Safety of local anaesthesia for cataract surgery: why we should look again.
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Biomedical subjects
Publications and source records attributed to T Eke.
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Looking at the sun can cause focal burns to the retina. We prospectively followed up all patients who presented to Eye Casualty of Leicester Royal Infirmary having observed the solar eclipse of August, 1999. 45 patients attended, of whom 20 had visual symptoms and five had visible changes in the retina; four patients were still symptomatic after 7 months.
OBJECTIVE: To report the spectrum of clinical findings in patients with ocular inflammation caused by plant sap from Euphorbia species. DESIGN: Clinical case series. SETTING: Ophthalmology emergency referrals in the United Kingdom. PATIENTS: We examined 7 patients, all of whom gave a history of recent ocular exposure to the sap of Euphorbia species. INTERVENTIONS: All patients were treated with antibiotic drops or ointment (chloramphenicol). Cycloplegic and steroid drops were also used for some patients. Patients were observed until all signs and symptoms had resolved. MAIN OUTCOME MEASURES: Symptoms, visual acuity, and clinical signs of inflammation. All patients provided a specimen of the plant for formal identification. RESULTS: Initial symptoms were generally burning or stinging pain with blurred vision. In most cases, visual acuity was reduced between 1 and 2 Snellen lines. In 1 patient with age-related maculopathy, acuity dropped from 20/80 to hand motions before recovering. Clinical findings varied from a mild epithelial keratoconjunctivitis to a severe keratitis with stromal edema, epithelial sloughing, and anterior uveitis. All signs and symptoms had resolved by 1 to 2 weeks. CONCLUSIONS: These cases illustrate the range of severity of Euphorbia sap keratouveitis. The condition seems to be self-limiting when managed supportively. People who work with Euphorbia plant species should wear eye protection. Clinicians managing keratopathy caused by Euphorbia species should be aware of the danger of sight-threatening infection and uveitis, particularly during the first few days.
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PURPOSE: To assess glaucoma awareness and screening uptake in relatives of people with glaucoma. METHODS: A questionnaire was administered to 52 patients with primary open-angle glaucoma. They were asked about their awareness of glaucoma clustering within families, and the need for glaucoma screening in relatives of glaucoma patients. Patients were asked to identify one or more first-degree relatives, aged over 40 years and thus eligible for free glaucoma screening in the United Kingdom. These relatives were mailed a similar questionnaire. In performing the statistical analysis we corrected for possible clustering within families. The study was approved in advance by our local ethics committee, and all participants were informed of the United Kingdom's free screening service afterwards. RESULTS: Ninety relatives were identified, of whom 70 (78%) returned questionnaires. Only 53% of responding relatives thought they were at increased lifetime risk of developing glaucoma. Though 81% of relatives had been screened, many were screened infrequently. We compared the responses of patients' siblings and patients' offspring. Perceived lifetime glaucoma risk was similar in the two groups, but the (older) siblings had a significantly lower awareness of the free screening service (p = 0.03) and attended for screening less frequently (p = 0.07). Uptake of regular, free glaucoma screening at least every 2 years was 57% among offspring and 30% among siblings (p = 0.005). Because of selection bias (good communicators were more likely to be invited to participate) the true rates of glaucoma awareness and screening uptake are almost certainly lower than this. CONCLUSIONS: Relatives of people with glaucoma should be made more aware of the need for glaucoma screening and encouraged to use the free screening service. Older relatives should be particularly targeted.
PURPOSE: To describe the current usage of the various techniques of local anaesthesia (LA) in the United Kingdom, and safety precautions taken. METHODS: An observational study of practice of LA in the whole of the United Kingdom was carried out over 3 months in late 1996. Staff in all ophthalmology theatres in the National Health Service were invited to report every LA given for the purpose of intraocular surgery during the first week, and thereafter to report adverse events only. RESULTS: Participation during the first week was calculated to be 72.8% overall. Anaesthesia techniques for intraocular surgery were: 70% LA alone, 5.8% LA with sedation and 24.2% general anaesthesia. LA techniques were: 65.6% peribulbar, 16.9% retrobulbar, 6.7% sub-Tenon's, 4.4% subconjunctival, 2.9% topical and 2.3% combinations. Of patients who were given LA, 96% were monitored, 84% had an anaesthetist available in theatres in case of a problem and intravenous access was established in 60%. CONCLUSION: Local anaesthesia is frequently used for intraocular surgery in the United Kingdom. A variety of techniques are used, and safety precautions are taken in most cases.
PURPOSE: To describe the adverse events associated with local anaesthesia (LA) for intraocular surgery. METHODS: An observational study of practice of LA in the whole of the United Kingdom was conducted over 3 months in late 1996. Staff in all ophthalmology theatres in the National Health Service were invited to report every LA given for the purpose of intraocular surgery during the first week, and thereafter to report adverse events only. RESULTS: During the first week, the reported incidence of all adverse events within the orbit was 2.7%, and for 'systemic' adverse events it was 0.9%. Serious adverse events were reported in association with all LA techniques. In 3 months, 18 events were described as 'life-threatening' by respondents, and further patients were reported to have had epileptic fits or were transferred directly from the operating theatre to an intensive care unit. The voluntary nature of the survey introduces some bias from under-reporting, making the incidence of these severe events difficult to assess. Reported incidence of severe 'systemic' adverse events was similar for all LA techniques. CONCLUSIONS: Serious adverse events were reported in association with with all LA techniques. This implies that we should be prepared for such events in all patients who have intraocular surgery.
PURPOSE: (i) To describe the course of ocular symptoms and recurrent corneal erosion (RCE) following traumatic corneal abrasion (TCA). (ii) To assess the efficacy of a regimen of nightly eye ointment in preventing symptoms and RCE. METHODS: Patients presenting with TCA were treated with g. cyclopentolate 1% stat. and oc. chloramphenicol q.d.s. for 5 days. Eye pads were not used. For injuries caused by a fingernail, patients were randomised to receive either this 'standard regimen' alone, or to follow with a lubricating ointment (Lacrilube) nocte for 2 months. Follow-up was by telephone, using a symptom-based questionnaire. Recurrent symptoms were graded as: (i) none or minimal, (ii) mild, (iii) moderate (difficulty with some activities, or sought further opinion) and (iv) disabling (confirmed macroform RCE). After 2 years, case-notes were reviewed. The study is continuing, with further telephone follow-up taking place. RESULTS: Three-month follow-up was completed for 42 'fingernail' injuries and 32 'non-fingernail' TCAs. When treated with our standard regimen, 'mild' symptoms were reported in 10% of 'fingernail' and 10% of 'non-fingernail' injuries. Symptoms were 'moderate' in 0 and 12% respectively. Chisquared test confirmed a significantly higher prevalence of recurrent symptoms in the 'additional nightly ointment' group of 'fingernail' injuries (p = 0.016). Two macroform RCEs were confirmed by 2 years: one from each treatment group of 'fingernail' injury. CONCLUSIONS: When TCA is managed as above, there is a high prevalence of recurrent symptoms in the following 3 months. Additional nightly ointment appears to worsen prognosis. Macroform RCE is not common in the 2 years following TCA.
OBJECTIVE: To estimate the prevalence of visual field defects in patients taking the anticonvulsant drug vigabatrin and to characterise the features of visual dysfunction found. METHODS: Thirty three unselected patients attending neurology and epilepsy clinics were identified as taking vigabatrin and asked to attend for neuro-ophthalmic evaluation. A control group of 16 patients with epilepsy unexposed to vigabatrin was also evaluated. Visual fields were examined by static perimetry using a Humphrey field analyser. Patients underwent detailed ophthalmic examination, various blood tests, and brain MRI where necessary. Visual evoked responses (VERs), electro-oculograms (EOGs), and electroretinograms (ERGs) were recorded. RESULTS: Of 31 assessable patients treated with vigabatrin, 16 (52%) had definitely abnormal visual fields, nine (29%) had fields that were inconclusive, four (13%) had normal fields, and two (6%) proved unable to cooperate with testing. In four patients some plausible cause was found for the field abnormality leaving 12 patients (39%) in whom a definite bilateral field defect was found, possibly caused by vigabatrin treatment. Of 16 control patients none had definitely abnormal fields, 12 (75%) had normal fields, and four (25%) had fields that were inconclusive. The field defects associated with vigabatrin treatment showed a characteristic pattern of concentric peripheral field loss with temporal and macular sparing. The VERs and ERGs were normal. The EOG Arden Index was reduced in patients taking vigabatrin, although this returned towards normal when vigabatrin was stopped, even in the presence of persistent field defects. Multifocal ERGs recorded in two patients were abnormal, showing marked reduction in amplitude of the peripheral focal ERG. CONCLUSIONS: Treatment with vigabatrin was associated with a high prevalence of peripheral visual field defects. This seemed to be the result of a toxic effect of vigabatrin on the retina and seemed to persist if the drug was withdrawn.
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