Peribulbar Injection Research Articles

Scleral perforation involving the papillomacular bundle secondary to peribulbar anaesthetic injection

Scleral perforation involving the papillomacular bundle secondary to peribulbar anaesthetic injection

99mTc-DTPA SPECT/CT provided guide on triamcinolone therapy in Graves' ophthalmopathy patients.

Distinguishing between the active and inactive stages of Graves' ophthalmopathy (GO) is essential for making treatment decisions. 99mTc-DTPA SPECT/CT is sensitive in identifying inflammation in extraocular muscles of GO patients, which we designate 99mTc-DTPA-active. This study aimed to evaluate the response of 99mTc-DTPA-active GO patients to local immunosuppressive therapy. Sixty-four 99mTc-DTPA-active GO patients (89 eyes) were retrospectively analyzed. Forty-five patients (64 eyes) received repeated peribulbar triamcinolone injection, and 19 patients (25 eyes) received no immunosuppressive treatment. Ophthalmological assessment, including clinical activity score, eyelid retraction, eyelid aperture, proptosis, diplopia, and ocular mobility, was recorded before and after treatment. Compared with untreated patients, the clinical activity score decreased significantly (P < 0.001) while eye symptoms (soft-tissue swelling and eyelid retraction and aperture) improved significantly (P = 0.02, P < 0.001, P < 0.001, respectively) in treated patients after six months. The inferior and medial recti were significantly smaller (P < 0.001, P < 0.001, respectively), and 99mTc-DTPA uptake in the two recti was significantly less (P = 0.001, P = 0.01, respectively) in treated patients than in untreated patients after 3 months. Clinical activity score of < 3 does not indicate inactive GO, as revealed with 99mTc-DTPA SPECT/CT. Patients with 99mTc-DTPA-active GO can improve the symptoms with peribulbar triamcinolone injection.

Study of pain in peribulbar anesthesia with buffered and nonbuffered agents

Study of pain in peribulbar anesthesia with buffered and nonbuffered agents - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/j.ijceo.2019.109, Indian Journal of Clinical and Experimental Ophthalmology-Indian J Clin Exp Ophthalmol

Effectiveness and Safety of Single Percutaneous Peribulbar Block Using Magnesium Sulphate as an Adjuvant to Local Anesthetics Versus the Standard Peribulbar Block for Strabismus Surgery in Adults

Background:Peribulbar anesthesia in ophthalmic surgeries is limited by delayed and/or incomplete orbital akinesia and inadequate operative and postoperative analgesia.Objective:The aim of this study was to assess the safety and effectiveness of a single percutaneous peribulbar block technique with 100 mg magnesium sulphate added to the local anesthetics used compared with the standard peribulbar block technique in adult strabismus surgery.Methods:A total of 54 consecutive patients undergoing strabismus surgery were included in the study. They were divided into two equal groups (27 patients each). In group I, 1 ml (100 mg/ml) magnesium sulphate added to a mixture of 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered through a single percutaneous peribulbar injection with a short (1 inch) needle, while in group II, a mixture of 1 ml saline added to 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered using the standard peribulbar block technique. The collected data included patient's baseline characteristics, perioperative and early postoperative outcomes and follow-up data.Results:The elapsed time before the onset of anesthesia and akinesia of the globe was significantly shorter in group I compared with group II (1.9 ± 0.7vs.3.9 ± 1.0 min,p&lt; 0.001; 2.3 ± 0.7vs.4.4 ± 1.2 min,p&lt; 0.001 respectively), and the duration of anesthesia was significantly longer in group I compared with group II (180.0 ± 0.0vs.43.0 ± 8.5 min,p&lt; 0.001). The median VAS pain score was significantly lower in group I compared with group II (1.0vs. 4.0,p&lt; 0.001), and the patient's satisfaction was significantly higher in group I compared with group II (100.0%vs. 25.9%,p&lt; 0.001).Conclusion:Co-administration of 100 mg magnesium sulphate with the local anesthetics was effective and safe. It achieved suitable conditions to start surgery rapidly. Further, it improved the quality of operative conditions and patient satisfaction.

Safety issues of peribulbar injection of umbilical cord mesenchymal stem cell (UC-MSC) in patients with retinitis pigmentosa

Background & Aim Hereditary retinal dystrophies, specifically retinitis pigmentosa (RP) are clinically and genetically heterogeneous diseases affecting primarily retinal cells and retinal pigment epithelial cells with blindness as a final outcome1. Retinitis pigmentosa is the term given to a set of hereditary retinal diseases that feature degeneration of rod and cone photoreceptors2. Typical symptoms include night blindness followed by decreasing visual fields, leading to tunnel vision and eventually legal blindness or, in many cases, complete blindness3. The worldwide prevalence of retinitis pigmentosa is about 1 in 4000 for a total of more than 1 million aff ected individuals. The disease can be inherited as an autosomal-dominant (about 30–40% of cases), auto somal-recessive (50–60%), or X-linked (5–15%) trait4. This disease is no hope no option treatment. Recent preclinical studies and clinical trials suggest cells-based therapy for the treatment of retinal degenerative diseases5. Cell-based therapy seems to be a promising strategy in Retinitis Pigmenotosa as it has the potential to regenerate new photoreceptors or retinal pigment epithelial (RPE) cells. Several types of stem cells had been investigated. However, in vivo studies showed that the cells from human umbilical corfd tissue appears to be the most effective in many diseases6-7 The purpose of this study is to evaluate of the safety of peribulbar injection of umbilical cord mesenchymal stem cells in patients with retinitis pigmentosa by a prospective, multi-center, randomized clinical trial. Methods, Results & Conclusion Methods This study was conducted on 18 eyes of 18 volunteers with retinitis pigmentosa, The cells delivery with peribulbar injection method. Clinical examinitation, visus and fundus examination, multifocal electroretinography were performed before and after an peribulbar injection of approximately one-million UC-MSC. The patients were followed in 1 hour, 24 hours and 1 month for safety evaluation. Results: There are adverse events, like edema under the eyes, were observed in eyes all patients 1 hour after transplantation of UC-MSCs. The edema will disappear within 24 hours. These patients reported improvements in perception of the light and visus after one week Conclusion Peribulbar injection of umbilical cord mesenchymal stem cells in eyes in patient with retinitis pigmentosa can occur edema under the eye which disappear within 24 hours. Hereditary retinal dystrophies, specifically retinitis pigmentosa (RP) are clinically and genetically heterogeneous diseases affecting primarily retinal cells and retinal pigment epithelial cells with blindness as a final outcome1. Retinitis pigmentosa is the term given to a set of hereditary retinal diseases that feature degeneration of rod and cone photoreceptors2. Typical symptoms include night blindness followed by decreasing visual fields, leading to tunnel vision and eventually legal blindness or, in many cases, complete blindness3. The worldwide prevalence of retinitis pigmentosa is about 1 in 4000 for a total of more than 1 million aff ected individuals. The disease can be inherited as an autosomal-dominant (about 30–40% of cases), auto somal-recessive (50–60%), or X-linked (5–15%) trait4. This disease is no hope no option treatment. Recent preclinical studies and clinical trials suggest cells-based therapy for the treatment of retinal degenerative diseases5. Cell-based therapy seems to be a promising strategy in Retinitis Pigmenotosa as it has the potential to regenerate new photoreceptors or retinal pigment epithelial (RPE) cells. Several types of stem cells had been investigated. However, in vivo studies showed that the cells from human umbilical corfd tissue appears to be the most effective in many diseases6-7 The purpose of this study is to evaluate of the safety of peribulbar injection of umbilical cord mesenchymal stem cells in patients with retinitis pigmentosa by a prospective, multi-center, randomized clinical trial. This study was conducted on 18 eyes of 18 volunteers with retinitis pigmentosa, The cells delivery with peribulbar injection method. Clinical examinitation, visus and fundus examination, multifocal electroretinography were performed before and after an peribulbar injection of approximately one-million UC-MSC. The patients were followed in 1 hour, 24 hours and 1 month for safety evaluation.

Sever inadvertent globe perforation during supplemental peribulbar anesthesia injection

A globe perforation is a well-known serious complication during peribulbar anesthesia. A second supplement injection may further increase the risk of this complication. Retrobulbar hemorrhage and brainstem injection are other serious complications have been reported following peribulbar injections. Although there is an increasing popularity for needle-free procedures of local anesthesia such as sub-tenon's injection and topical anesthesia, peribulbar anesthesia remains one of the favorite techniques for providing anesthesia in ophthalmic procedures. The risk for inadvertent globe perforation is increased if the patient has long axial length or posterior staphyloma. However, careful attention should be done to all patients and not only those with risk factors for globe perforation. Here we report a 69-year-old male patient referred to vitreoretinal surgeon with a vitreous hemorrhage due to a sever globe perforation during peribulbar anesthesia, in which early diagnosis and management helped in achieving a good final visual outcome. Also, in this case we discussed the safety of peribulbar anesthesia supplements, and how to avoid such complication. Using of balloon compression for adequate time to spread the local anesthesia around the globe and giving the injection with a shorter needle syringe may reduce the risk for inadvertent globe perforation following a supplemental peribulbar anesthesia injection.

Opposing Effects of PPARα Agonism and Antagonism on Refractive Development and Form Deprivation Myopia in Guinea Pigs.

To determine if drug-induced peroxisome proliferator-activated receptor α (PPARα) signal pathway modulation affects refractive development and myopia in guinea pigs. Pigmented guinea pigs were randomly divided into normal vision (unoccluded) and form deprivation myopia (FDM) groups. Each group received daily peribulbar injections of either a vehicle or (1) PPARα agonist, GW7647, clofibrate, or bezafibrate or (2) PPARα antagonist, GW6471, for 4 weeks. Baseline and posttreatment refraction and ocular biometric parameters were measured. Immunofluorescent staining of PPARα and two of its downstream readouts, cytosolic malic enzyme 1 (ME1) and apolipoproteinA II (apoA-II), was undertaken in selected scleral sections. Western blot analysis determined collagen type I expression levels. GW6471 induced a myopic shift in unoccluded eyes, but had no effect on form-deprived eyes. Conversely, GW7647 inhibited FDM progression without altering unoccluded eyes. Bezafibrate and clofibrate had effects on refraction similar to those of GW7647 in unoccluded and form-deprived eyes. GW6471 downregulated collagen type I expression in unoccluded eyes whereas bezafibrate inhibited collagen type I decreases in form-deprived eyes. GW6471 also reduced the density of ME1- and apoA-II-stained cells in unoccluded eyes whereas bezafibrate increased apoA-II-positive cell numbers in form-deprived eyes. As GW7647 and GW6471 had opposing effects on myopia development, PPARα signaling modulation may be involved in this condition in guinea pigs. Fibrates are potential candidates for treating myopia since they reduced both FDM and the associated axial elongation. Bezafibrate also inhibited form deprivation-induced decreases in scleral collagen type I expression and the density of apoA-II expressing cells.

Dopamine Receptor Subtypes Mediate Opposing Effects on Form Deprivation Myopia in Pigmented Guinea Pigs.

We reported previously that changes in dopamine receptor (DR) subtype activation modulate spontaneous myopia progression in albino guinea pigs. To determine if DR control of refractive error development is different than in its normal counterpart, we evaluated the contribution of dopaminergic pathways to emmetropization and form deprivation myopia (FDM) progression in pigmented guinea pigs. Monocular myopia was induced by unilateral form-deprivation (FD). The effects of agonists of D1R (SKF38393) and D2R (quinpirole), the corresponding antagonists (SCH23390 and sulpiride), and vehicle were tested by peribulbar injection around FD or untreated control eyes. High-performance liquid chromatography with electrochemical detection quantified retinal and vitreous dopamine (DA) and 4-dihydroxyphenylacetic acid (DOPAC) levels. Ocular refraction and axial dimensions were measured using eccentric infrared photoretinoscopy (EIR) and A-scan ultrasonography, respectively, initially and after 2 or 4 weeks of treatment. After treatment with any of these four agents for 2 weeks, retinal and vitreal DA and DOPAC levels were not significantly different in drug- and vehicle-treated eyes. Neither agonism nor antagonism of D1R or D2R activity affected emmetropization. In contrast, D1R activation by SKF38393 inhibited FDM progression, while D2R activation by quinpirole augmented this response. On the other hand, D2R antagonism with sulpiride slowed FDM progression while D1R antagonism with SCH23390 had no effect. In pigmented guinea pigs, D1R activation inhibited, whereas D2R activation enhanced, FDM. These results closely mirror previous findings in albino animals and offer further evidence that DA and its cognate receptors affect refractive error regulation in guinea pigs.

Efficacy of Osthole in Management of Hypoperfused Retina.

Purpose To determine the effect of osthole on the retina in a chronic cerebral hypoperfusion (CCH) rat model and to investigate its therapeutic activity. Methods Seventy-two rats were randomly allocated into 6 groups. CCH was induced by permanent bilateral common carotid artery occlusion (BCCAO) in five groups. Sham surgery was performed without occlusion of the artery in the sixth group (control group). Animals were administered with saline (model group), osthole (osthole-IG group), aspirin (aspirin group), or ginaton (ginaton group); the osthole-PI group was performed with peribulbar injection of osthole. Four rats in each group were sacrificed every 5 days after drug administration, and histopathology along with morphology of retina were observed. Fundus fluorescein angiography was performed before the animals were sacrificed at day 15. Retinal Akt, NF-κB, Bax, and Bcl-2 levels were assessed using immunohistochemistry, immunofluorescence, and reverse-transcription PCR; retinal injury was assessed using TUNEL in situ; retinal levels of superoxide dismutase (SOD) and malondialdehyde (MDA) were measured. Results Fundus fluorescein angiography revealed the retinal vascular diameter in the osthole-IG group rats to be wider than that in the model, osthole-PI, aspirin, or ginaton group rats. Histological analysis of retinal tissue revealed an increase in retinal thickness in all treatment groups, and significant improvement was noticed in the osthole-IG group. TUNEL staining revealed fewer apoptotic cells in the osthole-IG and osthole-PI groups than in the other groups. For immunohistochemistry results, in the osthole-IG group, levels of NF-κB and Akt were lower than those in the other treated groups, while levels of the ratio Bcl-2/Bax were higher. Levels of MDA were lower and levels of SOD were higher in the osthole-IG group than in the other groups. Conclusions Osthole protects the retina from ischemia injury secondary to CCH induced by BCCAO, mainly through anti-inflammatory, antioxidant, and antiapoptotic effects.

Vitreous hyper-reflective dots in pseudophakic cystoid macular edema assessed with optical coherence tomography.

PurposeThis study compares the presence of vitreous hyper-reflective dots (VHDs) detected with optical coherence tomography (OCT) between eyes with pseudophakic cystoid macular edema (CME) and those with no CME after cataract surgery. In addition, we evaluated the impact of VHDs on the responsiveness of pseudophakic CME to cortisone treatment.SettingDepartment of Ophthalmology, Medical University of Graz, Austria.DesignRetrospective, monocenter case-controlled study.MethodsInclusion criteria for the study group and the control group were CME and no CME within 12 weeks following uneventful phacoemulsification in otherwise healthy eyes, respectively. VHDs (number and size) and the macular thickness were assessed with OCT. Furthermore, the number of peribulbar or intravitreal steroid injections was assessed.ResultsA total of 284 eyes from 267 patients were analyzed, among which 119 met the inclusion criteria for the study (n = 63) and the control group (n = 56). VHDs were observed in 54 (85.7%) study eyes and 21 (37.5%, p = 0.013) control eyes. The number of VHDs was 3.9±3.4 in the study group and 0.7±1 in the control group (p<0.001). The size of the VHDs was 33.5±9.1 μm and 36.6±17.9 μm in the study and control groups, respectively (p = 0.978). Overall, the number of VHDs correlated with central subfield thickness (r = 0.584, p<0.001), cube volume (r = 0.525, p<0.001), and postoperative best-corrected visual acuity (BCVA) (r = -0.563, p<0.001). The number of VHDs did not correlate with the frequency of peribulbar or intravitreal steroid injections.ConclusionVHDs occurred more often in eyes with CME than in eyes without CME following cataract surgery. In addition, the number of VHDs had an impact on the extent of macular thickening and subsequently postoperative BCVA. No correlation was found between the number of VHDs and the frequency of required peribulbar or intravitreal steroid injections.

Formulation of a Peribulbar Block for Prolonged Postoperative Pain Management in Vitreoretinal Surgery: A Randomized Clinical Trial

To evaluate postoperative pain level using a supplemental peribulbar injection at the conclusion of retinal surgery. Prospective, parallel-assigned, single-masked, randomized clinical trial. Fifty-eight patients undergoing scleral buckle, vitrectomy, or combined surgery. In a single academic institutional practice, 58 patients undergoing scleral buckle, vitrectomy, or combined surgery were enrolled. Exclusion criteria included those with a risk for glaucoma, a pre-existing chronic pain disorder, among others. Patients were assigned randomly to receive a postoperative peribulbar formulation of either bupivacaine, triamcinolone acetonide, and cefazolin (group A) or bupivacaine, balanced salt solution, and cefazolin (group B). The postoperative pain score and ocular motility were assessed by a masked observer on the first postoperative day. The primary outcome measure was the postoperative pain score. Secondary outcome measures included oral analgesic use, ocular motility, and intraocular pressure (IOP). The mean pain scores were 2.8±2.9 for group A and 3.8±2.6 for group B (P= 0.095). Pain was absent in 28% of group A patients versus 14% of group B patients (P= 0.11). Group A required less narcotic pain medication (hydroxycodone: group A, 0.7±3 mg vs. group B, 3±6 mg; P= 0.05; oxycodone: group A, 7±7 mg vs. 9±13 mg; P= 0.2) than group B. Motility was full in group B and limited in group A (P ≤ 0.001), with no differences in mean IOP measurements at any point after surgery. We did not demonstrate a statistically significant reduction in mean postoperative pain scores. However, patients in group A required less hydroxycodone use and had greater akinesia, suggesting prolonged neural blockade.

A comparison of retrobulbar and two peribulbar regional anesthetic techniques in dog cadavers

ObjectiveTo compare injectate distribution and likelihood of regional anesthesia to the orbit following retrobulbar (RB) or peribulbar (PB) injections in dog cadavers. Study designRandomized, masked study. AnimalsTwenty-four dog cadavers (aged 5.5–17 years, 2.0–36.3 kg). MethodsOrbits underwent one of three injection techniques with bupivacaine 0.5% and iohexol (1:1): ventrolateral RB injection (1–2 mL; 15 orbits), medial canthal PB injection (2–8 mL; PB-1; 16 orbits), or dorsomedial and ventrolateral PB injections (each 1–4 mL; PB-2; 16 orbits). The likelihood of successful regional anesthesia was estimated based on computed tomographic images scored for injectate volume of distribution at the base and within the extraocular muscle cone (EOMC), and injectate distribution around the optic nerve. Intraocular pressure (IOP) was measured before and after injections. Mixed-effects linear regression with post hoc Bonferroni contrast adjustments was performed. Significance was set at 0.05. ResultsA difference in injectate volume of distribution within or at the base of the EOMC was not detected among groups. The median optic nerve circumference of injectate distribution was significantly higher in the RB injected group than in the PB-2 group. Injectate distribution following RB, PB-1 and PB-2 injections was graded as likely to provide regional anesthesia within the EOMC in 40%, 19% and 31% of eyes, and at the EOMC base in 60%, 63% and 50% of eyes, respectively. The probability of likelihood to provide regional anesthesia was lower in dogs of higher body weights. The IOP was significantly higher than baseline following PB-1 (18 ± 14 mmHg) and in comparison with RB (2 ± 3 mmHg), but not different from PB-2 injection (10 ± 11 mmHg). Conclusions and clinical relevanceNone of the techniques reliably produced ‘successful’ injectate distribution based on this study's definitions; however, clinical assessment of anesthetic success is required.

Tolerance of Laser Panretinal Photocoagulation Treatment Under Topical Anaesthesia Using Slit Lamp Delivery vs Indirect Ophthalmoscope Laser Panretinal Photocoagulation Under Peribulbar Anaesthesia

Background and Objective: To compare the pain perceived by patients undergoing argon laser panretinal photocoagulation treatment for proliferative diabetic retinopathy under slit lamp delivery after topical anaesthesia and indirect ophthalmoscope laser delivery after peribulbar anaesthesia. Study design/ Patient and Methods: Prospective, multicentre non-randomised, study. Forty-six eyes of 46 patients with proliferative diabetic retinopathy were treated either by slit lamp delivery using topical anaesthesia (Group A) or indirect ophthalmoscope laser panretinal photocoagulation after peribulbar anaesthesia (Group B). Patients in both the categories were divided into two subgroups, one receiving pan retinal photocoagulation for the first time (A1 &amp; B1) and the second group receiving laser treatment for the second or subsequent time (A2 &amp; B2). The primary outcome measure was eye pain perceived during the laser treatment and pain within 48 hours following laser treatment. Patients graded the pain from (0-10) on a visual analogue scale. Secondary outcome measure included the need for oral analgesia within 48 hours following the laser procedure. Results: Overall panretinal photocoagulation treatment under peribulbar anaesthesia is more comfortable than topical anaesthesia (p&lt;0.001), but pain within 48 hours following the laser procedure was similar in the two groups (p=0.118). Panretinal photocoagulation for the first time with peribulbar injection was more comfortable than topical anaesthesia (p=0.001), but both the groups perceived similar pain 48 hours following the laser procedure (p=0.571). Subsequent laser treatment is again more comfortable under peribulbar anaesthesia (p&lt;0.001) and is also more comfortable than topical anaesthesia causing less pain 48 hours following laser treatment (p=0.004). Conclusion: Peribulbar anaesthesia does not abolish pain completely, but definitely made argon laser panretinal photocoagulation treatment more comfortable for patients. Panretinal photocoagulation under topical anaesthesia is painful and this pain may persist for up to 48 hours. Peribulbar anaesthesia is not entirely effective in controlling pain during the first 48 hours following laser treatment in those patients undergoing laser application for the first time. Patients need to be counselled regarding pain following panretinal photocoagulation treatment and the need for oral analgesia.

Plasma bupivacaine concentrations following orbital injections in cats

ObjectiveTo determine plasma bupivacaine concentrations after retrobulbar or peribulbar injection of bupivacaine in cats. Study designRandomized, crossover, experimental trial with a 2 week washout period. AnimalsSix adult healthy cats, aged 1–2 years, weighing 4.6 ± 0.7 kg. MethodsCats were sedated by intramuscular injection of dexmedetomidine (36–56 μg kg−1) and were administered a retrobulbar injection of bupivacaine (0.75 mL, 0.5%; 3.75 mg) and iopamidol (0.25 mL), or a peribulbar injection of bupivacaine (1.5 mL, 0.5%; 7.5 mg), iopamidol (0.5 mL) and 0.9% saline (1 mL) via a dorsomedial approach. Blood (2 mL) was collected before and at 5, 10, 15, 22, 30, 45, 60, 120, 240 and 480 minutes after bupivacaine injection. Atipamezole was administered approximately 30 minutes after bupivacaine injection. Plasma bupivacaine and 3-hydroxybupivacaine concentrations were determined using liquid chromatography–mass spectrometry. Bupivacaine maximum plasma concentration (Cmax) and time to Cmax (Tmax) were determined from the data. ResultsThe bupivacaine median (range) Cmax and Tmax were 1.4 (0.9–2.5) μg mL−1 and 17 (4–60) minutes, and 1.7 (1.0–2.4) μg mL−1, and 28 (8–49) minutes, for retrobulbar and peribulbar injections, respectively. In both treatments the 3-hydroxybupivacaine peak concentration was 0.05–0.21 μg mL−1. Conclusions and clinical relevanceIn healthy cats, at doses up to 2 mg kg−1, bupivacaine peak plasma concentrations were approximately half that reported to cause arrhythmias or convulsive electroencephalogram (EEG) activity in cats, and about one-sixth of that required to produce hypotension.

Efficacy of retinalamin in the complex treatment of rhegmatogenous retinal detachment

From 2009 to 2014, a multicenter, open-labeled, comparative controlled randomized study was conducted investigating the efficacy of peribulbar injections of retinalamin in combination with standard therapy for rhegmatogenous retinal detachment compared with that of standard therapy in the early postoperative period.

Age-related desynchronosis in primary open-angle glaucoma patients: cause or consequence? Correction possibilities

Purpose of this investigation was to study the circadian biologic rhythm dysregulation of intraocular pressure (IOP), blood pressure (BP), and heart rate (HR) in primary open-angle glaucoma (POAG) patients of different age groups. Objectives: to reveal the desynchronosis pattern of biologic rhythm parameters in POAG patients, to study the influence of peptide bioregulatory complex on the synchronization of chosen parameters, to investigate correction possibilities from the perspective of the optic nerve tolerance enhancement, ischemia decrease and ocular perfusion improvement.Materials and methods. At the first stage, we performed a representative selection of patients with BP, HR and IOP dysregulation among POAG patients and subjects without glaucoma of corresponding age (n = 330). For mathematic justification of the desynchronosis identification, we used cosinor-analysis of circadian changes of functional indices. At the second stage, we performed a randomized study with parallel comparison groups masked for the investigator estimating the results. Patients with revealed desynchronosis (n = 56) were randomly divided into two groups for comparison. The main group consisted of 27 patients who, in addition to systemic and local pressure-lowering therapy, received 1 tablet of epifamin (Longvi-Farm, Russia) 3 times a day for 30 days; сortexin (Geropharm, Russia) 10 mg daily for 10 days; retinalamin (Geropharm, Russia) 5 mg daily as peribulbar injections for 10 days. 29 control group patients received traditional treatment (vitamins, spasmolytics, antioxydants) together with local and systemic pressure-lowering therapy. In compared groups, we calculated the tolerant pressure level, investigated the dynamics of retinal sensitivity mean deviation (MD), registrated the oscillatory potentials (OP) with the OP index calculation.Results. In elderly patients with glaucoma, significant changes of the temporal order of physiological parameters were found (deviation of IOP daily rhythm curves, systolic blood pressure (SBP), diastolic blood pressure (DBP), and hemodynamic indices).Conclusion. Through hemodynamic, nootropic, neurotrophic effects of the investigated bioregulatory peptide complex, the optic nerve tolerance to the stress influence of IOP, SBP and DBP asynchronous fluctuations increased, and ocular perfusion enhanced.

Abstract PR511

Background & Objectives: The use of intravitreal injection (IVI) has increased dramatically with the therapy for macular degeneration(1). Patients may experience pain during injection leading to sudden movements of the eye, wich can cause intraocular complications(2). The objective of this systematic review was to compare different local anesthetic techniques for IVI to determine the effectiveness of these methods to relieve pain of the patient undergoing intraocular injection. Materials & Methods: For this systematic review, we compared different techniques of local anesthesia with no sedation for intravitreal injection of antiangiogenic agents and steroids. Anesthetic and/or analgesic effect was evaluated by pain scale. Studies to be considered for inclusion were identified by searching the following electronic bibliographic databases: Cochrane, LILACS, PubMed, Scopus, and Web of Science. The methodology of the selected studies was evaluated using the Cochrane risk of bias tool. Results: After searching and comprehensive evaluation 13 randomized clinical trials were retained for the final selection. According to the Cochrane risk of bias tool (figure 1) only three studies presented a low risk of bias for random sequence generation. The reported anesthetic techniques included topical tetracaine, topical proparacaine, tetracaine gel, instilation of 5% lidocaine, 4% lidocaine pledget, 4% topical cocaine, peribulbar injection of lidocaine 2%, subconjunctival injection of lidocaine 2%, lidocaine gel in different concentrations 2,3.5,5,8 and 12%, topical levobupivacaine 0,75%. All techniques presented a low pain score reported by the patients during IVI. Rifkin showed that topical tetracaine has a better anesthetic effect than proparacaine or tetracaine gel(3). When considering subconjunctival injection (SCI) of lidocaine 2%, the interval between the placement of anestesia and IVI is importante. When waiting 5 minutes SCI of lidocaine 2% provides a better anesthetic effect when compared to other techniques(2).Conclusion: All techniques included in this review provides a good analgesia for IVI. The results should be evaluated carefully due to the risk of bias of the studies, specially regarding the random sequence generation.

Clinical efficacy of peribulbar injection of Troxerutin and Dexamethasone for corneal edema after cataract surgery

Objective To investigate the clinical efficacy of Troxerutin combined with Dexamethasone for corneal edema after phacoemulsification. Methods Two hundred eyes of 198 cases of serious corneal edema after cataract phacoemulsification were randomly divided into the control group and the observation group. The patients in the observation group received peribulbar injection of Troxerutin and Dexamethasone additionally except the treatments in the control group. The fading time of corneal edema of 100 eyes in each group and the number of eyes with transparent cornea at 1, 3, 5 and 7 d after the surgery were observed and compared. Results The fading time of corneal edema in the observation group was shorter than that in the control group.On one day after the surgery, the number of eyes with transparent cornea was 100 in each group.The numbers of patients with corneal edema were 45 versus 15 (t=21.43), 66 versus 32 (t=23.13) and 82 versus 45 (t=29.53), respectively, on the 3, 5, 7th d after surgery in the control group and observation group and the differences were statistically significant (P<0.005). Conclusion Troxerutin and Dexamethasone for the recovery of corneal edema after cataract surgery is effective. Key words: Surgery, cataract; Edema corneal; Dexamethasone; Troxerutin; Peribulbar injection

Comment on "Use of Carnosine for Oxidative Stress Reduction in Different Pathologies".

I congratulate Prokopieva et al. for their review “Use of Carnosine for Oxidative Stress Reduction in Different Pathologies” [1]. The authors overview properties and biological effects of the antioxidant carnosine (Cn). Data on the use of Cn in various conditions are discussed. Special attention is given to the use of carnosine in neurologic, mental diseases and alcoholism. I have read the paper with a great interest. However, a comment seems to be necessary to formulate a praxis-relevant and evidence-based conclusion.

Retro or PeriBulbar Injection Techniques to Reverse Visual Loss After Filler Injections.

With the increasing popularity of three dimensional filler treatments, the tip of the injecting needle or cannula is subdermal, often adjacent to the facial vasculature. Inadvertent canalization of these vessels can rarely result in vascular occlusion with consequent blindness or stroke. The goal was to demonstrate a technique of retro or peribulbar injection of hyaluronidase should such an emergency arise if no ophthalmologist was immediately available. The treatment is needed urgently because the retina can only withstand up to 90 minutes of hypoxia. We present verbal and diagrammatic instructions for this treatment and videos of both the retrobulbar technique (courtesy of Dr. D. Maberley) and peribulbar technique (courtesy of Dr. S. Fagien). None of us have yet used this technique to treat iatrogenic filler induced blindness but we present the information for the benefit of patient safety, given the limited time the retina can survive vascular occlusion. Inadvertent canalization of facial vessels can cause embolic occlusion of retinal vasculature because of the anastomotic nature of the facial vasculature and the end artery morphology of the retinal circulation. Embolism from 3-dimensional hyaluronic acid filler use is potentially reversible if hyaluronidase is injected into the adjacent tissue.