinical outcome is a visual impairment measure. Especially for surgically- implanted devices, the benefit a specified improvement in vision measures must be translated to a patient-specific benefit of the improvement in ability to function in everyday life. We developed, and validated with simulations, a strategy for measuring an individual patient's ability to function and the overall benefit to that patient of specified improvements in functional ability. Our strategy employs Rasch analysis to measure changes in functional ability; multidimensional scaling to measure patient-specific benefits of changes in functional ability; and structural equation modeling to cross-walk patient preferences for functional ability changes to changes in visual impairment measures.

Local versus general anaesthesia for adults undergoing pars plana vitrectomy surgery.

Vitrectomy surgery is one of the commonest ophthalmic procedures performed across the world. It may be performed using general or local anaesthesia encompassing regional or topical anaesthesia depending on a number of factors, including patient suitability, and patient, surgeon or anaesthetist preference. There have so far been no evidence-based recommendations on the best form of anaesthesia for this intervention. There is no clear collated evidence base as to the best type of anaesthesia to reduce harm, and provide best surgical conditions and optimal outcome for patients. To compare local with general anaesthesia for adults undergoing pars plana vitrectomy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library and the reference lists of updated studies on the 25th of July 2016; MEDLINE via Ovid SP (1972 to July 2016) and Embase via Ovid SP (1972 to July 2016). In addition we searched the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) in July 2016. We searched the proceedings of the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) up to July 2016 for information about other relevant studies.We also searched appropriate databases for ongoing reviews. We did not apply any language restriction. We assessed the search as up-to-date on the 25th of July 2016. We planned to include all published randomized controlled trials (RCTs) involving comparison of different modalities of local anaesthesia with general anaesthesia for pars plana vitrectomy. We considered the following different modalities of local anaesthesia: sub-Tenon's anaesthesia, retrobulbar anaesthesia, topical anaesthesia, peribulbar anaesthesia. We planned to include cluster-randomized controlled trials. We excluded quasi-RCT trials. Two review authors conducted independent searches and assessed identified studies for inclusion according to the prespecified selection criteria. Two review authors assessed trial quality and planned to extract the data. We found no eligible studies that met our inclusion criteria and were therefore unable to perform a meta-analysis or conduct a methodological quality assessment. This systematic review failed to locate relevant clinical evidence to support or refute a pars plana vitrectomy performed with various modalities of local anaesthesia versus general anaesthesia. Good-quality clinical trials are needed to define the role of local versus general anaesthesia for pars plana vitrectomy.

Enhancement of Corneal Visibility in Optical Coherence Tomography Images with Corneal Opacification.

PurposeTo establish and to rank the performance of a corneal adaptive compensation (CAC) algorithm in enhancing corneal images with scars acquired from three commercially available anterior segment optical coherence tomography (ASOCT) devices.MethodsHorizontal B-scans of the cornea were acquired from 10 patients using three ASOCT devices (Spectralis, RTVue, and Cirrus). We compared ASOCT image quality (with and without CAC) by computing the intralayer contrast (a measure of shadow removal), the interlayer contrast (a measure of tissue boundary visibility), and the tissue/background contrast (a measure of overall corneal visibility). All six groups (Spectralis, RTVue, Cirrus, Spectralis+CAC, RTVue+CAC, and Cirrus+CAC) were ranked according to a global performance index that averaged all contrast quantities.ResultsCAC provided mean intralayer contrasts improvement for all devices (all P < 0.05). Mean tissue/boundary contrasts were also improved for Spectralis and Cirrus (both P < 0.001). Mean interlayer contrasts were increased for Spectralis (P = 0.011) only. When comparing global performance indices, all CAC groups outperformed their corresponding baseline groups significantly. RTVue performed best without CAC, but Spectralis+CAC was ranked first.ConclusionsASOCT images of corneal scars may be enhanced by CAC through shadow removal, improved tissue boundary visibility, and enhanced corneal visibility against the image background. RTVue produces the finest baseline images but the best image quality can be achieved by applying CAC to Spectralis images.Translational RelevanceCAC could enhance visibility of corneal images with scars acquired from commercially available ASOCT devices and could aid preoperative planning of patients for ophthalmic procedures.

Assessment of the Effects of Intense Pulsed Light Procedure in Porcine Eyes with Different Treatment Strategies

1.1.Introduction: The use of intense pulsed light (IPL) increased in recent years. This study aimed to identify the types and degrees of eye injury caused by IPL in ‘’ex vivo’’ porcine eye, correlating the distance from the shooting location of the ocular region, power and pulse duration used. 1.2.Methods: Experimental study. Intense pulsed light (IPL) was applied in five different treatment strategies (7J/5ms, 9 J/12ms, 10J/18 ms, 11J/26ms and 12J/34 ms) with corneal thickness evaluation pre and post procedure and classification of degree of eye injury observed in biomicroscopy slit lamp in the phase after the procedure. 1.3.Results: There was no change in pachymetry in the group of lower power and frequency - Group 1 (7J/5 ms), but from 9J/12 ms (groups 2, 3, 4 and 5) all groups presented reduction of corneal thickness. The biomicroscopy analysis in slit lamp showed that inferior keratitis was observed a greater number of eyes subjected to intense pulsed light procedure with minor powers (7 and 9J) and iris lesion were observed a greater number of eyes subjected to light procedure intense pulsed with greater powers (12J). 1.4.Conclusion: Ocular adverse effects were observed in all strategies of the intense light pulse procedure in porcine eye. The intraocular effects such as iris lesions were more evident in treatments with higher powers. Change of corneal thickness was observed with intense pulsed light from 9J and 12 ms. Because of the lesions observed in the evaluation after the procedure we corroborate the recommendation of using scleral lenses, possibly made of stainless steel, to dissipate the energy of the IPL when ophthalmic procedures or esthetic procedure near the eyeball margin.

Fibrin glue inhibits migration of ocular surface epithelial cells

PurposeFibrin glue has been used successfully in numerous ophthalmic surgical procedures. Recently, fibrin glue has been used in limbal stem cell transplantation to reduce both operative time and to negate the need for sutures. The aim of this study was to determine the effects of fibrin glue on epithelial cell migration in vitro.MethodsCorneoscleral rims were split to retain the epithelial layer, Bowman's layer, and anterior stroma. Rims were cut into eight equal-sized pieces and were placed directly on culture plates or affixed with fibrin glue. Rims were maintained in culture for 25 days and epithelial cell growth was monitored. Cells were photographed to measure area or growth and immunofluorescence staining of explants for fibrin was performed.ResultsExplants that were glued demonstrated significantly delayed epithelial cell growth and migration as compared with explants without glue. By day 16, all fibrin glue had dissolved and coincided with onset of cell growth from glued explants. Cell growth commenced between days 3 and 4 for control explants without glue and around days 14-16 for explants with fibrin glue.ConclusionsFibrin glue delays epithelial cell migration by acting as a physical barrier and can potentially interfere with explant-derived limbal epithelial cell migration on to the corneal surface. We propose that glue should be used to attach the conjunctival frill of the limbal explant but care should be taken to ensure that the glue does not wrap around the explant if used to secure the explant as well. Strategic use of glue, to attach the recessed conjunctiva, can be advantageous in delaying conjunctival cell migration and reducing the need for sequential sector conjunctival epitheliectomy.

Características clínicas del estrabismo en pacientes con catarata congénita

IntroductionSensorial strabismus is a very frequent condition associated with congenital cataract. When the opacity is unilateral esotropia is more frequent. Objectivedetermine the frequency of strabismus in patients with congenital cataracts and their characteristics Material and methodsThis is a descriptive, observational and retrospective study.Case records of patients diagnosed with congenital cataract in the period January 2009 to August 2011, where reviewed. We include records with complete ophthalmic clinical examination and excluded patients with a history of any ophthalmic surgical procedure. Results38.9% of patients had some type of ocular deviation, esotropia was more common in bilateral cataracts. Nystagmus was found in 25.9%, predominantly in patients with nuclear and total cataracts, and visual acuity less than 20/400. Conclusionsvisual deprivation caused by the lens opacity, stops the maturation of binocularity which may manifest as function deficits such as amblyopia, strabismus or nystagmus.

Effect of Fentanyl Addition to Local Anesthetic on Peribulbar Block in Keratoplasty Sugery

Peribulbar anesthesia is now accepted as a safe locoregional anesthesia to carry out most of the ophthalmic procedures. However, in penetrating keratoplasty (PKP) it carries many risks if the patient becomes restless since PKP is an “open sky” procedure making it totally dependent on the changes in the intra-ocular pressure (IOP). [1] Therefore, the main concern of anesthesia is to limit the risks associated with unexpected increase of IOP , the most hazardous of which would be suprachoroidal hemorrhage. [2]. Advancements in keratoplasty techniques are thus being made constantly to further improve prognosis and minimize the risks. Some of these include deep lamellar techniques and femtosecond laser assisted keratoplasty , the latter of which requires the patient to be transferred from one room, where the recipient’s and donor’s cornea are being cut by the femtosecond laser, to the operating room for graft suturing. Unfortunately, these advancements came at a cost as the procedure became lengthier.

Rebound tonometry over an air-filled anterior chamber in the supine child after intraocular surgery

Intracameral air is a critical component of multiple ophthalmic surgical procedures and is frequently used in pediatric intraocular surgery. Among other benefits, it helps to facilitate postoperative examination in uncooperative children by allowing quick confirmation of a formed anterior chamber. The purpose of this study was to evaluate the usefulness and accuracy of a position-independent rebound tonometer (Icare PRO) in measuring intraocular pressure (IOP) intraoperatively in pediatric eyes with intracameral air compared to a commonly used handheld applanation tonometer (Tono-Pen XL). In this prospective study of sequential children undergoing intraocular surgery, IOP was measured immediately following general anesthesia induction using both Icare PRO rebound tonometry and Tono-Pen XL tonometry, with instrument order randomized, in the supine child's eye(s). At completion of surgery after standard placement of intracameral air IOP was again measured using both instruments. A total of 42 eyes of 30 children were included. Surgeries included glaucoma (25), cataract-related (16), and both (1). Mean preoperative IOP by Tono-Pen XL was 23.52±9.76mm Hg; by Icare PRO, 20.94±10.01mm Hg (P=0.0012). Mean IOP over intracameral air at surgery conclusion by Tono-Pen XL (n=41) was 12.66±4.90; by Icare PRO (n=42), 12.96±5.10mm Hg (P=0.46). One eye had postoperative IOP unrecordable by Tono-Pen XL but 7.9mm Hg by Icare PRO. Bland-Altman analysis, which included only paired measurements, showed a preoperative mean difference in IOP (ΔIOPT-I) of 2.58mm Hg (95% CI, -6.86 to 12.02); postoperative mean ΔIOPT-I of -0.42mm Hg [95% CI, -7.57 to 6.73]. Position-independent rebound tonometry (Icare PRO) accurately measured IOP in supine children's eyes postoperatively in the presence of intracameral air.

Robotic Systems in Ophthalmology

The use of robotic systems has developed extensively in various surgical subspecialties. This article attempts to provide an overview of the applications of these systems in the field of ophthalmology. The robotic surgical platforms available for ophthalmic use are discussed with their inherent advantages and disadvantages, including the da Vinci and the IRISS (Intraocular Robotic Interventional and Surgical System). The potential for complete automation of ophthalmic surgical procedures in the recent future makes the field of robotics an exciting development.

Continuous intraoperative OCT guided management of post-deep anterior lamellar keratoplasty descemet’s membrane detachment

Continuous intraoperative optical coherence tomography (iOCT) integrated into the operating microscope is a new modification in the current operating microscope to aid in the surgical procedures involving both the anterior and the posterior segment. This helps in intraoperative planning, modification of the surgical steps if required and confirmation of the surgical endpoint in the operating room itself. iOCT was used for the successful management of descemet’s membrane detachment (DMD) following deep anterior lamellar keratoplasty (DALK) with intracameral injection of 20% Sulphur hexafluoride. The gas was injected under direct visualization through the microscope with continuous real time monitoring of the change in height of the detached Descemet’s membrane (DM). Additionally stab incisions were given through the anterior cornea due to the presence of residual fluid above the DM which was visible on continuous iOCT images. This led to the successful apposition of the DM which otherwise would have remained detached due to the residual fluid. This highlights the importance of continuous iOCT monitoring of the ophthalmic surgical procedures in order to produce a successful anatomical outcome of the surgery without disruption of the surgical procedure.

Mensurações do bulbo ocular e cálculo do poder dióptrico da lente intraocular em miniporcos

Objetivou-se com este trabalho determinar o poder dióptrico da lente intraocular (LIO) em miniporco e as dimensões do bulbo do olho. Foram utilizados 17 miniporcos, sadios, adultos, machos e fêmeas, com peso médio de 70kg. Em todos os olhos foram realizadas a ultrassonografia modo A, a ceratometria e a medida da distância limbo a limbo. O cálculo do poder dióptrico da LIO foi obtido utilizando-se as fórmulas Haigis, Hoffer Q, SRK/T, Holladay I e Holladay II e o software Holladay IOL Consultant(r). Na comparação entre o sexo e a lateralidade do olho, não houve diferença nas variáveis biométricas e poder da LIO. A aplicação das fórmulas (Haigis, Holladay II, Holladay I, SRK/T e Hoffer Q) possibilitou o cálculo do poder da LIO. A Holladay II, fórmula que melhor individualiza o bulbo do olho do miniporco, estima valor dióptrico ao redor de 41 D. Os miniporcos têm potencial como modelo experimental em oftalmologia, relacionado ao seu menor porte e à facilidade no manejo, especialmente em experimentos de longa duração.

Morphometric Alteration of Intestinal Epithelium of Rats (Rattus norvegicus) Submitted to the Technique of Enteropexy

Background: Due to the numerous complications that enteropexy may cause in domestic animals and humans, this study aimed at investigating the microscopic level, the damage generated by this technique in mice, in order to investigate the morphometric changes caused by enteropexy technique in rats.Materials, Methods &amp; Results: Eighteen Wistar rats were submitted to surgical technique of enteropexy. To evaluate intestinal disorders they were euthanized at 30 (Group I), 60 (group II) and 90 (group III) days after the procedure. The animals were perfused with 2.5% glutaraldehyde and 4% paraformaldehyde for the removal of intestinal fragments for analysis in conventional microscopy and scanning electron microscopy. In classical histopathology, group I presented mild lesions with necrosis of the epithelium and infiltration of mononuclear cells. After 60 days, extensive ischemic necrosis area was observed, characterized by the denudation of epithelium cells and cellular debris in the lumen surface and loss of intestinal crypts. After 90 days (group III) lesions were evident and were characterized by strong coagulative necrosis of epithelial cells and intestinal crypts. Under electron microscopy, group I showed early fusion of the adjacent intestinal walls. After 60 days there was adherence of luminal stenosis and intestinal walls. In group III loss of epithelium and substitution of necrotic tissue were identified.Discussion: In the current study it was noticed microscopically that the groups had inflammatory reactions to foreign bodies. It is known that the sutures, independent of manufacture, behave as foreign bodies that induce tissue inflammation of the recipient organism and could harm the scar repair. Among the surgical threads, the nylon type (which was chosen for the current experiment) is indicated in the approach tissues in general and bandages, including cardiovascular, ophthalmic and neurological procedures. This category wire induces minimal inflammation of the receptor tissue. In studies of the histopathological analysis of the tissue reactions produced by the wire implant or nylon thread clamp in rats, it was observed that when the local action of two implants were compared, inflammation showed qualitatively similar responses, although they had different characteristics regarding their course. Inflammation is proportional to the proliferation of fibroblasts and the presence of fibrous tissue around the suture. This quote confirms the analyzed samples, in which, in all postoperative times showed inflammatory process, although at different magnitudes. Surgical research in laboratory animals has expanded in recent decades, mainly due to better anesthetic support, the sophistication of infrastructure, material for perioperative continuous monitoring and an incessant search for species that reproduce human morbid conditions. The main focus of these studies have been improving the knowledge about the pathophysiological mechanisms of disease, undertake therapeutic trials with new drugs, studying biomarkers and evaluate new techniques to be applied prospects in man. The most common sites of occurrence of intestinal are ileocolic intussusception junction and jejunojejunal segment. The enteroplication has been used to reduce the occurrence of intussusception, promoting the adhesion of the adjacent serosa layers of intestinal segments and thereby decreasing intestinal motility, their applicability is reported in humans, dogs and cats. The enteropexy technique causes morphological changes in intestinal epithelium of rats, evidenced in conventional and electron microscopy, progress with the passing of time the procedure.

Comparing Different Decontamination Procedures in Harvesting Human Donor Cornea

ABSTRACTPurpose: To evaluate the effects of current hygiene standards for the enucleation of postmortem eyes by investigating the number of microorganisms during subsequent steps of decontamination and tissue processing.Materials and methods: This prospective, non-randomized cohort study includes 184 postmortem eyes of 92 human donors. Enucleation was performed, according to an ophthalmic surgical procedure. Two groups were generated as follows: right eyes were allocated to group A, left eyes were allocated to group B. In group A, a mucosal disinfectant was used accessorily. Conjunctival smears were taken to examine germ load in both groups before any intervention, in group A after mucosal disinfection, in both groups after transportation of the whole globes in transport fluid, and in both groups after a bath in 0.75% povidone iodine solution for at least 3 minutes just before preparation of the corneoscleral disc. Smears were sent to the local microbiologic laboratory in an aseptic package for testing.Results: All smears showed multiple contaminations (n = 184/184 eyes) before treatment with povidone iodine solution. Contamination was in both groups significantly prevented using the treatment strategy of an at least 3-minute bath in 0.75% povidone iodine solution (n = 1/184 eyes; p < 0.01) As a side effect, almost every eye of group A and none of group B showed brown iodine staining corresponding to corneal epithelial erosion.Conclusions: An aseptic setting for donor enucleation similar to a surgical procedure seems not to influence the outcome of germ colonization. The most effective step to decontaminate donor eyes is to use 0.75% povidone iodine solution for at least 3 minutes.

Update and review of Urrets-Zavalia syndrome.

For more than half a century, Urrets-Zavalia syndrome (fixed dilated pupil) has been described as a postoperative complication of ophthalmic surgery. Since first reported as a complication of penetrating keratoplasty for keratoconus in patients receiving atropine, the characteristic features of Urrets-Zavalia syndrome have been expanded. In previous literature, a total of 110 cases resulted in a fixed and dilated pupil. Increased intraocular pressure (IOP) in the immediate postoperative period, phakia, and air or gas in the anterior chamber appear to be the most important risk factors for Urrets-Zavalia syndrome following ophthalmic procedures. Mannitol, IOP control, the removal of air or gas in the anterior chamber, and iridectomy have all demonstrated utility in managing Urrets-Zavalia syndrome.