Peribulbar Injection Research Articles

A controlled clinical study on efficacy and safety of periocular triamcinolone acetonide injection for treating ocular myasthenia gravis

ObjectiveTo evaluate the efficacy and safety of peribulbar triamcinolone acetonide injection for treating ocular myasthenia gravis (OMG), with a comparison of traditional oral drug therapy.MethodsA total of 22 patients with OMG who received periocular triamcinolone acetonide injection (initially 20 mg weekly, then once per month later if symptoms were improved) from July 2019 to July 2022 were evaluated by a comparison of symptom degree before and after treatment. Adverse reactions were also monitored during the period of treatment. The period of follow-up was more than 6 months. Additionally, a comparison of the treatment efficacy between this periocular injection and traditional oral administration was performed in OMG patients.ResultsAfter 4 weeks of treatment, the degree of ptosis in OMG patients decreased to -3.00 ± 0.69, compared to the value (-0.86 ± 1.32) before treatment. The degree of ophthalmoplegia also decreased from 3.12 ± 0.72 to 0.86 ± 0.88 (P < 0.001) after treatment. The achievement rates of minimal manifestations status (MMS)for ptosis and ophthalmoplegia after 4 week-treatment were 86.3% and 75%, respectively, while they were 50% and 30% in patients with traditional oral administration. There was statistically significant difference only in MMS (rather than symptom relief rate and generalization conversion rate) between two groups. No serious complications (except for intraorbital hematoma) were found in OMG patients during the treatment period.ConclusionRepeated peribulbar injection of triamcinolone acetonide can effectively alleviate the initial symptoms of OMG patients. However, the evaluation of its long-term efficacy is still needed.Clinical Trial RegistryThis study has been clinically registered by Chinese Clinical Trial Registry (ChiCTR), first trial registration date:05/07/2019, registration number: ChiCTR1900024285.

Comparing Peribulbar and Topical Anesthesia in Cataract Surgery among Patients with Cardiovascular Disease.

To compare topical and peribulbar anesthesia in cataract surgery for hemodynamic changes, rate of complications and pain score in patients with cardiovascular disease. A prospective comparative study at a tertiary care center in India. Patients >40 years old with treated/controlled hypertension and cardiovascular disease scheduled for cataract surgery under topical or peribulbar anesthesia were recruited. Heart rate, blood pressure, and ophthalmic and systemic complications were noted: preoperatively, immediately after block, intraoperatively, immediately postoperatively and 1 hour postoperatively. A visual analog scale was used to assess the pain score. A total of 150 patients (75 in each group) underwent cataract surgery. There was a significant rise in pulse rate and blood pressure after peribulbar injection and intraoperatively, which gradually reduced to baseline 1 hour after surgery in both groups (p < 0.001), with systolic blood pressure intraoperatively being significantly greater in the peribulbar group (155.49 ±18.14 mmHg vs. 147.95 ±17.71 mmHg, p = 0.01). The topical group had slightly lower visual analog scale scores (1.12 ± 0.99) than the peribulbar group (1.44 ± 0.90, p = 0.04). Cataract surgery appears safe in patients with adequately controlled cardiovascular disease, and topical anesthesia may be preferable due to noninvasiveness, adequate analgesia, and minimal effect on hemodynamic parameters. Therefore, hemodynamically stable patients of cardiovascular disease undergoing uncomplicated cataract surgery may be counselled for topical anesthesia.

Diagnostic challenges of posterior scleritis in pembrolizumab treated patient for cutaneous melanoma: A case report

PurposeTo describe various clinical pictures of posterior scleritis following pembrolizumab therapy for metastatic cutaneous melanoma. MethodsDescription of the clinical case with data from patient presentation and recurrences, diagnostic examinations, treatment, and six-months follow up. Clinical presentation of previous reports of pembrolizumab related of eye inflammation are discussed. ResultsA 49-year-old patient underwent resection of metastatic melanoma of the skin with sentinel lymph nodes removal and pembrolizumab adjuvant therapy every three weeks. Nine months after pembrolizumab initiation the patient accessed ophthalmology emergency service complaining one week vision loss on her right eye associated with pain on eye movement. Ocular examination revealed right eye papillitis and posterior scleritis. Intravenous corticosteroid treatment was started associated with topical prednisolone drops, after which complete resolution of the subretinal fluid was seen. During the six months follow up one episode of posterior scleritis was observed in the contralateral eye and resolved after peribulbar corticosteroid injection and oral therapy and one recurrence of intermediate scleritis in the right eye which resolved after oral therapy. ConclusionPosterior and intermediate scleritis may be added to the spectrum of pembrolizumab related eye inflammation; in the case presented posterior scleritis occurred asymmetrically in both eyes suggesting chronic features, importance of steroid tapering and follow up.

Successful antibiotic management of Staphylococcus epidermidis endophthalmitis after implantable collamer lens implantation

PurposeWe report a case of successful medical management of endophthalmitis post implantable collamer lens (ICL) culture-positive of Staphylococcus epidermidis.Observations: A 18-year-old female presented with decreased visual acuity in the left eye 20 days after ICL implantation. A diagnosis of postoperative endophthalmitis was made based on examination and ultrasonography. A vitreous tap was taken, and intravitreal antibiotics (vancomycin 1 mg/0.1ml and ceftazidime 2 mg/0.1ml) were administered twice (every 72 h), and peribulbar injection of triamcinolone acetonide after four days of the second intravitreal injection. The vitreous culture was confirmed for Staphylococcus epidermidis. The endophthalmitis was resolved, and visual acuity improved from 6/20 to 12/20 on day 7 and 22/20 on day 38. This is the first successful medical resolution of Staphylococcus epidermidis endophthalmitis post ICL surgery without ICL explantation and vitrectomy in the V4c model.Conclusions and importance: In antibiotic therapy, the excellent compliance and close follow-up of this endophthalmitis patient enabled careful postoperative surveillance on the effect of antibiotic therapy, avoiding the removal of the ICL or the loss of the integrity of the eye. The risk of potential infectious endophthalmitis post-ICL surgery should be fully emphasized during preoperative counseling.

Методы оптимизации комплексного лечения больных глаукомой после лазерной трабекулопластики

Aim. To evaluate the results of complex treatment of advanced stage POAG (stage III) with the use of Retinalamin. Methods.In a hospital under observation there were 67 patients (67 eyes) with stage III POAG, including 37 men and 28 women. The age of the patients varied from 53 to 78 years. Depending on the therapy, the patients were divided into two groups. The first (main group) after laser trabeculoplasty received Retinalamin in subconjunctival injections for 10 days and patients in the control group received Retinalamin in peribulbar injections. A comprehensive examination included general ophthalmological studies: visometry, perimetry, gonioscopy, biomicroscopy, ophthalmoscopy, tonometry, tonography, as well as dopplerography of retinal vessels. Results. A year later, stabilization of the glaucoma process in the main group was achieved in 89 % of cases, in the control group – in 68 %. Conclusion. In the late stages of glaucoma, in the complex of conservative treatment, it is pathogenetically justified to use laser trabeculoplasty followed by subconjunctival injection of Retinalamin for 10 days. Key words: POAG; laser trabeculoplasty; Retinalamin.

Frequency and Treatment Regimens of Macular Edema in 1946 Consecutive Patients with Noninfectious Uveitis at a Tertiary Ophthalmic Center in Shaanxi, China.

We investigated the frequency of uveitic macular edema (UME) in patients with different types of noninfectious uveitis and present the primary treatment methods for UME at a specialized eye center in Shaanxi Province, China. We conducted a retrospective, noninterventional, observational survey involving 1946 patients with noninfectious uveitis (2816 eyes). The collected data included sex, age of uveitis onset, age of UME onset, anatomical classification of uveitis, and the treatment administered to UME patients. Of the 1946 patients with noninfectious uveitis, 929 (47.74%) were male and 1017 (52.26%) were female. The average age of all participants in the study was 42.19 ± 15.34years, with average age at uveitis onset of 39.50 ± 15.52years. Among the patients, 1003 (51.54%), 239 (12.28%), 410 (21.07%), and 294 (15.11%) had anterior uveitis, intermediate uveitis, posterior uveitis, and panuveitis, respectively. UME was observed in 134 (6.89%) of the uveitis patients. The average age of UME patients was 47.33 ± 17.17years, with average age at uveitis onset of 45.78 ± 17.20years. Out of the 134 UME patients, 3 (0.30%), 15 (6.28%), 47 (11.46%), and 69 (23.47%) had anterior uveitis, intermediate uveitis, posterior uveitis, and panuveitis, respectively. Among them, 37 were lost to follow-up, 44 received adalimumab (ADA) combined with low-dose prednisone and with or without conventional immunosuppressants, 19 received interferon-α2a therapy, 14 received intravitreal corticosteroid injections (such as dexamethasone implant or fluocinolone acetonide), 11 received low-dose corticosteroids combined with conventional immunosuppressants, 5 received only oral prednisone, and 4 received repeated peribulbar or subconjunctival injections of triamcinolone acetonide. At our tertiary ophthalmic center in Shaanxi Province, China, only 6.89% of patients with noninfectious uveitis were diagnosed with UME. The primary treatment modality for UME in our center is ADA, in accordance with treatment guidelines and the Chinese medical insurance reimbursement system.

A case of globe explosion after peribulbar anesthetic injection

The ocular explosion is a very rare but serious complication of peribulbar anesthetic injection with only a few reports in the literature. A 360 Degrees dialysis of the retina due to a globe explosion after the peribulbar injection has been reported only in one case. We are reporting the complication of 360 d dialysis of the retina with the incarceration of the detached retina in the scleral wound after periocular injection of anesthetic for cataract surgery. Management and results of the case are reported here.

Comparative efficacy of mepivacaine vs. bupivacaine added to lignocaine plus hyaluronidase for percutaneous peribulbar injection in cataract surgery

Background: Peribulbar anesthesia had been developed as a safer, easier, and effective alternative to retrobulbar anesthesia that provides ocular akinesia and anesthesia.&#x0D; Objective: This study aimed to compare the efficacy of mepivacaine 3% – lidocaine 2% hyaluronidase mixture with that of bupivacaine 0.5% – lidocaine 2% - hyaluronidase to produce optimal operative and post-operative conditions in patients receiving single peribulbar injection for cataract surgery.&#x0D; Patients and Methods: In this randomized, double -blind study, 90 adult patients were assigned to one of two groups (M and B), each comprising 45 patients. Study participants received 6-8 ml combination of equal parts of either mepivacaine 3% (Group M) or bupivacaine 0.5% (Group B) both with lidocaine 2% and hyaluronidase 25 IU/ml. Akinesia was assessed with a 12-point scale at 2, 5, 10 and 15 min after injection. Onset of sensory block, time to start surgery, pain and requirement for supplemental injection were also assessed.&#x0D; Results: Group M showed better akinesia scores than Group B and the onset of globe akinesia and sensory block were significantly faster in Group M. The duration of globe and lid akinesia was longer in Group B (159.16 ± 5.71 min and 150.02 ± 4.42 min, respectively) than in Group M (142.89 ± 6.52 min and 135.69 ± 4.81 min, respectively) and this showed statistical significance (P &lt; 0.001). The percentage of patients who required supplementary injection was significantly higher in Group B (7 patients) compared to that in Group M (2 patients).&#x0D; Conclusion: Using a mixture of mepivacaine and lidocaine gives perfect globe akinesia and quicker establishment of appropriate conditions to start cataract surgery and shortens the block onset time with faster recovery compared with the addition of bupivacaine to lidocaine in peribulbar anesthesia.&#x0D; Trial registration: Registered at http:// www.pactr.org; No. PACTR201810828658359. Dated: October8, 2018.&#x0D; Abbreviations: ASA PS - American Society of Anesthesiologists Physical Status; PACU - Post Anesthesia Care Unit; VRS - Verbal Rating Scale; PBA - Peribulbar Anesthesia&#x0D; Key words: Peribulbar block, Cataract extraction, Mepivacaine, Lidocaine, Bupivacaine.&#x0D; Citation: Saleh AN, Haiba Ali Ibrahim DM, Zekry MR. Comparative efficacy of mepivacaine vs. bupivacaine added to lignocaine plus hyaluronidase for percutaneous peribulbar injection in cataract surgery. Anaesth. pain intensive care 2023;27(5):464−470; DOI: 10.35975/apic.v27i5.2167&#x0D; Received: April 09, 2023; Reviewed: August 08, 2023; Accepted: August 18, 2023

Levobupivacaine Combined with Cisatracurium in Peribulbar Anaesthesia in Cats Undergoing Corneal and Lens Surgery

The aims of the study included evaluating the effects of levobupivacaine combined with cisatracurium on akinesia and mydriasis when administered by peribulbar injection, and evaluating if the chosen dose of cisatracurium is enough to avoid the use of systemic neuromuscular blockade in cats. The animals were divided into four groups as follows: group L received 1.25 mg kg-1 levobupivacaine administered by peribulbar injection; group LC received the same dose of levobupivacaine combined with 0.01 mg kg-1 of cisatracurium administered by peribulbar injection; group C received 0.01 mg kg-1 of cisatracurium administered by peribulbar injection; group GC received 0.01 mg kg-1 of cisatracurium intravenously. Physiological variables, intraocular pressure, akinesia, and mydriasis were measured before and up to 30 min after peribulbar injection. The onset of akinesia, duration of akinesia, and train of four (TOF) were evaluated. Physiological variables remained in the physiological range in all groups. Effective akinesia and mydriasis were observed in all groups. The (TOF) was 0.9 in all groups. Throughout the study was observed in group LC a shortened onset of akinesia and a prolonging its duration. The peribulbar injection of cisatracurium and levobupivacaine provided effective akinesia and mydriasis, and shortened the onset of akinesia while prolonging its duration.

Adverse effects associated with peribulbar injection of triamcinolone for the treatment of thyroid eye disease: a retrospective case series.

Peribulbar injection of triamcinolone is an alternative treatment for thyroid eye disease; however the safety profile of this therapeutic option remains controversial. The aim of this study was to describe the occurrence of local and systemic adverse effects after peribulbar injection of triamcinolone in patients with thyroid eye disease. This was a retrospective case series. Medical records of patients with thyroid eye disease treated with peribulbar injections of triamcinolone at a single academic institution between 2007 and 2019 were analyzed. Local and systemic complications were documented. A total of 123 patients were treated. Only 11 patients (8.9%) developed local complications. The most frequent complication was the presence of superficial eyelid ecchymosis (nine patients; 7.3%). Notably, systemic complications (hyperglycemic and suprarenal inhibition after stop treatment) occurred in two patients (1.6%). All complications were transient, and the patients did not have any long-term sequelae. Peribulbar injection of triamcinolone for the treatment of thyroid eye disease is linked to a very low rate of local or systemic complications. Prospective studies are warranted to delve into this topic.

Assessing The Efficacy of Single Inferomedial Peribulbar Injection in Lacrimal Intubation Surgery in Adult Patients: A Randomized Clinical Trial

Assessing The Efficacy of Single Inferomedial Peribulbar Injection in Lacrimal Intubation Surgery in Adult Patients: A Randomized Clinical Trial

Comparative study to assess the effect of ropivacaine and a mixture of lidocaine and bupivacaine on intraocular pressure after peribulbar anesthesia for cataract surgery.

To compare the efficacy of ropivacaine with a mixture of lidocaine and bupivacaine in peribulbar anesthesia for cataract surgery, in terms of post-block intraocular pressure (IOP). A one-year comparative study was done to compare two anesthetic solutions in peribulbar anesthesia for cataract surgery, from January 2020 to December 2020 at a tertiary health care hospital. Two hundred patients (40-70 years of age) planned for small-incision cataract surgery with posterior chamber intraocular lens (IOL) implantation under peribulbar anesthesia were included in the study. A single-site inferotemporal injection was given till a total eyelid drop was observed. The IOP was measured at four time-points: before block (control), 1-, 5-, and 15-minute post-block with a tonometer. The 1-minute post-block mean IOP in both the groups was higher than the baseline levels. This reflected raised intraorbital pressure secondary to peribulbar injection of local anesthetic. However, the rise in 1-minute post-block IOP was significantly less in the ropivacaine group. The 5- and 15-min post-block mean IOP values in the ropivacaine group were significantly lower than the corresponding values of the lidocaine-bupivacaine group and baseline (control) ropivacaine values. The results of this study support that ropivacaine as a local anesthetic drug for peribulbar block for small-incision cataract surgery can be a suitable alternative to the lidocaine-bupivacaine combination. Studies involving a larger sample size are required to consider ropivacaine as a superior drug to the lidocaine-bupivacaine combination.

Globe penetration during loco-regional anesthesia: prevalence and review of cases.

To describe prevalence and different clinical signs and management of cases with penetrating eye injuries during loco-regional anesthesia for ophthalmic surgery. A retrospective review of clinical records was carried out, identifying cases of globe penetration secondary to peribulbar anesthesia injection during 5y activity in Centro de Oftalmología Barraquer. A total of 17 460 needle-based ocular anesthesia procedures were performed in our centre and 4 cases of globe penetration were recorded with an estimated prevalence of 0.024%. Globe penetrations were always detected in the first 24h after surgery. Vitreous haemorrhage was found in all the cases. Two eyes presented retinal detachment and two eyes choroidal detachment (CD). The initial surgical approach was performed within the first 48h. Silicone oil was used as tamponade in three eyes and the fourth case remained only with air. Detachments were solved successfully in all the cases. Functional results varied among cases, depending on ocular remarkable antecedent and globe penetration with or without retinal or CD. Prevalence of globe penetration during loco-regional anesthesia is low in our centre. Physicians should consider the possibility of globe penetration in eyes with postoperative atypical appearance after loco-regional anesthesia. Immediate B-scan ultrasonography is recommended in suspicious cases with a dense vitreous haemorrhage. An early vitrectomy surgery in conjunction with laser or cryotherapy at the penetration sites is essential for good anatomical and functional results.

Опыт применения глюкокортикоидов у пациентов с макулярным отеком, связанным с саркоидозом

Purpose. To evaluate the results of treatment of patients with sarcoidosis with chronic non-infectious uveitis complicated by macular edema by intravitreal injection of a glucocorticosteroid implant with previously used methods. Material and methods. The study performed a comparative analysis of data from patients with cystic macular edema against the background of chronic non-infectious uveitis associated with sarcoidosis, with corrected visual acuity of more than 0.05 (according to the Golovin-Sivtsev table). Group 1 (prospective analysis) included the results of treatment of patients with sarcoidosis with corticosteroid implants (4 eyes, 4 patients). In the 2nd group (retrospective analysis of the medical history), patients underwent peribulbar administration of betamethasone (9 eyes, 7 patients). The parameters were analyzed after 2.0±0.5, 4.0±0.5 and 6.0±0.5 months with assessment of maximally corrected visual acuity (BCVA), OCT, color photography, and IOP control. The risk of recurrence of macular edema when comparing groups was assessed over a 6-month follow-up period. Results. During the observed period in both groups, no complications were detected in any case. According to visometry and OCT, the best functional results were obtained in group 1. Average visual acuity after 6 months. was 0.7±0.1, the thickness of the retina in the central zone was 331±15µm. Conclusion. According to the results of the study, it was found that intravitreal injection of dexamethasone implant in its effectiveness surpasses the previously used peribulbar injections of betamethasone in terms of the quality of restoration of visual functions, the effectiveness of reducing macular edema and the duration of remission of the chronic inflammatory process. Key words: sarcoidosis, chronic uveitis, macular edema, dexamethasone implant, surgical treatment

Exploring the globe salvaging treatment options in patients of COVID-19-associated mucormycosis with orbital involvement.

To explore the various globe salvaging treatment strategies for patients with coronavirus disease 2019-associated mucormycosis (CAM). interventional analytical study conducted at a Medical College in rural India. A total of 84 patients of CAM admitted between May 2021 and August 2021 were enrolled for the study. Patients with histologically proven CAM with clinical and/or radiological evidence of orbital involvement were divided into three treatment categories based on the site and extent of the lesion. Re-assessment was performed after 7 days. For patients who worsened with the primary approach, orbital exenteration was considered based on a Sion Hospital Scoring System. A novel approach to intra-orbital anti-fungal therapy, site-centered peri-bulbar injection of amphotericin B (SCPeriAmB), was also explored. All the patients were followed up for at least 3 months. Convenience sampling with descriptive statistics was used. Six patients had to finally undergo exenteration by the end of the study period. The rest of the patients were reported to be stable or improved. No mortalities were reported on delaying the exenteration. No adverse events were noted in patients who were given SCPeriAmB. Globe salvaging treatment options should be advocated as a primary approach in patients with CAM. Site-centered peri-bulbar injections can be considered as an approach for delivering intra-orbital anti-fungal therapy in selected patients.

Recurrent toxoplasma chorioretinitis in a patient with a selective deficiency of NKT cells and CD8+ cytotoxic T lymphocytes associated with a genetic deficiency of the folate cycle. Case report

This article describes a case study of recurrent Toxoplasma chorioretinitis in a young patient with cell immunodeficiency. Patient K., 37 years old, was admitted to ophthalmologist with complaints of decreased visual acuity and discomfort in the left eye. The history of the disease evidenced that he had suffered at least 2 episodes of acute posterior uveitis in the past without finding out the etiological factor. Ophthalmological examination revealed an old scar on the retina of the right eye and signs of acute vitreous and chorioretinitis around the old scar on the retina of the left eye. By applying the method of paired sera, it was possible to establish the etiological factor of ophthalmic lesions — Toxoplasma gondii. Assessment of immune status demonstrated selective deficiency of CD8+ cytotoxic T lymphocytes and NKT cells. Obvious causes of secondary immunosuppression, including HIV, were ruled out. The Genetic Panel «Primary Immunodeficiencies» with sequencing of more than 400 genes of known primary human immunodeficiencies did not reveal pathology. However, persistent hyperhomocysteinemia was noted, and a genetic test for folate deficiency was performed. MTHFR A1298C in the heterozygous state and MTRR A66G in the homozygous state were detected, which was associated with the detected cell immunodeficiency, taking into account the results of studies on immune status in folic acid metabolism disorders and reports of severe opportunistic infections in humans with genetic deficiency of folate cycle.&#x0D; Treatment included spiramycin at a dose of 3 million IU orally three times a day for 14 consecutive days (to inhibit Toxoplasma), recombinant human a2b interferon at a dose of 3 million IU i/m every other day at night №15 (to compensate for the deficiency of NKT cells and CD8+ cytotoxic T lymphocytes), oxodihydroacridinylacetate sodium 2 mL i/m every other day at night №15, alternating with interferon (to compensate for the deficiency of NKT cells and CD8+ cytotoxic T lymphocytes) and local peribulbar injections of betamethasone № 3 (to eliminate the inflammation in the left eye). Improvement in visual acuity was observed on day 8 of treatment, and recovery of left eye function was observed at the end of the month of therapy. Due to the additional three‑month courses of recombinant human alpha2b‑interferon to compensate cell immunodeficiency, which were carried out during the next 2 years of follow‑up, it was possible to prevent further recurrence of toxoplasma invasion.&#x0D;

EFFECT OF ALKANISATION AND WARMING OF LIDOCAINE FOR PAIN REDUCTION IN PERIBULBAR ANAESTHESIA

Objective : Methods :To study the effect of alkanisation and warming of lidocaine for pain reduction in peribulbar anaesthesia. 100 patients were divided into 4 groups of 25 patients each to receive peribulbar injection. Group Co (Control) received 10 ml of plain 2% lidocaine solution at room temperature 18°C, Group W received 10 ml of 2% lidocaine solution at 37°C, Group BO received 10 ml of 2% lidocaine solution buffered to an estimated pH of 7.09 ± 0.10 and Group WBO received 10 ml of 2% lidocaine solution at 37°C buffered to an estimated pH of 6.92. Patients were explained about visual analogue scale to assess the pain received by them. Mean pain score obtained was 2.72, 1.70, 1.15 and 1.12 inResults : Group Co, Group W, Group BO and Group WBO respectively. Alkanized lidocaine with or without warming produces less pain thanConclusion : lidocaine injected at room temperature. Also, alkanization does not have a synergestic effect on warming for pain reduction in peribulbar anaesthesia. To study the effect of alkanisation and warming of lidocaine for pain reduction in peribulbar anaesthesia

Quantitative OCT Angiography Assessment of the Effect of Peribulbar Anesthesia on Retinal Microvasculature in Primary Open-Angle Glaucoma Patients Undergoing Cataract Surgery.

ObjectiveTo assess the effect of peribulbar anesthesia on retinal microvasculature in primary open-angle glaucoma (POAG) patients undergoing cataract surgery using OCT Angiography.ParticipantsForty-nine patients undergoing cataract surgery were divided into two groups. Group I included patients with no history of glaucoma, while group II included patients previously diagnosed as POAG with controlled IOP. Each participant received 6 mL of peribulbar anesthetic injection of 4 mL lidocaine 2% containing 150 IU hyaluronidase and 2 mL bupivacaine 0.5%. They were scanned with the OCT-A 10 minutes before and 10 minutes after injection for foveal deep (DCP), superficial (SCP) capillary plexuses density and total vessel density, foveal avascular zone (FAZ) diameter, optic disc total vessel density, and radial peripapillary capillary (RPC) network density. In addition, IOP was checked before and 10 minutes after injection.ResultsMedian percent change in DCP post-injection was significantly greater in group II (−43%) than in group I (−2.5%) (P < 0.001). Also, DCP total density median percent change post-injection was significantly higher in group II (−21%) than in group I (−0.9%) (P < 0.001). Foveal SCP vessel density and total vessel density median percent change post-injection were −62.6% and −16.2%, respectively, in group II and were −2.6% and −1.1%, respectively, in group I, which are statistically significant (P < 0.001). The FAZ diameter median percentage change post-injection was higher in group II (40.6%) than in group I (2.5%) (P < 0.001). Optic disc total vessel density and radial peripapillary capillary (RPC) network density post-injection median percent change were significantly higher in group II (−13.6%) and (−13.1%) respectively than in group I (−1.1%) and (−1.25%) respectively (P < 0.001).ConclusionPeribulbar anesthesia harbors a deleterious ischemic effect on the retinal vascular tree of glaucoma patients, which could harmfully affect the vision and the visual field in those vulnerable patients.

Dietary ω-3 polyunsaturated fatty acids are protective for myopia

Myopia is a leading cause of visual impairment and blindness worldwide. However, a safe and accessible approach for myopia control and prevention is currently unavailable. Here, we investigated the therapeutic effect of dietary supplements of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) on myopia progression in animal models and on decreases in choroidal blood perfusion (ChBP) caused by near work, a risk factor for myopia in young adults. We demonstrated that daily gavage of ω-3 PUFAs (300 mg docosahexaenoic acid [DHA] plus 60 mg eicosapentaenoic acid [EPA]) significantly attenuated the development of form deprivation myopia in guinea pigs and mice, as well as of lens-induced myopia in guinea pigs. Peribulbar injections of DHA also inhibited myopia progression in form-deprived guinea pigs. The suppression of myopia in guinea pigs was accompanied by inhibition of the "ChBP reduction-scleral hypoxia cascade." Additionally, treatment with DHA or EPA antagonized hypoxia-induced myofibroblast transdifferentiation in cultured human scleral fibroblasts. In human subjects, oral administration of ω-3 PUFAs partially alleviated the near-work-induced decreases in ChBP. Therefore, evidence from these animal and human studies suggests ω-3 PUFAs are potential and readily available candidates for myopia control.

Ocular Penetrance and Safety of the Dopaminergic Prodrug Etilevodopa.

PurposeAnimal models have demonstrated the role of dopamine in regulating axial elongation, the critical feature of myopia. Because frequent delivery of dopaminergic agents via peribulbar, intravitreal, or intraperitoneal injections is not clinically viable, we sought to evaluate ocular penetration and safety of the topically applied dopaminergic prodrug etilevodopa.MethodsThe ocular penetration of dopamine and dopaminergic prodrugs (levodopa and etilevodopa) were quantified using an enzyme-linked immunosorbent assay in enucleated porcine eyes after a single topical administration. The pharmacokinetic profile of the etilevodopa was then assessed in rats. A four-week once-daily application of etilevodopa as a topical eye drop was conducted to establish its safety profile.ResultsAt 24 hours, the studied prodrugs showed increased dopaminergic derivatives in the vitreous of porcine eyes. Dopamine 0.5% (P = 0.0123) and etilevodopa 10% (p = 0.370) achieved significant vitreous concentrations. Etilevodopa 10% was able to enter the posterior segment of the eye after topical administration in rats with an intravitreal half-life of eight hours after single topical administration. Monthly application of topical etilevodopa showed no alterations in retinal ocular coherence tomography, electroretinography, caspase staining, or TUNEL staining.ConclusionsAt similar concentrations, no difference in ocular penetration of levodopa and etilevodopa was observed. However, etilevodopa was highly soluble and able to be applied at higher topical concentrations. Dopamine exhibited both high solubility and enhanced penetration into the vitreous as compared to other dopaminergic prodrugs.Translational RelevanceThese findings indicate the potential of topical etilevodopa and dopamine for further study as a therapeutic treatment for myopia.