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Biomedical subjects

G D Sturrock

Publications and source records attributed to G D Sturrock.

13 recordsLinked to original sources

Comparison of articaine and bupivacaine/lidocaine for peribulbar anaesthesia by inferotemporal injection.

BACKGROUND: Articaine is a novel amide local anaesthetic with a shorter duration of action than prilocaine. METHODS: In a randomized, double-blind study we compared the efficacy of 2% articaine with epinephrine 1:200,000 with a mixture of 0.5% bupivacaine and 2% lidocaine with epinephrine 1:200,000 for peribulbar anaesthesia in cataract surgery using a single inferotemporal injection. Eighty-two patients were randomly allocated to one of two groups to receive peribulbar anaesthesia with 6-7 ml of articaine or a bupivacaine/lidocaine mixture. Both solutions contained hyaluronidase 30 iu ml(-1). Ocular movement was scored at 2 min intervals up to 10 min, at the end of surgery and at time of discharge from hospital. Time to readiness for surgery and any complications (proptosis, chemosis, pain) were recorded. RESULTS: The articaine group demonstrated a rapid onset of peribulbar block with mean time (SD) to readiness for surgery of 4.2 (4.5) min compared with 7.2 (5.7) min in the bupivacaine/lidocaine group (P=0.0095). The block obtained in the articaine group was dense with eye movement scores at 2, 4, 6, 8 and 10 min all significantly reduced (P<0.01 at each interval). There was also a faster offset of the block in the articaine group (P=0.0009). There was no difference in incidence of minor complications between the groups. CONCLUSIONS: Two per cent articaine is safe and effective for peribulbar anaesthesia by inferotemporal injection and is a suitable alternative to the traditional mixture of 0.5% bupivacaine and 2% lidocaine.

Aged↗

Comparison of articaine and bupivacaine/lidocaine for single medial canthus peribulbar anaesthesia.

In a single-centre, randomized, double-blind study, we compared the efficacy of 2% articaine with that of a mixture of 0.5% bupivacaine and 2% lidocaine for peribulbar anaesthesia in cataract surgery, using a single medial canthus injection technique. Eighty-two patients were allocated randomly to receive 7-9 ml of a mixture of 0.5% bupivacaine and 2% lidocaine or an equal volume of 2% articaine with 1:200,000 epinephrine. Hyaluronidase 30 iu ml(-1) was added to both solutions. The degree of akinesia was scored 1, 5 and 10 min after the block, at the end of surgery and at discharge from the day case unit. Primary outcome measures were the difference in ocular movement scores 5 min after block and the need for supplementary inferolateral injections. There was greater akinesia in the articaine group at 5 min (P=0.01). Ten patients (24%) in the articaine group and 21 patients (51%) in the bupivacaine/lidocaine group required a supplementary injection (P=0.02). The mean (SD) volume of local anaesthetic required to achieve adequate block for surgery was 9.7 (2.1) ml in the articaine group and 11.0 (2.2) ml in the bupivacaine/lidocaine group (P=0.01). There was a faster offset of akinesia after surgery in the articaine group (P=0.01). There were no differences between groups in the incidence of reported pain or of minor complications. In our study, 2% articaine with 1:200,000 epinephrine was safe and efficacious for single medial canthus peribulbar anaesthesia.

Aged↗

Chronic ocular ischaemia.

The ocular changes due to chronic ischaemia are described in seven patients, aged between 59 and 77 years, with severe carotid artery disease. Doppler sonography was used to confirm the presence of high-grade arterial stenosis or occlusion in all the patients. The treatment of chronic ocular ischaemia is discussed, including the role of carotid bypass surgery, which is mentioned briefly. Three patients died of cardiovascular or cerebrovascular disease within 6 to 18 months of presentation.

Aged↗

Lattice corneal dystrophy: a source of confusion.

Published descriptions of families with lattice dystrophy of the cornea reveal a much more varied clinical course and a more pleomorphic corneal picture than the rather stereotyped textbook descriptions would suggest. This report describes a family with lattice dystrophy of unusually late onset with retention of useful vision into the 7th decade. Herpes simplex keratitis was misdiagnosed in 5 members of the family by different ophthalmologists, probably because the typical lattice lines were fine and visible only by retroillumination.

Adolescent↗

Specular microscopy of the corneal endothelium.

The endothelium of the normal corneas of 67 human subjects was studied in vivo with the specular microscope in order to quantify the method as a means of sampling the cell density of the tissue. It was found that (1) axial cell counts of the endothelium are reproducible in the same cornea after an interval of time; (2) the cell counts of the centre and periphery of the same cornea are similar; (3) the axial cell counts of pairs of eyes are similar; and (4) there is a gradual reduction of cell number with increasing age. The significance of these data is discussed.

Adult↗

Endothelial cell loss and corneal thickness after intracapsular extraction and iris clip lens implantation: a randomised controlled trial (interim report).

Patients in a randomised controlled trial were chosen either to have iris clip lens implantation after intracapsular cataract extraction or intracapsular extraction only. They were assessed in terms of corneal thickness, postoperative epithelial oedema, and endothelial cell counts. All patients had 1 eye submitted to operation, which was carried out by the same surgeon. There was significantly greater increase in corneal thickness (P less than 0.05) on the 5th postoperative day in eyes which had lens implants (23 patients with intracapsular extraction and 19 with implant), but the difference between the 2 groups became insignificant at 1 month (17 patients in each group). Daily corneal thickness measurements and observations of epithelial oedema in a subgroup (20 patients divided equally into 2 groups) showed that postoperatively there was greater and more widespread corneal oedema after implant surgery. When the operated eye was compared with the unoperated eye, endothelial cell loss was significantly greater in those with implants (P less than 0.01) than in those with simple intracapsular extraction.

Aged↗

Corneal oedema and endothelial cell loss after iris-clip lens implantation.

Lens implantation as a form of replacement surgery has some clear advantages over other forms of aphakic correction. The most feared complication of this type of operation is bullous keratopathy. A short-term study was carried out in two comparable groups of patients to assess corneal oedema and endothelial cell loss after simple cataract extraction and after iris-clip lens implantation following intracapsular extraction as a primary procedure. All patients were randomly chosen to have one or other procedure. The results indicate that lens implantation causes greater postoperative corneal oedema and greater endothelial cell loss. It is therefore important for implant surgeons to bear in mind the possible harm they may be inflicting and the need both for stringent criteria of selection and for the adoption of techniques which will minimize endothelial trauma.

Cell Count↗

Nocturnal lagophthalmos and recurrent erosion.

The symptoms and corneal changes caused by sleeping with one or both eyes open are described in 102 patients. The clinical picture is identical to that of the microform recurrent erosion. The close relationship between the micro- and macro-forms of recurrent corneal erosion suggests that the latter condition is also precipitated by nocturnal lagophthalmos.

Adult↗

Pigmented lens striae.

The clinical features of pigmented lens striae were studied biomicroscopically in seven patients. The lenses of three of these, obtained by cataract surgery, were examined by electron microscopy to determine the structure of the striae. We concluded that the striae are not formed by remnants of tunica vasculosa lentis, as earlier workers believed, but consist of fine fibrils of zonular bundles entrapping pigment granules of uveal origin.

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