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

We examined two women who had keratic precipitates, minimal intracameral cells and flare, diffuse iris stromal atrophy, posterior subcapsular cataract, and vitreous opacities in their left eyes. No ocular pain, photophobia, or posterior synechia was noted. Their right irises appeared brown. Heterochromia was evident in both patients. Recurrent subconjunctival hemorrhages were also in their affected left eyes. It is possible that subconjunctival hemorrhages in our patients may be associated with Fuchs' heterochromic iridocyclitis.
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PMID:Recurrent subconjunctival hemorrhages in patients with Fuchs' heterochromic iridocyclitis. 857 Jan 56

I present an atraumatic technique for small pupil phacoemulsification using topical anesthesia. Fifty consecutive small pupil phacoemulsification cases were performed with topical anesthesia and mild intravenous sedation. Viscoelastic combined with a modified two instrument stretch was used for pupillary enlargement adequate for phacoemulsification. After preoperative cycloplegia, two or more multidirectional stretches were used for 3.0 to 5.0 mm pupils; three or more multidirectional stretches were used for pupils less than 3.0 mm. Pain and proprioceptive responses were avoided by reducing the stretch length, leaving the angle structures and ciliary body untouched. Sodium hyaluronate (Healon GV) created additional expansive power. Of 50 successfully implanted cases, 45 (90%) had acceptable pupillary form and function postoperatively. The 5 (10%) with enlarged, atonic pupils had past injury or inflammatory disease. This technique minimizes anterior segment trauma, instrumentation, and operating time.
J Cataract Refract Surg
PMID:Modified stretch technique for small pupil phacoemulsification with topical anesthesia. 865 56

Two hundred and thirty-one patients were questioned the day following their cataract surgery to ascertain the incidence of postoperative morbidity. One hundred and nineteen patients received local anaesthesia (LA) and 112 received general anaesthesia (GA). There was a significant difference in the incidence of nausea (21% in GA group, 3% in LA group, p < 0.01), sore throat (41% GA group, 3% LA group, p < 0.01), and bruising of the eye (15% GA group, 39% LA group, p < 0.01). There was no significant difference in the incidence of vomiting, headache, double vision, the severity of postoperative pain, or the need for analgesia. The time before the patients drank and ate postoperatively was significantly shorter in the local anaesthetic group (1.3 h and 1.8 h LA group, 4.1 h and 6.7 h GA group respectively, p < 0.01).
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PMID:Postoperative morbidity following cataract surgery. A comparison of local and general anaesthesia. 903 83

In an observer blind study, the efficacy of lignocaine-prilocaine eutectic mixture was established in alleviating the pain of needle insertion during retrobulbar and periorbital tissues block in cataract surgery. Thirty-three patients were allocated randomly into two groups. Patients in group 1 (n = 17) received EMLA cream 60 min. prior to local anesthesia while those of group 2 (n = 16) were used as a control group. Pain was graded by the patients on a four-point verbal rating scale (VRS) as well as by an observer, unaware of the treatment patients received, on a 4-point scale. In both groups there were no differences in pain scores between patient's and observer's assessments. In EMLA group significantly (p < 0.05) less pain was registered during performance of the local anesthetic procedure. Our results demonstrate that the eutectic mixture may be very effective in reducing pain associated with locoregional procedures for eye surgery.
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PMID:EMLA prevents pain during local anesthesia for cataract surgery. 871 53

Fifty unselected patients undergoing routine cataract surgery were randomised to receive either topical or sub-Tenon's local anaesthesia with 2% prilocaine administered by a blunt cannula. Visual analogue scales were used to assess pain during administration of sub-Tenon's anaesthetic and pain during surgery, and any complications were noted. Sub-Tenon's anaesthesia proved to be entirely comfortable to administer, and allowed for a statistically significantly more pain-free operation, at the expense of some residual eye movement and an inevitable subconjunctival haemorrhage. Both techniques compared well with other studies assessing periorbital or retro-orbital injections, and both have significant safety advantages which are discussed in the context of the joint Royal Colleges report on ophthalmic anaesthesia. It is suggested that a combination of one or other technique could safely cover all requirements for intraocular surgery under local anaesthesia.
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PMID:Randomised trial of topical versus sub-Tenon's local anaesthesia for small-incision cataract surgery. 937 9

Epithelial ingrowth is a major complication of penetrating trauma or intraocular surgery. The present study was undertaken to analyze the clinical and histopathologic findings in a large series of consecutive patients. All cases of epithelial ingrowth on file in the Eye Pathology Laboratory of the Wilmer Ophthalmological Institute, Johns Hopkins Hospital, were included. Histopathologic slides of 207 consecutive cases of epithelial ingrowth were reviewed and, where necessary, additional sectioning and staining was performed. Transmission electron microscopy was performed in 15 cases and immunohistochemistry, in 28 cases. The histopathologic specimens included globes (46), corneal buttons (64), iris tissue (87), and block excisions (7). The causes of epithelial ingrowth were penetrating trauma (48), cataract surgery (123), keratoplasty (21), and others (15). There was a wide spectrum of presenting signs and symptoms, most frequently glaucoma (35), fistula (34), retrocorneal membrane (31), "uveitis" (29), iris cyst formation (28), pain (25), bullous keratopathy (20), and corneal graft failure (19). Glaucoma was present in 43.1% of eyes and fistula and/or wound dehiscence was present in 29 eyes. Epithelial ingrowth was cystic in 40 cases and diffuse in 167 and was not suspected prior to histopathologic examination in 36% of cases. Histologically a multilayer of surface epithelium was present on intraocular surfaces such as the cornea, iris, chamber angle, ciliary body, lens capsule, and Bruch's membrane. Epithelial ingrowth may present with a wide variety of often uncharacteristic signs and symptoms and should always be included in the differential diagnosis of unusual posttraumatic or postoperative findings.
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PMID:Epithelial ingrowth: a study of 207 histopathologically proven cases. 885 5

Retro- und peribulbar anesthetic injections, the common techniques in cataract surgery, have persistently reported complications. Recently topical anesthesia has been mentioned as a possible alternative. The effectiveness of anesthesia, the acceptance on the part of the patients and the consequences of the lack of akinesia were analysed in a prospective study. We compared two groups of 27 patients. Patients in the first group had only topical anesthesia, while patients in the control group had a peribulbar injection. None of the patients included had such conditions as deafness or dementia or felt overanxious. Both methods were accepted very well by the patients. There were no significant differences in the improvement of visual acuity and the opinion of the patients about pain during the operation. The surgeon's assessment revealed a few cases of increased voluntary eye movements in the topical anesthesia group, but this did not affect the complication rate significantly. There was one case of vitreous loss in each group and in the peribulbar group one case of zonular defect. Topical anesthesia should be seen as an alternative to injection anesthesia.
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PMID:[Eyedrop anesthesia in cataract surgery]. 886 64

A new technique was developed that combines topical and subconjunctival sub-Tenon's anesthesia, with the goal of enhancing the topical anesthesia by blocking the perilimbal nerve plexus and the long posterior ciliary nerves as they pass intrasclerally in the horizontal hemimeridians of the eye. In this technique-circumferential peribulbar anesthesia-topical 4% lidocaine hydrochloride (Xylocaine) is administered, followed by a subconjunctival injection of 0.25 cc 4% Xylocaine 3.0 to 4.0 mm superior to the limbus. Then, the anesthetic is spread 360 degrees around the limbus. Medical records and postoperative interviews of 68 consecutive patients having phacoemulsification with circumferential peribulbar anesthesia showed no reports of intraoperative pain.
J Cataract Refract Surg 1996 Oct
PMID:Circumferential perilimbal anesthesia. 910 94

Visual disturbances often signal serious ophthalmic disease. Comprehensive general medical and ophthalmic histories are most helpful. Information about the animal's vision, based on its performance in familiar and unfamiliar environments, should be obtained from the owner. As bilateral involvement and visual disturbances are often associated with systemic diseases, a complete physical examination is indicated. The ophthalmic examination consists of a series of diagnostic procedures to isolate and define the ophthalmic disorder. Several clinical tests can be performed easily in the examination room, including the light-induced pupillary reflex, the dazzle or photic reflex, the menace reflex, the obstacle course test and, if indicated, the flash electroretinogram, the visual evoked response and, recently, the pattern electroretinogram. Ophthalmic diseases that produce visual disturbances in dogs often affect the cornea, aqueous pathways, lens and ocular fundus; in cats, they usually affect the uveal tract and are associated with serious systemic diseases. Orbital diseases are not usually associated with visual disturbance unless the optic nerve is involved. Corneal diseases and cataract formation that involve the visual axis and pupillary aperture often cause visual disturbance. Inflammations of the Iris and ciliary body can produce both acute and long-term visual disturbance and even blindness. Diseases of the retina and optic nerve usually present as visual disturbances in the absence of pain.
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PMID:Visual disturbance: where do I look? 928 37

A 29-year-old Hispanic man who had bilateral radial keratotomy (RK) and astigmatic keratotomy (AK) in his right eye 1 year previously went swimming in a lake. He subsequently developed foreign-body sensation and pain with a gradual decrease in vision over the following 5 weeks, despite treatment with ciprofloxacin hydrochloride (Ciloxan) and diclofenac sodium (Voltaren). The patient sought a second opinion. On examination, best corrected visual acuity was 20/40 in the right eye and 20/20 in the left. Slitlamp examination revealed mild conjunctival and scleral injection and a 3.5 mm diameter stromal infiltrate densest at the edges (Figure 1). The infiltrate involved one RK and one AK incision with gaping of both, approximately 90% depth incisions (Figure 2). The anterior chamber was deep and quiet. Examination was otherwise unremarkable. The cornea was scraped, but the smears were negative. The Ciloxan and Voltaren were stopped, and scopolamine four times a day was started. Cultures for aerobic, anaerobic, fungal, acid-fast bacilli, and Acanthamoeba were performed but showed no growth in the following week. Except for vascular ingrowth, there was no change in the appearance of the microbial keratitis during this week. An incisional biopsy and rescraping were performed, but there was again no growth of micro-organisms and no change in the microbial keratitis in the following 4 days. How would you manage this patient at this time?
J Cataract Refract Surg
PMID:Consultation section. Refractive surgical problem. 929 62


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