The quest for effective pain control during suture adjustment after strabismus surgery: a study evaluating supplementation of 2% lidocaine with 0.4% ropivacaine

PURPOSE: To determine whether the addition of 0.4% ropivacaine to the standard 2% lidocaine peribulbar anesthetic block improves pain scores during suture adjustment in patients undergoing strabismus surgery with adjustable sutures. METHODS: Prospective, double-blind study of 30 adult patients aged 21–84 years scheduled for elective strabismus surgery with adjustable sutures. Patients were divided into two groups of 15 patients each based on the local anesthetic. Group A received 2% lidocaine and Group B received 2% lidocaine/0.4% ropivacaine. Pain was assessed using the visual analog scale (VAS) preoperatively and at 2, 4, and 6 hours postoperatively. The Lancaster red-green test was used to measure ocular motility at the same time points. RESULTS: The pain scores in the two groups were low and similar at all measurement intervals. The VAS for Group A versus Group B at 2 hours (1.7 versus 2.4, P=0.5) and 4 hours (3.5 versus 3.7, P=0.8) showed no benefit from the addition of ropivacaine. At 6 hours, the VAS (3.7 versus 2.7) was not statistically significant, but the 95% confidence interval indicated that ropivacaine may provide some benefit. A repeated measures ANOVA did not find a statistically significant difference in VAS scores over time (P=0.9). In addition, the duration of akinesia was comparable in both groups (P=0.7). CONCLUSION: We conclude that the 50:50 mixture of 2% lidocaine with 0.4% ropivacaine as compared to 2% lidocaine in peribulbar anesthetic blocks in adjustable-suture strabismus surgery does not produce significant improvements in pain control during the postoperative and adjustment phases. In addition, ropivacaine did not impair return of full ocular motility at 6 hours, which is advantageous in adjustable-suture strabismus surgery

The Effect of Patient Characteristics and Sleep Quality on Visual Field Performance Reliability

Purpose. To investigate the association of automated visual field (VF) reliability indices (false positive [FP], false negative [FN], and fixation loss [FL]) and sleep quality, VF experience, and age. Methods. Prospective, cross-sectional study. Adult patients (age ≥ 18 years) completing automated VF testing were invited to participate. Baseline participant characteristics were obtained, and all participants were asked to complete the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Nonparametric Spearman correlations and logistical regression models were performed. Results. 63 patients were enrolled. Lower PSQI score was correlated with higher percentage (%) FL in the right eye (p=0.03). Fewer prior VF was significantly correlated with higher %FP in the right eye (p=0.008). Older age was significantly correlated with higher %FN in the left eye (p=0.01). Greater mean deviation (MD) and pattern standard deviation (PSD) were strongly correlated with higher %FN in the right (p=0.02 and 0.002, resp.) and left eyes (p=0.01 and 0.02, resp.). Conclusion. In this prospective, cross-sectional study, worse MD and PSD are strongly correlated with increased FN in both eyes. Increased FN in the left eye associated with older age might be attributable to test fatigue. Worse sleep quality is associated with decreased FL in the right eye

Teaching in a Busy Clinical Setting

Teaching in a clinical setting poses many unique challenges, including balancing the learning objectives of the student with clinical care of the patient. Overcoming these challenges can be difficult; however, this chapter aims to provide some techniques to construct a successful educational environment that is productive for the student, the patient, and the teacher

What Lies Beneath: When Unusual Visual Complaints Present With A Normal Exam

Nonorganic vision loss (NOVL) is characterized by the onset of a visual deficit or disturbance that cannot be explained by organic pathology. Typically, patients present with subjective visual complaints, but extensive diagnostic imaging, labs, and exams reveal no abnormalities. We present an unusual presentation of NOVL in which a child presents with an abrupt onset of a persistent monocular visual field deficit

The Role of the Ocular Surface Microbiome (OSM) in Diseases of the Anterior Segment and Ocular Surface

Purpose of Review In this article, we define the ocular surface microbiome (OSM) and review the literature investigating its putative role in anterior segment diseases. Recent Findings The complex networks of microorganisms that compose the OSM play integral roles in many physiologic processes. The three most common bacterial phyla that contribute to the microbiome are Proteobacteria, Firmicutes, and Actinobacteria, although the composition has been found to vary by anatomic site, age, and systemic disease. Multiple ocular conditions have definitive associations with OSM alterations, some with specific signature colonization of atypical genera or species, while others have more broad changes in abundance or alpha diversity of natural microbiota. Summary Dysbiosis of the OSM appears to play a role in multiple ocular surface and anterior segment diseases. Future larger, longitudinal, and multicentered studies investigating its composition will lend insight into the pathophysiology of disease and potential methods for therapeutic interventions