Intracameral lidocaine as supplement to classic topical anesthesia for relieving ocular pain in cataract surgery

● AIM: To evaluate safety, efficacy, and patient adherence of intracameral lidocaine as supplement of classic topical anesthetic drops in cataract surgery. ● METHODS: A prospective and controlled trial including a large cohort of 1650 individuals suffering with bilateral cataract not complicated, in program by phacoemulsification surgery, were randomly assigned to 2 different groups for the type of anesthesia received, 0.4% oxybuprocaine hydrochloride (INN) drops, and INN drops associated to intracameral 1% lidocaine hydrochloride monohydrate. At the end of surgery, tables were assigned to each patient indicating the degree of pain (0-3) felt during the operation. ● RESULTS: Thirty-two percent of patients in group 1 declared to have not felt any pain against the 77% of patients in group 2. Fifty-nine percent of patients in group 1 complained about only a slight discomfort against 20% of group 2 patients. Only a small percentage of patients in group 1 (5%) admitted severe pain, while no patient in group 2 admitted severe pain. Four patients of group 2 reported an episode of transient amaurosis, lasting several hours after surgery. ● CONCLUSION: Intracameral administration of lidocaine is a simple and secure method able to increase the analgesia during the cataract surgery, eliminating the discomfort and increasing also the cooperation of the patients during the steps of manipulation

Outcomes of ab interno trabeculectomy with the trabectome by degree of angle opening.

AimTo analyse ab interno trabeculectomy (AIT) with the trabectome and combined phacoemulsification with AIT (phaco-AIT) by Shaffer angle grade (SG).MethodsProspective study of AIT and phaco-AIT with narrow angles of SG≤2 versus open angles ≥3. Outcomes included intraocular pressure (IOP), medications, complications, secondary surgery and success (IOP <21 mm Hg and >20% reduction without further surgery). Exclusion criteria were missing preoperative data and <1 year follow-up.ResultsOf 671 included cases, at 1 year AIT SG≤2 (n=43) had an IOP reduction of 42% from 27.3±7.4 to 15.7±3.0 mm Hg (p<0.01) versus AIT SG≥3 (n=271) with an IOP reduction of 37% from 26.1±7.8 to 16.4±3.9 mm Hg (p<0.01). In phaco-AIT with SG≤2 (n=48), IOP was reduced 24% from 20.7±7.0 to 15.7±3.6 mm Hg (p<0.01) versus phaco-AIT with SG≥3 (n=309) with an IOP reduction of 25% from 22.6±6.4 to 17.0±3.4 mm Hg (p<0.01). There was no difference between SG≤2 and SG≥3 in reduction of IOP or medications, complications, secondary surgery and success rates (p>0.05).ConclusionsSG≤2 is not associated with worse outcomes in AIT or phaco-AIT

A Review of Cavitation Uses and Problems in Medicine; Invited Lecture

There are an increasing number of biological and bioengineering contexts in which cavitation is either utilized to create some desired effect or occurs as a byproduct of some other process. In this review an attempt will be made to describe a cross-section of these cavitation phenomena. In the byproduct category we describe some of the cavitation generated by head injuries and in artifical heart valves. In the utilization category we review the cavitation produced during lithotripsy and phacoemulsification. As an additional example we describe the nucleation suppression phenomena encountered in supersaturated oxygen solution injection. Virtually all of these cavitation and nucleation phenomena are critically dependent on the existence of nucleation sites. In most conventional engineering contexts, the prediction and control of nucleation sites is very uncertain even when dealing with a simple liquid like water. In complex biological fluids, there is a much greater dearth of information. Moreover, all these biological contexts seem to involve transient, unsteady cavitation. Consequently they involve the difficult issue of the statistical coincidence of nucleation sites and transient low pressures. The unsteady, transient nature of the phenomena means that one must be aware of the role of system dynamics in vivo and in vitro. For example, the artificial heart valve problem clearly demonstrates the importance of structural flexibility in determining cavitation occurrence and cavitation damage. Other system issues are very important in the design of in vitro systems for the study of cavitation consequences. Another common feature of these phenomena is that often the cavitation occurs in the form of a cloud of bubbles and thus involves bubble interactions and bubble cloud phenomena. In this review we summarize these issues and some of the other characteristics of biological cavitation phenomena

Refractive change following pseudophakic vitrectomy: a retrospective review

Background To assess the occurrence and magnitude of refractive change in pseudophakic eyes undergoing 20 gauge pars plana vitrectomy without scleral buckling and to investigate possible aetiological factors. Methods Retrospective case note review of 87 pseudophakic eyes undergoing 20 gauge pars plana vitrectomy for a variety of vitreo-retinal conditions over a three-year period. Anterior chamber depth (ACD) was measured before and after vitrectomy surgery in 32 eyes. Forty-three pseudophakic fellow eyes were used as controls. Results Eighty-seven eyes (84 patients) were included in the study. Mean spherical equivalent refraction prior to vitrectomy was -0.20 dioptres, which changed to a mean of -0.65 dioptres postoperatively (standard deviation of refractive change 0.59, range-2.13 to 0.75 dioptres) (p < 0.001). Sixty-one of the 87(70%) eyes experienced a myopic shift and 45(52%) eyes had a myopic shift of -0.5 dioptres or more. Mean fellow eye refraction was -0.19 dioptres preoperatively and -0.17 dioptres postoperatively (p = 0.14)(n = 37) Mean ACD preoperatively was 3.29 mm and postoperatively 3.27 mm (p = 0.53) (n = 32) and there was no significant change in ACD with tamponade use. Regression analysis revealed no statistically significant association between changes in anterior chamber depth, as well as a wide variety of other pre-, intra and postoperative factors examined, and the refractive change observed. Conclusion Significant refractive changes occur in some pseudophakic patients undergoing 20 g pars plana vitrectomy. The mean change observed was a small myopic shift but the range was large. The aetiology of the refractive change is uncertain

Follow-up study of over three years of patients with uveitis after cataract phacoemulsification: outcomes and complications

Purpose: To evaluate the rate and onset of intraoperative and postoperative complications post-phacoemulsification. Methods: One hundred sixty-two eyes of 145 patients with uveitis who underwent phacoemulsification between 2006 and 2009 were identified through surgical record review. Fifty-nine eyes of 46 patients met the inclusion criteria. Hazard ratio (HR) and Kaplan-Meier survival probability were calculated for each class of uveitis. Results: Macular edema (ME) resulted to be associated to chronic postoperative inflammation (r = 0.6; p = 0.00) and mostly related to patients who presented more than one postoperative relapse/year (r = 0.2; p = 0.02). Fuchs uveitis resulted to be a risk factor for posterior capsule opacification (PCO) (HR 3.36 IC95%1.0-10.5; p = 0.03). Hypotony and elevated intraocular pressure (IOP) were detected in the anterior uveitis group (0.02 EY). Conclusion: The HR to develop ME was significantly related to chronic anterior uveitis. PCO and elevated IOP are

Cavitation in Biological and Bioengineering Contexts

There are an increasing number of biological and bioengineering contexts in which cavitation is either utilized to create some desired effect or occurs as a byproduct of some other process. In this review an attempt will be made to describe a cross-section of these cavitation phenomena. In the byproduct category we describe some of the cavitation generated by head injuries and in artificial heart valves. In the utilization category we review the cavitation produced during lithotripsy and phacoemulsification. As an additional example we describe the nucleation suppression phenomena encountered in supersaturated oxygen solution injection. Virtually all of these cavitation and nucleation phenomena are critically dependent on the existence of nucleation sites. In most conventional engineering contexts, the prediction and control of nucleation sites is very uncertain even when dealing with a simple liquid like water. In complex biological fluids, there is a much greater dearth of information. Moreover, all these biological contexts seem to involve transient, unsteady cavitation. Consequently they involve the difficult issue of the statistical coincidence of nucleation sites and transient low pressures. The unsteady, transient nature of the phenomena means that one must be aware of the role of system dynamics in vivo and in vitro. For example, the artificial heart valve problem clearly demonstrates the importance of structural flexibility in determining cavitation occurrence and cavitation damage. Other system issues are very important in the design of in vitro systems for the study of cavitation consequences. Another common feature of these phenomena is that often the cavitation occurs in the form of a cloud of bubbles and thus involves bubble interactions and bubble cloud phenomena. In this review we summarize these issues and some of the other characteristics of biological cavitation phenomena