Biomedical subjects

Richard M Sheard

Publications and source records attributed to Richard M Sheard.

6 recordsLinked to original sources

PubMed2004

Subtenons lidocaine injection for postoperative pain relief after strabismus surgery in children: A prospective randomized controlled trial.

BACKGROUND: We previously reported a pilot study of the use of subtenons lidocaine after primary, unilateral strabismus surgery in children. This study suggested an association between subtenons lidocaine administration at the conclusion of surgery and a reduction of pain in the immediate postoperative period. As a result of this pilot study we performed a full-scale prospective, randomized controlled trial to fully evaluate the efficacy of this intervention. METHODS: Children undergoing primary surgery or reoperations for strabismus were recruited. If randomized to the treatment group, 1 ml of 2% lidocaine was injected into the subtenons space of each operated eye, just prior to conjunctival closure. The child's parents, who were masked to the intervention, assessed pain over 4 h postoperatively using an objective pain-scoring tool. Pain scores were recorded on return to the ward (0 h, approximately 20 to 30 min after the completion of surgery) and at 1, 2, and 4 h later. RESULTS: One hundred eleven children were recruited, of whom 91 (82.0%) underwent unilateral and 20 (18.0%) underwent bilateral surgery. Ninety operations (81.1%) were primary procedures and 21 (18.9%) were reoperations. Fifty-four children (48.6%) were randomized to the treatment group and 57 (51.4%) were randomized to the control group. A subtenons lidocaine injection was associated with a significant reduction in pain at the 0 h observation (P = 0.0056), and the total pain score over the 4-h postoperative period was significantly lower in the treatment group compared to controls (P = 0.0381). There was no difference between the groups with respect to the need for additional systemic analgesia (P = 0.307). CONCLUSION: This study showed that an intraoperative injection of subtenons lidocaine is associated with a significant reduction in postoperative pain during the first postoperative hour for all types of childhood strabismus surgery. There was no difference between the groups in the need for systemic analgesia.

Analgesia↗

PubMed2004

Unexpected posterior capsule rupture with unfolding silicone plate-haptic lenses.

PURPOSE: To evaluate the incidence, management, and long-term outcomes of unexpected posterior capsule rupture during injection of a C11UB plate-haptic silicone intraocular lens (IOL) with the Passport II system (both Bausch & Lomb Surgical). SETTING: Tertiary referral center and teaching hospital. METHODS: This retrospective analysis comprised 24 cases of posterior capsule rupture during plate-haptic silicone IOL injection. RESULTS: Over 6 months, a C11UB IOL was injected after phacoemulsification in 3446 cases, from which 24 patients were drawn. Thus, the rate of posterior capsule rupture was 0.70%. The median preoperative best corrected visual acuity was 6/48 (range 6/12 to light perception). The median best spectacle-corrected acuity at the time of discharge or the last visit was 6/9 (range 6/4 to 6/24). Twenty patients had improved acuity, 2 lost 1 Snellen line, and 2 had unchanged acuity. There were no postoperative complications in 13 patients (54%). Three patients required further surgery. Twenty-one patients were discharged after a mean of 32 weeks +/- 22 (SD); they required a mean of 5 +/- 4 visits. The remaining 3 continue to be followed because of their preoperative ocular comorbidity. CONCLUSIONS: Although no predisposing factor was identified, we believe the risk for posterior capsule rupture during IOL injection can be minimized by careful injection technique. In particular, if there is doubt about the integrity of the zonules, anterior capsule, or posterior capsule, a plate-haptic silicone IOL should not be injected. With the appropriate management, the final visual outcome was good.

Aged↗

PubMed2003

Acute macular pucker.

PURPOSE: To describe the presenting features, histopathology, and surgical outcome in a group of patients with rapidly progressive macular pucker. DESIGN: Retrospective interventional noncomparative case series. PARTICIPANTS: Five patients. METHODS: Review of case notes and the existing literature. RESULTS: All five patients had rapidly progressive visual loss and metamorphopsia over 2 weeks to 3 months, secondary to macular pucker after retinal tears or detachment. Vitrectomy and epiretinal membrane removal was performed within 1 month of diagnosis. In the absence of complications, there was rapid recovery of the visual acuity with resolution of metamorphopsia within 6 weeks to 3 months. Surgical complications limited the visual outcome in two cases. Histopathologic examination of epiretinal membrane removed from two of the cases suggests that these tend to form tubuloacinar structures and contain more retinal pigment epithelium-derived cells than tissue excised from cases with idiopathic macular pucker. CONCLUSIONS: Patients with acute macular pucker have precipitous visual loss caused by epiretinal membrane formation after retinal tear or detachment. Early surgery in these patients results in rapid recovery of visual acuity and resolution of metamorphopsia. The clinical features and comparative immunohistochemistry suggest that acute macular pucker is a distinct clinicopathologic entity.

Acute Disease↗

PubMed2003

Posterior vitreous detachment after neodymium:YAG laser posterior capsulotomy.

PURPOSE: To determine whether retinal detachment (RD) after neodymium:YAG (Nd:YAG) laser posterior capsulotomy is due to a greater incidence of posterior vitreous detachment (PVD) than in controls and whether vitreous status at the time of capsulotomy is useful in predicting the risk for RD. SETTING: Teaching hospital ophthalmology service. METHODS: Patients having Nd:YAG laser posterior capsulotomy after uneventful cataract surgery (treatment group) were prospectively studied. Fellow eyes that had extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation but no Nd:YAG capsulotomy (no-laser group) formed 1 control group, and eyes that had no cataract surgery (phakic group) formed a second control group. The treatment group comprised 322 eyes; the no-laser group, 97; and the phakic group, 142. Dilated fundus and vitreous examinations were performed at baseline (before Nd:YAG capsulotomy) and 12 months postoperatively. RESULTS: At baseline, the prevalence of PVD was similar in the treatment and no-laser groups (61.8% and 63.9%, respectively; P=.2014) but was significantly lower in the phakic group (50.7%; P=.0151). There was no significant difference among the groups in the development of PVD in eyes with attached vitreous at baseline (17.9%, treatment group; 11.4%, no-laser group; 17.1%, phakic group) (P=.6588). CONCLUSIONS: The prevalence of PVD was significantly higher in eyes after ECCE and IOL implantation than in phakic eyes independent of Nd:YAG laser posterior capsulotomy. Capsulotomy was not associated with a significantly higher incidence of new PVD; therefore, the presence or absence of PVD at the time of capsulotomy is not helpful in assessing the risk for RD in the first year after laser treatment.

Aged↗

PubMed2003

Subtenons lidocaine injection for postoperative pain relief after strabismus surgery in children: a pilot study.

BACKGROUND: Ophthalmologists are now encouraged to perform strabismus surgery as an outpatient procedure, but postoperative pain may be a barrier to discharge. Systemic analgesics have side effects or are contraindicated in some patients. We designed a trial to determine the efficacy of subtenons lidocaine injection at reducing postoperative pain and systemic analgesia requirements. METHODS: Children having unilateral primary horizontal muscle surgery were randomized to either receive an injection of 1 mL of 2% lidocaine into the inferonasal subtenons space or not. The child's parents, who were masked to the intervention, assessed pain over 4 hours postoperatively using an objective pain-scoring tool. RESULTS: Seventeen children received injections and 14 did not. Five of the subtenons group required additional analgesia (29%) compared to 9 of the controls (64%, chi(2): P =.052). The pain scores at each time interval tended to be lower in the treatment group, compared to controls, statistically significantly so at the 2-hour observation (Mann-Whitney U test: P =.01). CONCLUSIONS: These data provide some evidence of an association between the use of subtenons lidocaine injection and a reduction of pain experienced by children in the immediate postoperative period following primary strabismus surgery.

Anesthetics, Local↗

PubMed2002

A novel ophthalmic presentation of the Proteus syndrome.

PURPOSE: To report a patient with the Proteus syndrome who had ocular complications not previously described in the literature. DESIGN: Single observational case report. METHODS: Retrospective review of the medical record and review of the literature. RESULTS: The 26-year-old man has systemic features fulfilling the diagnostic criteria for the Proteus syndrome. His ocular abnormalities are myopia, mild calcific band keratopathy, cataract, abnormal vitreous structure, vitreous hemorrhage, a large chorioretinal mass, and a resolved serous retinal detachment. CONCLUSIONS: Ocular complications are frequently reported in patients with the Proteus syndrome. Few of the patients reported in the literature have had comprehensive ocular examination by an ophthalmologist. Our patient is unique because he has been examined by ophthalmologists from childhood, and it is clear that the ocular findings may change with time. As far as we are aware, calcific band keratopathy, abnormal vitreous structure, and chorioretinal hamartoma associated with serous retinal detachment and vitreous hemorrhage have not previously been described.

Adult↗