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Anterior sub-Tenon's anesthesia for the treatment of retinopathy of prematurity.
J Pediatr Ophthalmol Strabismus. 2008 May-Jun; 45(3): 186-8
Ah-Chan J, Rubinstein A, Patel CK
The authors describe a technique of combined oral chloral hydrate and sub-Tenon's anesthesia that is simple, avoids the risks of general anesthesia, and provides superior anesthesia to topical agents alone.
Vet Ophthalmol. 2007 Nov-Dec; 10 Suppl 1: 8-11
Taylor NR, Zele AJ, Vingrys AJ, Stanley RG
OBJECTIVE: To record intraocular pressure (IOP) of three different dog breeds following administration of one drop of 1% tropicamide. ANIMALS: Three dog breeds -- Golden Retrievers (n = 20), Siberian Huskies (n = 20) and English Cocker Spaniels (n = 36) -- were studied. PROCEDURE: IOPs were measured using a Tonopen following corneal anesthesia with a single drop of 0.5% proxymetacaine. A drop of 0.5% tropicamide was then administered bilaterally and a second IOP measurement was taken 30 min later (postdilation). The difference between the two measurements was considered as the effect of mydriasis on IOP. RESULTS: Dogs had an average IOP of 14.9 +/- 3.2 mmHg, with 95% confidence limits ranging from 8 to 22 mmHg. There were significant differences between breeds (P < 0.006) with Siberian Huskies having higher IOPs (17.2 +/- 3.7 mmHg) than the other breeds (Spaniels: 14.2 +/- 2.8 mmHg, P < 0.01; Retrievers: 14 +/- 1.9 mmHg, P < 0.001). The majority (60%) of dogs displayed 5 mmHg or less in IOP change postmydriasis. Siberian Huskies showed the highest IOP levels, and also had the greatest variability with dilation. CONCLUSIONS AND CLINICAL RELEVANCE: Interbreed variability in effect of tropicamide of canine IOP is evident.
Doc Ophthalmol. 2008 May; 116(3): 245-9
Parkinson J, Tremblay F
Clinical circumstances often demand flexibility in electrodiagnostic procedures. We present a clinical case that required alteration of our routine full-field electroretinography technique. The patient presented with reports of allergy to Xylocaine (lidocaine) and refused the use of any type of topical anesthetic drops. This conflicted with our routine ERG method that combines the use of the Henkes Lovac hard contact lens and the topical anesthetic Alcaine (proparacaine hydrochloride). We acquired a successful electroretinogram without topical anesthesia by using a "piggy-back" system involving the interposition of a soft hydrophilic contact lens between the cornea and the recording hard lens. The procedure yielded excellent ERG recordings and was well tolerated. This non-routine technique was also compared to our standard ERG technique using a normal volunteer. It appears that this proposed "piggy-back" technique is a useful alternative to routine ERG procedure in cases of refusal/allergy to ophthalmic solutions and also potentially in cases where additional corneal protection is needed.
Phacoemulsification complication rates.
Ophthalmology. 2007 Nov; 114(11): 2101-2
Shaw AD, Ang GS, Eke T
[Self-medication with local anaesthetics by glaucoma patients using teletonometry]
Ophthalmologe. 2007 Dec; 104(12): 1052-9
Schäffner G, Antal S, Jürgens C, Tost F
BACKGROUND: Self-tonometry, a supplementary measurement of the intraocular pressure in ophthalmology by glaucoma patients using an automatic tonometer, will become more and more important in the future. As long as the self-tonometry has to work in the contact modus with the ocular surface, home application of a topical anaesthetic by the glaucoma patient will be a requirement for a successful measurement. So far no severe problems within this controlled self-medication have been seen. Nevertheless, public health authorities believe patient health is put at high risk by the application of local anaesthetics during self-tonometry. As there are no clinical studies of the health care, we evaluated the local tolerability of a topical anaesthetic in line with self-tonometry employing a modified tonometer OCUTON S. MATERIAL AND METHODS: A total of 100 glaucoma patients participated in a prospective clinical study of the routine clinical service in which each was monitored for 1 year. The telemonitoring involved self-tonometry for at least 6 months in every case and Ocuton S Proparakain-POS 0.5% eyedrops (proxymetacaine-HCl) were applied by the probands before every measurement of the intraocular pressure with a modified self-tonometer. Information regarding the local tolerability of the topical anaesthetic was analysed using a standardised questionnaire. The intensity of the following subjective symptoms was listed in separate visual analogue scales for: lacrimation, burning, foreign body sensation, mucus aggregation, pruritus and pain. RESULTS: Information from 83 glaucoma patients on local tolerability of proparacaine eyedrops could be analysed. For several reasons no data could be gathered from 17 probands, which were refusal to complete the questionnaire, cancelled participation and, in two test persons, there emerged an allergic reaction (local eyelid redness and swelling) which necessitated a change to a different topical anaesthetic. In all other participants the application was carried out without any significant local or systemic symptoms or side-effects. Immediately after application of the eyedrops 36.1% of the test persons suffered a minor conjunctival hyperaemia which eased off within 1 h in 20.4% of these patients. Of the interviewed glaucoma patients 91.5% judged the single symptoms on the visual analogue scale between zero and medium intensity. The severest effects, according to the subjective evaluation, were felt in symptoms of burning with a score of 94 and lacrimation graded 96. The least intensity was established in the symptom of mucus aggregation where 72.3% rated this symptom in the visual analogue scale between 0 and 10. The other symptoms pruritus, feeling of pressure and foreign body sensation hardly differed in subjective ratings. CONCLUSION: A self-medication with topical anaesthetics on undamaged ocular surfaces for self-tonometry purposes can be performed by glaucoma patients without a high risk potential. However, the application presupposes that routine ophthalmological examinations are carried out according to the ophthalmological associations' recommendations. Therefore, medical care concepts which integrate self-tonometry into routine ophthalmological services and comply with the complex requirements of a modern glaucoma management should be applied more often.
Cochrane Database Syst Rev. 2007; CD005276
Ezra DG, Allan BD
BACKGROUND: Cataract is defined as loss of transparency of the natural lens and is usually an age-related phenomenon. The only recognized treatment available for cataract involves surgery. An ideal anaesthetic should allow for pain-free surgery with no systemic or local complications. It should be cost effective and should facilitate a stress-free procedure for surgeon and patient alike. Topical anaesthesia involves applying anaesthetic eye drops to the surface of the eye prior to and during surgery. This has found large acceptance especially in the USA where it is used by 61% of cataract surgeons. Many surgeons who perform cataract surgery under topical anaesthesia also use intraoperative supplementary intracameral lidocaine (injected directly into the anterior chamber of the eye). The benefits and possible risks of intracameral lidocaine have been assessed by a number of randomized controlled trials, but the results have been conflicting and many of the endpoints have been heterogeneous. OBJECTIVES: The primary objective of this systematic review was to assess pain during surgery and patient satisfaction with topical anaesthesia alone compared to topical anaesthesia with intracameral anaesthesia for phacoemulsification. The secondary objectives were to assess adverse effects and complications attributable to choice of anaesthesia and the need for additional anaesthesia during surgery. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 2), MEDLINE (1966 to May 2006), EMBASE (1980 to May 2006) and LILACs (1982 to 3 May 2006). We also searched the reference lists of the identified studies and the Science Citation Index. We did not have any language restriction. SELECTION CRITERIA: We included only randomized controlled trials (RCTs) comparing topical anaesthesia alone to topical anaesthesia with intracameral lidocaine. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. For dichotomous outcomes data were presented as odds ratios. For continuous outcomes the weighted mean difference was employed. A random-effects model was used unless there were fewer than three trials in a comparison, where a fixed-effect model was used. We explored heterogeneity between trial results using a chi-squared test. MAIN RESULTS: A total of eight trials comprising of 1281 patients were identified for analysis. Our data comparison showed a significantly lower intraoperative pain perception in patient groups using supplementary intracameral lidocaine, although the difference was small. No significant difference was demonstrated between the groups receiving topical anaesthesia alone and topical combined with intracameral anaesthesia in terms of the need for supplemental anaesthesia, intraoperative adverse events or corneal toxicity. AUTHORS' CONCLUSIONS: The use of intracameral unpreserved 1% lidocaine is an effective and safe adjunct to topical anaesthesia for phacoemulsification cataract surgery.
Phacoemulsification in vitrectomized eyes under topical anesthesia.
Eur J Ophthalmol. 2007 May-Jun; 17(3): 336-40
Zaheer I, Taylor SR, Pearson RV
PURPOSE: To study phacoemulsification in vitrectomized eyes under topical anesthesia, assessing anesthetic and intraoperative characteristics and complications. METHODS: A prospective study was performed on 52 eyes of 51 patients who underwent phacoemulsification of cataract with intraocular lens implantation under topical anesthesia, having previously undergone pars plana vitrectomy. Surgical and anesthetic observations and complications were recorded, as were visual outcomes. RESULTS: Ninety-two percent of patients had improved visual acuity postoperatively with only one patient having visual loss as a result of surgery. The most common intraoperative observations were of a deep anterior chamber, posterior capsular plaques, posterior synechiae, and nuclear sclerotic cataracts. Topical anesthesia proved satisfactory in 96%, with only two patients requiring intracameral lignocaine 1%; no patients required conversion to injection anesthesia. There were no major operative or postoperative complications. CONCLUSIONS: Phacoemulsification in vitrectomized eyes can be challenging, but is visually rewarding. Topical anesthesia proved satisfactory for the vast majority of cases, with none of our patients requiring conversion to injection anesthesia.
Ophthalmic Physiol Opt. 2007 May; 27(3): 311-4
Haddad DE, Rosenfield M, Portello JK, Krumholz DM
PURPOSE: It is common clinical practice to instill a topical anaesthetic prior to the instillation of a mydriatic agent into the eye. The main rationale for using the anaesthetic is to increase corneal permeability, so that more of the mydriatic agent reaches the receptor sites within the anterior chamber. It addition, as mydriatics generally cause stinging, prior use of an anaesthetic should reduce the degree of discomfort. The aim of the present study was to determine whether the efficacy of mydriasis produced by an antimuscarinic agent is enhanced by prior instillation of a topical anaesthetic. METHOD: The study was performed using a double-masked protocol on 20 healthy young subjects. One drop of either proparacaine (proxymetacaine) (0.5%) or isotonic saline was instilled into the eye, followed by one drop of tropicamide (0.5%). Pupil diameter was measured using a customized photographic device at 0, 10, 20, 30 and 60 min following drug instillation. Additionally, subjects were asked to rate the degree of discomfort following the instillation of each drop on a scale from 0 (no discomfort) to 10 (agony). RESULTS: There was no significant difference in either the rate of onset of mydriasis, or the maximum pupil diameter achieved between the two conditions. The mean change in pupil diameter produced by tropicamide after the instillation of saline or proparacaine was 2.31 and 2.28 mm, respectively. The mean discomfort scores following instillation of saline and proparacaine were 1.15 and 1.65, respectively, while mean discomfort scores following the instillation of tropicamide after saline or proparacaine were 4.00 and 0.85, respectively. CONCLUSIONS: Instillation of a topical anaesthetic does significantly reduce the degree of discomfort produced by the instillation of tropicamide. However, it does not produce any significant increase in either the magnitude or rate of onset of mydriasis.
Assisted local anaesthesia for endoscopic dacryocystorhinostomy.
Clin Experiment Ophthalmol. 2007 Apr; 35(3): 256-61
Howden J, McCluskey P, O'Sullivan G, Ghabrial R
BACKGROUND: Endoscopic dacryocystorhinostomy is traditionally performed under general anaesthesia. However, there are reports in the literature of various local anaesthetic techniques with or without sedation for this procedure. An effective and acceptable local anaesthetic technique enables the avoidance of the risks associated with general anaesthesia, particularly for elderly patients, with the added benefit of reduced bleeding, reduced nausea and vomiting, and reduced length of hospital stay and thus health care cost savings. This study aims to evaluate the safety and patient acceptance of a minimally invasive assisted local anaesthetic technique for endoscopic dacryocystorhinostomy. METHODS: A prospective questionnaire-based study is presented of 24 consecutive adult patients who underwent 26 endoscopic dacryocystorhinostomies in a day surgery including 22 primary and four revision procedures performed by one surgeon under local anaesthesia and sedation over a 4-month period. RESULTS: Apart from persistent postoperative vomiting in one patient there were no anaesthetic complications. There were no instances of epistaxis. The mean pain score on a visual analogue scale of 0-10 was 1.56 and 56% reported no pain. Ninety-two per cent would recommend the procedure to others. CONCLUSION: This assisted local anaesthetic technique for endoscopic dacryocystorhinostomy is safe and acceptable to patients.
Subtenon lidocaine vs topical proparacaine in adult strabismus surgery.
Ann Ophthalmol (Skokie). 2006; 38(3): 201-6
Kiliç A, Gürler B
Intraoperative subtenon 2% lidocaine and topical 0.5% proparacaine in patients undergoing strabismus surgery were compared. No additional systemic analgesics and sedatives were used. Mean and total pain scores intraoperatively and postoperatively were not different. Each anesthetic agent provides good intraoperative anesthesia and postoperative analgesia. Topical 0.5% proparacaine may be preferred because of its easy administration and fewer side effects, lack of hospital admission, and immediate and predictable alignment of the eyes.