Assessing the accuracy of intracameral phenylephrine preparation in cataract surgery

Purpose: Unpreserved phenylephrine is often used as an off-licence intracameral surgical adjunct during cataract surgery to assist with pupil dilation and/or stabilise the iris in floppy iris syndrome. It can be delivered as a neat 0.2 ml bolus of either 2.5 or 10% strength, or in a range of ad-hoc dilutions. We wished to assess the accuracy of intracameral phenylephrine preparation in clinical practice. Methods: Phenylephrine 0.2 ml was analysed both neat (2.5 and 10%) and in diluted form (ratio of 1:1 and 1:3). Samples were analysed using the validated spectrophotometric method. Results: A total of 36 samples were analysed. The standard curve showed linearity for phenylephrine (R2 = 0.99). Wide variability was observed across all dilution groups. There was evidence of significant differences in the percentage deviations from intended results between dilutions (p < 0.001). Mean percentage deviation for 1:3 dilution was significantly greater than neat (p = 0.003) and 1:1 dilution (p = 0.001). There was no evidence of a significant difference between 1:1 and neat (p = 0.827). Conclusions: Current ad-hoc dilution methods used to prepare intracameral phenylephrine are inaccurate and highly variable. Small volume 1 ml syringes should not be used for mixing or dilution of drug. Commercial intracameral phenylephrine products would address dosage concerns and could improve surgical outcomes in cases of poor pupil dilation and/or floppy iris syndrome

Radiographic and Histological Findings in an Atypical Orbital Myxoma

Myxomas are rare neoplasms of mesenchymal origin. Diagnostic evaluation requires histopathological confirmation. We report a rare case of atypical orbital myxoma with radiographic and histopathological correlation

Non-accidental Trauma

Non-accidental trauma (NAT) is a leading cause of childhood traumatic injury in the United States. Retinal findings in NAT are common and well described, including extensive retinal hemorrhages in multiple layers, retinoschisis, perimacular retinal folds, vitreous and optic nerve hemorrhage. Management keystones include a multidisciplinary approach to the patient’s multiple comorbidities, careful photographic and angiographic documentation of ophthalmic findings, amblyopia prevention and visual development, as well as interventions including photocoagulation and vitrectomy