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

This paper presents a clinical specular microscope for the examination and photography of endothelial cells at high magnification (X200). The instrument is used easily during routine examination without inconvenience or discomfort to the patient. We have found the specular microscope extremely useful clinically in the elucidation and documentation of corneal endothelial diseases in vivo. This instrument allows the detection of endothelial damage or disease which may not be seen by slitlamp examination. The effects of normal aging, endothelial dystrophies, trauma, and inflammation can be monitored. The instrument is especially useful in the evaluation of ocular surgical procedures. It can be used on the first postoperative day without inconvenience to the patient or damage to the eye. By the comparison of photographs taken before and after the operation, an estimate of endothelial cell loss may be made. Thus, the endothelial effects of different techniques of cataract extraction intraocular lens insertion, and penetrating keratoplasty can be observed and compared. This new technique for the clinical examination of corneal diseases has great promise in improving diagnosis as well as therapy.
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PMID:Clinical specular microscopy. 79 65

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

Ophthalmic pain following uncomplicated extracapsular cataract surgery was assessed postoperatively in 61 patients; 55% undergoing ophthalmic surgery had no pain or discomfort postoperatively, and 32% reported slight discomfort. Approximately 8% of patients reported mild pain and the remaining 5% experienced moderate to severe pain. Local anaesthesia was shown to be more comfortable postoperatively than general anaesthesia in the immediate postoperative period with both groups receiving similar amounts of postoperative analgesics.
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PMID:Ophthalmic pain following cataract surgery: a comparison between local and general anaesthesia. 139 Apr 90

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

Administering intravenous sedation in conjunction with intraoperative monitoring to cataract surgery patients is a widely accepted technique. Numerous articles report local sedation techniques for cataract surgery that are, in essence, abbreviated general anesthetic techniques for insertion of the retrobulbar block (RBB). Because of variations in levels of consciousness, a number of complications have been encountered with this specific patient population, ie, movement upon insertion of the RBB, intraoperative patient movement, confusion, hypotension, respiratory depression, and respiratory arrest. In an attempt to meet the specific needs of this patient population, a study comparing propofol-fentanyl with midazolam-fentanyl was initiated. Seventy-five (ASA 1 to 3) patients were randomly assigned to two groups: propofol-fentanyl (P/F) or midazolam-fentanyl (M/F). The mean age of patients in the P/F group was 71.1 +/- 13 SD, and the mean age in the M/F group was 74.4 +/- 8.8 SD. All patients entered the operating room unpremedicated. Before the RBB, patients in both groups were given a single intravenous dose of 50 micrograms fentanyl. Propofol (mean dose, 24.7 mg) or midazolam (mean dose, 1.58 mg) was then titrated to slurred speech or nystagmus. Patients' responses to the RBB were evaluated and recorded by an objective observer. The amnestic properties of both agents were evaluated by patient questioning at 10 minutes and 24 hours. Levels of discomfort were evaluated on a scale of 1 to 5, with 1 being extremely uncomfortable and 5 being noticeable without pain. Respiratory depressant effects of both techniques was assessed via continuous pulse oximetry. Results were analyzed using the chi 2 test, rank t test, and SD.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Propofol-fentanyl versus midazolam-fentanyl: a comparative study of local sedation techniques for cataract surgery. 147 88

We retrospectively studied secondary intraocular lens (IOL) implantation in 165 aphakic patients (162 eyes) from May 1983 to August 1989. Seventy-five eyes (46.3%) had secondary IOL implantation; these included seven cases of trans-sulcus scleral fixation of the posterior chamber lens. The remaining 87 eyes could not have secondary IOL implantation because of the ocular conditions. The most common reason for secondary implantation was to relieve the discomfort caused by spectacles or contact lenses (56.2%). An anterior chamber lens was used in 43 eyes (57.3%) and a posterior chamber lens in 32 eyes (42.7%). Final postoperative visual acuity of 20/40 or better was achieved in 92.0% of the eyes with posterior chamber lenses, in 71.4% of the eyes with anterior chamber lenses, and in 57.1% of the eyes with scleral-fixated posterior chamber lenses. Endothelial cell loss was greater in the eyes with anterior chamber lenses than in the eyes with posterior chamber lenses. Of the cases that could be followed, 83.3% showed endothelial cell loss of less than 30% at six months postoperatively. Postoperative complications such as cystoid macular edema, persistent fibrinous membrane formation, and neovascular glaucoma occurred in only ten (13.3%) of the 75 eyes that had secondary implantation. These complications occurred more frequently in eyes that had anterior chamber lenses with anterior vitrectomy. There were no noticeable complications in the eyes that had trans-sulcus scleral fixation of posterior chamber lenses. Updrawn pupil, prolapsed vitreous, and peripheral anterior synechia were common conditions preventing secondary IOL implantation.
J Cataract Refract Surg 1992 Mar
PMID:Secondary intraocular lens implantation in aphakia. 156 58

A prospective trial was conducted on 142 patients who underwent cataract surgery, to compare the efficacy of a single point, low volume peribulbar with that of retrobulbar anaesthesia. It was found that peribulbar anaesthesia is as efficacious as retrobulbar anaesthesia without the associated complications. It also avoids the facial block used by most ophthalmologists to supplement a retrobulbar block, thus markedly reducing the post-operative patient discomfort as well as the total volume of anaesthetic used.
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PMID:One point low volume peribulbar anaesthesia versus retrobulbar anaesthesia. A prospective clinical trial. 191 78

A prospective, randomized, masked study was conducted to evaluate whether intraocular aspiration of sodium hyaluronate used in cataract surgery influenced postoperative intraocular pressure (IOP). Ninety-nine patients (105 eyes) underwent uncomplicated extracapsular extractions with posterior chamber intraocular lens implantation using 1% sodium hyaluronate (AMVISC). In 53 eyes, sodium hyaluronate was aspirated from the anterior chamber prior to wound closure. Sodium hyaluronate was left in the anterior chamber of 52 eyes. The IOP of 33 of the patients was measured 4 hours after surgery. No significant difference was found between the pressure in the eyes from which the sodium hyaluronate had been aspirated and the pressure in those from which it had not. The IOP of all the patients was measured on the first postoperative day. The mean 24 hours after surgery was 23.4 mm Hg in the aspirated eyes and 23.1 mm Hg in the not-aspirated group. Thirteen eyes in the aspirated group and 14 in the not-aspirated group had pressures above 30 mm Hg during the first 24 hours after surgery. There were no significant differences in visual outcome, patient discomfort, corneal clarity, anterior chamber inflammation, or subsequent IOPs during 3 months postoperative examination. Aspiration of sodium hyaluronate at the end of cataract surgery does not appear to significantly reduce either the incidence or the degree of postoperative pressure elevations.
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PMID:Effect of intraocular aspiration of sodium hyaluronate on postoperative intraocular pressure. 220 54

A prospective clinical trial comparing peribulbar with retrobulbar anaesthesia is reported. Ninety-nine consecutive patients for cataract extraction under local anaesthesia were randomly allocated to a peribulbar or retrobulbar technique. The effectiveness of the anaesthetic, the operative conditions, and the degree of patient discomfort were recorded. Pain scores (as assessed separately by the patient, surgeon, and attendant nurse) demonstrated that anaesthetic administration and surgery were less painful with the peribulbar method. This technique gave more reliable ocular akinesia and orbicularis oculi paralysis in addition to a lower operative complication rate.
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PMID:Peribulbar versus retrobulbar anaesthesia. 220 7

Alfentanil, a short-acting congener of fentanyl, was studied as an analgesic sedative in monitored anesthetic care for outpatient cataract surgery with the intent of investigating efficacy in this setting and establishing dosage guidelines. Nineteen outpatients were studied, all of whom received droperidol 0.625 mg and midazolam 0.5 to 1.0 mg prior to a bolus dose of alfentanil preceding the administration of local anesthetic facial nerve and retrobulbar blocks. Alfentanil was titrated to achieve patient comfort during block administration, and sedatives were repeated as necessary intraoperatively. A mean alfentanil dose of 8.9 micrograms/kg was found to be effective. Eighteen patients (94%) rated the discomfort of local anesthetic blocks as absent or mild, and only 1 patient (5%) rated the blocks as severely painful. No severe cardiorespiratory or central nervous system side effects were observed, and 15% of patients were nauseated postoperatively despite droperidol administration. It can be concluded that alfentanil is an effective sedative in outpatient cataract surgery with minimal side effects reported in this clinical study.
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PMID:Monitored anesthetic care for outpatient cataract surgery with alfentanil. 228 18


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