Biomedical subjects

Ossama M Hakim

Publications and source records attributed to Ossama M Hakim.

3 recordsLinked to original sources

PubMed2005

Strabismus surgery under augmented topical anesthesia.

PURPOSE: Recently, topical lidocaine 2% jelly had been used in phacoemulsification and trabeculectomy surgeries. The purpose of this study is to evaluate the efficacy and stability of one-stage adjustable suture using topical lidocaine jelly 2% in combination with intravenous nalbuphine (Nubain). METHODS: Forty adult patients aged 16 to 46 years (median, 24 years) underwent adjustable rectus muscle surgery under topical lidocaine jelly 2% and intravenous 10 mg nalbuphine given 10 minutes before surgery. Adjustment was performed on the operating table before conjunctival closure. The stability of adjustment was studied by comparing the postadjustment deviation to that at 1 day, 1 week, and 3 weeks postoperatively. Success was defined as alignment within 10 prism diopters on distant fixation. Analgesia was assessed using Verbal Description Scale. Changes in vital signs were recorded during surgery to evaluate the oculocardiac reflex. RESULTS: Forty rectus muscles were recessed, 22 muscles were resected, 3 muscles were tucked, and 2 muscles were retrieved. During the operation, 35 patients expressed no pain, 3 patients complained of discomfort, and 2 patients complained of distressing pain and required an additional 10 mg of intravenous nalbuphine. Thirty-eight patients (95%) were successfully aligned during the first postoperative day, 37 patients (92.5%) after 1 week, and 36 patients (90%) after 3 weeks. Intraoperative cardiac monitoring did not record positive oculocardiac reflex in any patient. CONCLUSION: Lidocaine jelly in combination with intravenous nalbuphine is an effective topical anesthesia strategy that provides for the patient's comfort and the surgeon's ability to fine-tune ocular alignment on the operating table.

Adolescent↗

PubMed2005

Releasable adjustable suture technique for children.

PURPOSE: Residual esotropia is a problem for children with esotropia that can follow bilateral medial rectus recession, and the use of adjustable sutures is nearly impossible. The aim of this work is to describe a new suture technique to overcome this problem. METHODS: Medial rectus muscle was recessed and secured to the sclera at the predetermined recession position after suspending it 1.50-2.00 mm farther. A second, releasable suture was placed at the original insertion site, passed under the previously tied muscle suture knot, and tied in a strengthened loop knot, advancing the muscle to the new scleral insertion. The looped end was left long enough to be kept in the inferior fornix. The next day, if the child was undercorrected, intranasal midazolam was given and the releasable suture was drawn out, providing additional muscle recession. Patients aged 10 to 94 months (mean 34 months) with angle of deviation 20 to 60 prism diopters (PD; mean 33 PD) and with follow-up 1 to 12 weeks (mean 4.5 weeks) were studied. Success was defined as alignment within 10 PD. RESULTS: Of 50 children with esotropia, 32 (64%) were successfully aligned, and 18 (36%) were undercorrected with residual angle 14 to 25 PD (mean, 18 PD). After release of the suture, 15 children (83%) were successfully aligned, and 3 children were still undercorrected. The overall success rate was 94%. CONCLUSION: Releasable adjustable suture is a new technique that can help strabismologists attempt bilateral medial rectus recession in children, with a second chance for correction during early postoperative period.

Child↗

PubMed2005

Silicone intubation with trans-sac fixation to prevent tube dislocation.

PURPOSE: To report a new technique for silicone tube fixation, after successful intubation for congenital nasolacrimal duct obstruction, to minimize its lateral dislocation. METHODS: Thirty patients (40 eyes) aged 20 months to 5 years (median, 28 months) were treated using the Ritleng bicanalicular lacrimal intubation system. After drawing the silicone stent out of the nose, a piece of 7-O Prolene suture was tied securely around one of its limbs. This limb was then pulled up, pulling the tied end of the Prolene suture to the medial canthal area. The same procedure was repeated with the other limb of the stent, pulling up the other Prolene suture end. This suture end was then un-tied. After adjusting the exposed silicone loop, the free end of the Prolene suture was tied securely to the corresponding part of the silicon stent. The nasally drawn two ends of silicone tube were tied in a single square knot. After 2 to 3 months, stents were removed in the medical office for all the patients. RESULTS: This technique was used successfully for all the patients. Of the 40 tubes in this study, 39 did not displace and one tube was displaced laterally due to loosely tied Prolene suture. On follow-up, the trans-sac suture was well tolerated and no complications were noted. CONCLUSION: The trans-sac fixation suture prevents lateral displacement of square-knotted silicone tube, which still can be removed easily at the physician's office.

Child, Preschool↗