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Query: UMLS:C0086543 (cataract)
 29,165 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The unopened eye maintains a relatively stable spherical contour due to the expansile influence of the intraocular pressure. When the eye is opened this expansile pressure is lost and some degree of collapse of the scleral shell ensues. In eyes with a relatively flaccid sclera an anterior segment incision may induce significant reduction in the volume of the posterior segment of the globe. During intracapsular cataract extraction on such eyes, scleral collapse can cause anterior displacement of the lens and iris when the eye is opened and vitreous loss as soon as the lens is extracted. Scleral collapse tends to occur during intraocular surgery on previously aphakic eyes. In this situation it may become difficult to achieve a vitreous-free anterior sement by open sky vitrectomy. Metallic scleral supporters prevent inward collapse of that portion of the sclera to which they are attached. They do not prevent downward collapse of the posterior sclera shell. Upward traction is required to prevent the downward component of scleral collapse. A system for controlled suspension of the globe during intraocular surgery has been devised and used in a variety of surgical procedures. The apparatus is simple and it does help to minimize downward scleral collapse. It does not prevent scleral identation or distortion by external forces and cannot substitute for inadequate anesthesia and akinesia or faulty surgical technique.
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PMID:Suspension of the globe during intraocular surgery. 75 77

After listing the bibliography, the author sugests cases in which neuroleptanalgesia is specially advisable in ophthalmic surgery, mainly in delicate and not too long operations (cataract, glaucoma a.s.o.). In cases of ocular hypertension "Diamox" is previously injected. In the premedication "Valium", and in some patients "Fentanest" and "Droperidol". During surgery the patient breathes spontaneously; oxygen is provided by means of a nasopharyngeal sound. In cataract operations akinesia is recommended. Neuroleptanalgesia has been employed in 140 eyes, mainly in cataracts (80 cases) and chronic simple glaucoma (40 cases).
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PMID:[Neuroleptanalgesia in ophthalamic surgery (author's transl)]. 89 89

Hypnosis is able to induce a state of total psychological calm in very many subjects, including maintenance or even enhancement of their ability to cooperate. A smaller number of more receptive subjects may even achieve ocular anaesthesia, though this is not suitable for the performance of operations because the Dagnini-Aschner reflex persists and hypotonia is not attained. It is considered, therefore, that the association of hypnosis, retrobulbar pharmacological anaesthesia, and akinesia offers the best conditions for the performance of operations involving major opening of the eyeball, such as those associated with cataract, i.e. psychological tranquility with the ability to cooperate, anaesthesia with neurovegetative areflexia, hypotonia, and a postoperative course undisturbed by coughing and vomiting. The results of several years' experience have shown the complete suitability of the method and its wide possibilities of application.
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PMID:[Hypnosis in ophthalmology]. 118 37

In modern cataract surgery the introduction of akinesia, the corneal incision, the intracapsular extraction with forceps or cryo-stick, the zonulolysis and measures against complications and the optic correction of unilateral cataract with contact lenses can be seen as definite advances. Critically seen, the use of the operating microscope for senile cataract is not necessary, as the binocular loupe is fully sufficient. In the same way the selective use of zonulolysis - but not after the age of 55 - and of the cryo-stick - only on a stretched lans capsule is advised. Also the artificial pupillary lens is not recommended because of the excellent functional results of the contact lens. The same argument applies to emulsification of the crystalline lens. Also, from our experience, the routine use of antibiotics is not necessary. As well as the actual operation methods, including premedication, the methods used to avoid complications are finally and thoroughly discussed.
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PMID:[The advance and regression of the cataract operation]. 121 94

We report our experience of a recently described local anaesthetic technique which seeks to avoid risk of perforation of the globe, damage to the optic nerve, or injection into the subarachnoid space, whilst providing prolonged and reliable anaesthesia. A prospective series of 19 patients who underwent vitreoretinal surgery using this technique were compared with 19 patients who had retrobulbar anaesthesia for cataract extraction. The vitreoretinal group had excellent akinesia and very good anaesthesia, allowing prolonged retinal reattachment surgery lasting up to 3 hours. Patient evaluation of discomfort or pain experienced in the two groups was assessed using a visual analogue pain score chart. The pain scores for the two groups were not significantly different (p = 0.03) and 16 of 19 patients in each group (84%) experienced only slight pain or less. Satisfaction with local anaesthesia, in both groups, was also assessed by asking patients which method of anaesthesia they would prefer if future surgery were to be performed. In the vitreoretinal group, 18 of 19 patients expressed a preference for local anaesthesia and in the cataract group 17 ot 19 also favoured local anaesthesia. The vitreoretinal patients' median pain score was 0 compared with 1 for the cataract patients. This study demonstrates that local anaesthesia provides pain relief for vitreoretinal surgery which is comparable to the experience of patients undergoing cataract surgery by retrobulbar anaesthesia. The technique described can provide successful local anaesthesia for vitreoretinal procedures. The success of this technique for pain relief and akinesia calls for a reappraisal of the number of patients suitable for vitreoretinal surgery under local anaesthesia.
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PMID:Four-quadrant local anaesthesia technique for vitreoretinal surgery. 128 34

A new technique of local anesthetic administration has been used for 50 patients undergoing cataract extraction. The simple technique involves direct transconjunctival infiltration of local anaesthetic directly to the sub-Tenon's space, in the inferior-nasal quadrant, using a blunt 19-gauge Southampton cannula. This method seeks to avoid the risks of retrobulbar haemorrhage, perforation of the globe, damage to the optic nerve, and injection into the subarachnoid space, whilst providing prolonged and reliable anaesthesia. Akinesia is achieved by the inferior-nasal placement of solution and if not sufficient, a top-up can easily be given. Patients graded any discomfort or pain using a 10 cm visual analogue graphical pain score chart with numerical and descriptive rating scale. The delivery of 50:50 mixture of lignocaine 2% and bupivacaine 0.5% anaesthetic was evaluated by patients with a median response of 'slight discomfort'. The operative procedure was graded with a median of 'no pain or discomfort', both for extracapsular cataract extraction and phakoemulsification. This is a new, modified, sub-Tenon technique which is simple, reliable, and which offers excellent anaesthesia and akinesia and avoids a sharp instrument being passed into the orbit.
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PMID:A new local anesthesia technique for cataract extraction by one quadrant sub-Tenon's infiltration. 814 45

The effect of needle length on the efficacy of regional ophthalmic anesthesia in conjunction with cataract surgery was studied in 97 patients using a two-site injection technique. The local anesthetic used was etidocaine 1.5% with hyaluronidase. In 48 patients, the anesthetic was administered inferolaterally with a 22-millimeter needle, and in the other 49 patients, with a 31-millimeter needle. Every patient had a medial injection with a 12-millimeter needle to achieve lid akinesia and to complete the globe akinesia. At 5 minutes, lid akinesia was considered better in the 22-millimeter needle group (P < .005). After one supplemental dose, when necessary, complete globe akinesia was achieved at 15 minutes significantly more often (94% vs 79%) in the 31-millimeter needle group (P < .05). Lid akinesia in the two groups was identical at that time. Eight patients in the short-needle group and three in the long-needle group experienced some pain during surgery. Throughout the study, the required intraorbital anesthetic volumes were smaller in the 31-millimeter needle group. We recommend the use of a 31-millimeter needle inferolaterally in combination with a 12-millimeter needle medially to achieve satisfactory regional anesthesia for cataract surgery.
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PMID:Comparison of two needle lengths in regional ophthalmic anesthesia with etidocaine and hyaluronidase. 148 66

Ninety patients scheduled for elective cataract extraction under local anesthesia received an inferolateral intraconal injection of 4 mL of etidocaine mixed with hyaluronidase. They were divided into three groups of 30 patients each according to the method used to provide orbicular akinesia. Those in group I had a nasal, intraorbital injection; those in group II underwent electrostimulation to locate branches of the facial nerve in the eyelids; and those in group III had the anesthetic agent injected subcutaneously into the lids. Ten minutes after the regional blockade, orbicular muscle activity of the upper eyelid, as measured by electromyography, was found to be higher in group I than in the other two groups. The muscular activity of the lower lid at 10 minutes, or of either of the lids at 20 minutes, was similar in all three groups. The use of electrostimulation did not yield better orbicular akinesia than the infiltration technique alone. Nasal injection improved globe akinesia.
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PMID:Orbicular muscle akinesia: a comparison, using electromyography, of three techniques. 151 39

METHODS. The features of retrobulbar and peribulbar blocks were compared prospectively in 300 patients undergoing elective, ambulatory cataract surgery. Both techniques were clinically applicable, but to achieve total akinesia of the eye muscles, an additional injection was needed in 13% of the patients with retrobulbar block and in 35% with periocular block. RESULTS. In younger patients (less than 65 years), the number of injections and the volume of the local anesthetic needed to produce a total akinesia of the eye were significantly higher when compared with the elderly.
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PMID:Regional anesthesia for cataract surgery: comparison of retrobulbar and peribulbar techniques. 151 89

Peribulbar and retrobulbar anaesthesia are commonly used techniques in cataract extraction. They offer satisfactory analgesia and akinesia but serious complications although uncommon are consistently reported. Intravenous sedation combined with a facial nerve block offers an alternative method of anaesthesia. This is a retrospective study of patients who underwent extracapsular cataract extraction using this technique between 1 January 1986 and 1 September 1990. The operating conditions were judged to be very suitable with minimal peroperative complications. The postoperative ocular complication rate was low (minimum follow-up 3 months) and no serious medical complications were noted: 93.8% of patients achieved 6/12 vision or better. This study demonstrates that it is possible to achieve satisfactory ocular analgesia and akinesia during cataract extraction under local anaesthesia without the use of a periocular injection.
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PMID:Neuroleptanalgesia and extracapsular cataract extraction. 154 May 58


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