[Is oculopression before phacoemulsification in general anesthesia necessary?].
Explore the source record for details and available documents.
Anesthesia, General↗
Biomedical subjects
V Hessemer
Publications and source records attributed to V Hessemer.
Effect of heparin in irrigating solution on inflammation following small incision cataract surgery.
PURPOSE: To study the effect of heparin-sodium added to the irrigating solution on postoperative inflammation in patients having cataract surgery. SETTING: Department of Ophthalmology, University of Giessen, Giessen, Germany. METHODS: Seventy-two patients having phacoemulsification with posterior chamber intraocular lens (IOL) implantation were randomly assigned to receive regular irrigating solution or solution with heparin-sodium (final diluted concentration 10 IU/mL). In half the patients, poly(methyl methacrylate) (PMMA) IOLs were implanted and in half, foldable silicone IOLs. The patients were examined preoperatively, on days 1 and 3, and 1 year postoperatively. Postoperative inflammation was objectively evaluated by measurement of flare and cells using laser flare-cell photometry. RESULTS: The mean postoperative flare values were significantly lower in the groups with additional heparin-sodium at days 1 and 3 (P < . 01). Flare values were not significantly different 1 year postoperatively. Cell values for the heparin-treated groups were lower, but the difference did not reach statistical significance. Flare and cells values for the two IOL materials were not significantly different during the entire follow-up. CONCLUSION: Heparin-sodium added to the infusion solution during small incision cataract surgery reduced inflammation in the early postoperative period.
Aged↗
Influence of the vasodilator drug isosorbide dinitrate on ocular circulation.
OBJECTIVE: To evaluate the ocular hemodynamic effects of the vasodilator drug isosorbide dinitrate. DESIGN: Randomized, prospective, controlled clinical trial assessing the short-term effects of 1 tablet containing 40 mg of isosorbide dinitrate vs placebo. SETTING: Department of Ophthalmology, University of Giessen, Germany. MAIN OUTCOME MEASURES: Systolic ophthalmic artery pressure (SOAP), systolic ocular perfusion pressure (SOPP), ocular pulsation amplitude (OPA), product of OPA x heart rate (HR), intraocular pressure (IOP), systolic and diastolic brachial artery pressure (SBAP and DBAP). Measurements were performed before and up to 7 hours after patients received the medication. PARTICIPANTS: Twenty healthy subjects (mean age, 28 years) who provided informed consent. RESULTS: After isosorbide dinitrate administration, SBAP, SOAP, and SOPP were significantly lowered (P = .01), and IOP tended to be lower (P = .08) compared with placebo. Maximum reduction was 3 to 5 hours after medication: SBAP was reduced by 10.9 mm Hg (9% reduction; P = .01), SOAP was reduced by 12.5 mm Hg (14% reduction; P = .01), SOPP was reduced by 11.3 mm Hg (14.5% reduction; P = .01), and IOP by 1.5 mm Hg (12% reduction; P = .08). The relation between SBAP and SOAP was significantly linear (P < .001), the correlation coefficient was 0.39. The DBAP remained unchanged, and the HR increased by 4 to 7/min (P = .08). The OPA and the product OPA x HR were significantly decreased (P < .001; P = .002) by maximum values of 44% and 40%, respectively. CONCLUSIONS: Administration of isosorbide dinitrate reduced SOAP and SOPP, reflecting reduced systemic systolic blood pressure. The decrease in OPA and the product OPA x HR (a measure of pulsatile ocular blood flow) may reflect a reduction in cardiac stroke volume typical for nitrates. Due to these hemodynamic effects and the minute reduction in IOP, the vasodilator drug isosorbide dinitrate, which has been proposed for glaucoma therapy, may be used only with caution in patients with glaucoma.
Adult↗
[Minor effect of anti-inflammatory therapy on intraocular inflammation after minimally invasive phacoemulsification].
UNLABELLED: In a prospective study, we examined the influence of different anti-inflammatory treatments on intraocular inflammation after minimally invasive cataract surgery. PATIENTS AND METHODS: A total of 150 patients (39-88 years of age) underwent phacoemulsification using a temporal clear-corneal tunnel incision and implantation of a 5-mm PMMA posterior chamber. Each patient was randomly assigned to one of the following 5 treatment groups, each consisting of 30 patients: (1) diclofenac 0.1% unconserved eyedrops (DICun) pre- and postoperatively; (2) diclofenac 0.1% conserved eyedrops (DICco) pre- and postoperatively; (3) DICun postoperatively; (4) DICun pre- and postoperatively, plus dexamethasone-21-dihydrogenphosphate 0.1% eyedrops (DEXA) postoperatively; (5) DEXA postoperatively. The aqueous flare was measured pre- and postoperatively using the laser flare-cell meter. RESULTS: In group 1, the flare (in photon counts/ms) increased from 10.8 +/- 1.7 preoperatively to only 14.7 +/- 3.1 in the afternoon of the day of surgery. Even on day 1 postoperatively, the flare decreased to 9.3 +/- 0.9 and remained relatively constant on days 3 and 7 after surgery. There were no significant differences among the groups concerning flare means (P = 0.35) or time courses (P = 0.51). DISCUSSION: Anti-inflammatory treatment had no significant influence on the amount of postoperative aqueous flare. This is because of the fact that clear corneal phacoemulsification per se leads to an extremely low intraocular inflammation and thus makes the importance of anti-inflammatory pharmacotherapy relative.
Administration, Topical↗
Influence of panretinal photocoagulation on the ocular pulse curve.
PURPOSE: To study the ocular pulsation amplitude (an indicator of choroidal circulation) and systolic ophthalmic artery pressure after panretinal photocoagulation. METHODS: Prospectively, in 10 patients with diabetes mellitus (eight with type II and two with type I; mean age, 64 years) and severe, hitherto untreated, bilateral proliferative diabetic retinopathy, we performed intensive, unilateral panretinal photocoagulation with 1,500 argon laser burns (spot size, 500 microm) in two sessions (interval, 3 weeks). Before and (in 3-week intervals) up to 9 weeks after treatment, we recorded ocular pulse curves using oculo-oscillodynamography and determined each patient's ocular pulsation amplitude and systolic ophthalmic artery pressure. RESULTS: Compared with the untreated contra-lateral eyes, panretinal photocoagulation led to a reduction of ocular pulsation amplitude. Three weeks after the first coagulation, the reduction averaged 20%. Maximum reduction was found 9 weeks after onset of treatment (6 weeks after the second coagulation) and amounted to 29.9%. The differences between photocoagulated and untreated eyes were highly significant on average (P < .01; analysis of variance) as well as for time course (P < .001). Systolic ophthalmic artery pressure was not changed significantly during panretinal photocoagulation follow-up. CONCLUSIONS: Ocular pulsation amplitude is determined by the cardiac cycle-related intraocular volume changes that depend predominantly on choroidal blood flow. The morphologic substrate is probably choriocapillary closure after photocoagulation.
Adolescent↗
Pseudophakic retinal detachment in high axial myopia.
PURPOSE: To investigate the effect of extracapsular cataract surgery with intraocular lens (IOL) implantation and neodymium:YAG (Nd:YAG) laser posterior capsulotomy on the rate of retinal detachment (RD) in myopic eyes with an axial length of 27 mm or more. SETTING: Department of Ophthalmology, University of Giessen, Germany. METHODS: This retrospective, nonrandomized study comprised the records of 386 consecutive surgical procedures in 275 patients performed between December 1985 and December 1993. In May 1994, all patients were asked by a mailed questionnaire whether they had had an RD in either eye or laser treatment for posterior capsule opacification. Responses from 190 patients concerning 253 surgical procedures were evaluated. RESULTS: The pseudophakic RD rate was 0.8% (two cases). One patient developed aphakic RD after IOL explanation. One expulsive choroidal hemorrhage occurred during secondary IOL implantation. Four eyes (1.6%) had vitreous loss, and 74 eyes (29.2%) had an Nd:YAG capsulotomy. Mean axial length was 29.2 mm +/- 1.71 (SD), mean follow-up was 3.8 +/- 2 years, and mean age at surgery was 69.8 +/- 12 years. CONCLUSION: Pseudophakia with no other risk factor posed little additional risk for RD in eyes with high axial myopia; however, Nd:YAG laser posterior capsulotomy was a risk factor for pseudophakic RD. Complicated surgery, such as a secondary procedure or vitreous loss, and young age were major causative factors.
Adult↗
Reduced ocular pulse amplitude in low tension glaucoma is independent of vasospasm.
PURPOSE: A vascular basis for the pathogenesis of primary open angle glaucoma has been postulated for many years. Defects in the regulation of ocular blood flow may be the initiating factor in this group of multifactorial diseases. This study was designed to evaluate the effect of vasospasm on ocular pulse amplitude (OPA) in low tension glaucoma (LTG) patients. METHODS: OPA, using the Langham Ocular Blood Flow (OBF) System, applanation intraocular pressure (IOP), systemic blood pressure and heart rate were measured and vasospasm was determined by a fingernail capillary blood flow test. RESULTS: OPA (mmHg) in the LTG patients with a vasospastic reaction (LTG-V, 1.4 +/- 0.1, n = 17) was not significantly (p > 0.09) different when compared with non-vasospastic LTG patients (LTG-NV, 1.5 +/- 0.2, n = 15) but was significantly (p < 0.001) reduced in LTG-V and LTG-NV patients when compared with matched healthy control subgroups (2.3 +/- 0.2 and 2.4 +/- 0.3, respectively). IOP (mmHg) in LTG-V (13.3 +/- 0.4) and LTG-NV (13.2 +/- 0.5) patient groups was not significantly (p > 0.05) different when compared with each other, but was significantly (p < 0.05) lower when compared with matched control subgroups (15.0 +/- 0.3 and 15.2 +/- 0.4, respectively). Haemodynamic parameters were not significantly different from controls. CONCLUSION: The abnormality in choroidal perfusion indicated by a reduction in OPA in all LTG patients is unrelated to the presence or absence of vasospasm.
Adult↗
[Effect of panretinal photocoagulation on the ocular pulse curve].
BACKGROUND: Most studies on the effects of panretinal photocoagulation (PRPC) on ocular circulation are concerned with retinal circulation. In the present study, we examined the ocular pulse curve after PRPC and determined pulsatile ocular blood flow (an indicator of choroidal circulation) and ocular perfusion pressure. PATIENTS AND METHOD: In 10 patients with diabetes mellitus (8 with type II and 2 with type I; mean age 64 yrs) and severe, hitherto untreated, bilateral proliferative diabetic retinopathy, an intensive unilateral PRPC with 1500 argon laser burns (spot size: 500 mu) was performed in 2 sessions (interval: 3 wks). Before and-in 3-wk intervals-up to 9 wks after onset of treatment, an ocular pulse curve was recorded using oculo-oscillo-dynamography, and the following variables were determined: ocular pulsation amplitude (OPA), pulsatile ocular blood flow (POBF), systolic ophthalmic artery pressure (SOAP), and systolic ocular perfusion pressure (SOPP). RESULTS: PRPC led to a reduction of OPA and POBF in relation to the untreated contralateral eyes. 3 wks after the 1st coagulation, the reduction averaged 20% (OPA) and 19.1% (POBF). The maximum reduction was found 9 wks after onset of treatment (6 wks after the 2nd coagulation) and amounted to 29.9% and 29.2%, respectively. The differences between photocoagulated and untreated eyes were highly significant on average (P < 0.01; ANOVA) as well as for the time course (P < 0.001). SOAP and SOPP were not changed significantly during PRPC. CONCLUSIONS: OPA and POBF are determined by the cardiac cycle-related intraocular volume changes depending predominantly on choroidal blood flow. Thus, the reduction of POBF after PRPC is indicative of a lowered pulsatile choroidal blood flow. The morphological substrate is probably the choriocapillaries closure after photocoagulation described in the literature.
Adolescent↗
Influence of physical exercise and nifedipine on ocular pulse amplitude.
BACKGROUND: Ocular pulse amplitude (OPA) was measured to investigate the influence of peripheral vasoconstriction and vasodilation on choroidal perfusion in healthy volunteers and to determine whether low OPA in low-tension glaucoma (LTG) patients is associated with a vasospastic reaction and its response to the calcium channel blocker nifedipine. METHODS: OPA was determined using the Langham ocular blood flow (OBF) system, applanation intraocular pressure (IOP), systemic blood pressure, and heart rate were measured, and ocular perfusion pressure was calculated before and after exercise and smoking in 12 otherwise nonsmoking, healthy volunteers and prior to and for 3 months after initiation of nifedipine therapy in 32 LTG patients with and without a vasospastic reaction as manifested by a nailfold capillary blood flow test. RESULTS: Exercise significantly (P < 0.05) increased heart rate, systolic blood pressure and ocular perfusion pressure, while it significantly (P < 0.05) reduced IOP and diastolic blood pressure. However, OPA was not significantly (P > 0.1) affected by changes in these parameters. Smoking significantly (P < 0.05) increased systolic and diastolic blood pressure, heart rate, and ocular perfusion pressure but did not significantly (P > 0.09) alter OPA. There were two distinct LTG subtypes, with and without a vasospastic reaction. Only those with a vasospastic reaction showed a significant (P < 0.001) increase in OPA after 3 months of nifedipine treatment, while all other parameters tested were not significantly altered. CONCLUSION: Despite affecting ocular and systemic perfusion parameters, exercise and smoking did not alter OPA, suggesting functional isolation, i.e. autoregulation of the choroidal and/or ophthalmic artery circulation in healthy volunteers. Low OPA in LTG was increased by nifedipine only in vasospastic LTG patients, suggesting different, vasotonus-related pathologies. Calcium channel blockers and other vasodilators may be useful in vasoreactive LTG patients with reduced OPA.
Adult↗
[Anti-inflammatory effects and aqueous humor concentration of various nonsteroidal anti-inflammatory drugs in extracapsular cataract surgery].
BACKGROUND: Within the spectrum of anti-inflammatory drugs, the preference of nonsteroidal anti-inflammatory drugs (NSAID) is definitely increasing. In the present study, we compared the anti-inflammatory effects and aqueous humour concentrations of 3 topical NSAID (indomethacin, diclofenac, and flurbiprofen) during extracapsular cataract surgery. PATIENTS AND METHODS: We examined 90 patients (52-89 yrs of age) without pre-existing deficiencies of the blood-aqueous barrier. In 60 of these patients (series 1), and examination using the laser flare-cell meter was performed prior to and following extracapsular cataract surgery with intraocular lens implantation. In 30 patients (series 2), aqueous humour was drawn intraoperatively, and the NSAID concentration was determined using high-pressure liquid chromatography (HPLC). Patients were randomly assigned to one of the following three treatment protocols with commercially available NSAID: protocol A: indomethacin 1% eyedrops (Chibro-Amuno -3); protocol B: diclofenac 0.1% eyedrops (Voltaren ophtha); protocol C: flurbiprofen 0.03% eyedrops (Ocuflur). 2 drops of either drug were administered as follows: day before surgery (4:00 p.m., late night), day of surgery (2, 1, and 1/2 hrs preop, end of operation, 4:00 p.m., late night), and days 1-3 postoperatively (5 times per day). RESULTS: Under indomethacin therapy (protocol A), the flare [in photon counts/ms] increased from a preoperative value of 8.0 +/- 2.8 (means +/- SE) to 20.1 +/- 2.2 on day 1 postoperatively, and decreased to 16.9 +/- 2.5 on day 3. Under diclofenac therapy (protocol 2), the flare averaged 25.8 +/- 3.8 and 16.9 +/- 2.8 on postoperative days 1 and 3, respectively. Under flurbiprofen therapy (protocol C), the flare amounted to 31.4 +/- 6.6 and 26.2 +/- 3.4 on days 1 and 3, respectively. On day 1 postoperatively, there was a significant difference (p < 0.01) between all three treatment protocols. Postoperative fibrin exsudation was observed in 1 of 20 indomethacin- and 1 of 20 flurbiprofen-treated patients (5%), and in 4 of 20 diclofenac-treated patients (20%). The highest individual aqueous humour concentration of indomethacin was 430 micrograms/1, the lowest 30. The concentrations of flurbiprofen lay between 42 and 31, those of diclofenac between 80 and 30 micrograms/1. All patients treated with indomethacin had detectable aqueous humour concentrations, whereas 3 flurbiprofen- and 7 diclofenac-treated patients had no HPLC-detectable concentrations (detection limit: 30 micrograms/1). CONCLUSIONS: After extracapsular cataract surgery, the anti-inflammatory potency of topical indomethacin 1% is superior to that of flurbiprofen 0.03% and diclofenac 0.1%, as demonstrated by the laser flare-cell meter. The rate of postoperative fibrin exsudation is lower under treatment with topical indomethacin or flurbiprofen compared to diclofenac. Using the commercially available substances (with different drug concentrations and vehicles), indomethacin exhibits a higher aqueous humour concentration than flurbiprofen, and diclofenac shows the lowest concentration.
Aged↗
[Effect of the vasodilator isosorbide dinitrate on ocular circulation].
BACKGROUND: Vasodilator drugs are increasingly being discussed as possible antiglaucomatous substances. Aim of the present study is to evaluate, from a hemodynamic point of view, the vasodilator drug isosorbide dinitrate (ISDN) regarding its suitability for glaucoma therapy. METHODS: 20 healthy subjects (mean age: 28 yrs) volunteered to participate in the study. In randomized order, each subject received one tablet containing 40 mg ISDN (sequels) or--in a second trial--one tablet placebo (+500 mg of the analgetic metamizol, respectively, for prophylaxis of nitrate headache). 1 h before as well as 1, 3, 5, and 7 hrs after medication, the following variables were determined using oculo-oscillo-dynamography: systolic ophthalmic artery pressure (SOAP), systolic ocular perfusion pressure (SOPP), ocular pulsation amplitude (OPA) and the product OPA x heart rate (HR). Intraocular pressure (IOP) as well as systolic and diastolic brachial artery pressures (SBAP, DBAP) were also measured. RESULTS: After administration of ISDN (+analgetic), the variables SBAP, SOAP and SOPP were significantly (p = 0.01) lowered compared to placebo (+analgetic), and also the IOP tended to be lower (p = 0.08). The maximum reduction was found 3-5 hrs after medication: SBAP 10.9 mm Hg (9%), SOAP 12.5 mm Hg (14%), SOPP 11.3 mm Hg (14.5%), and IOP 1.5 mm Hg (12%). The relation SOAP vs. SBAP was significantly (p = 0.0004) linear, the correlation coefficient amounted to 0.39. DBAP remained unchanged, HR was increased by 4-7 beats/min (p = 0.08). OPA and the product OPA x HR showed highly significant decreases by maximum values of 44% and 40%, respectively. CONCLUSION: ISDN (+analgetic) caused a reduction of SOAP and SOPP, which can be accounted for by the reduced systolic systemic blood pressure. In addition, there was a decrease of OPA and of the product OPA x HR (a measure of pulsatile ocular blood flow), which finding may be explained by a cardiac stroke volume reduction that is typical for nitrates. Due to these hemodynamic effects and due to the only weak IOP reduction, ISDN does not appear to be suitable for glaucoma therapy.
Adult↗
[Minimally inflammatory cataract surgery].
BACKGROUND: Cataract surgery leads to a more or less intensive postoperative inflammation due to breakdown of the blood-aqueous barrier. In a prospective, randomized and controlled clinical trial, we examined aqueous flare as well as intraocular pressure and visual acuity after a minimally invasive cataract surgical procedure under different anti-inflammatory treatment. PATIENTS AND METHOD: In 150 patients (39-88 years of age) without glaucoma or pre-existing deficiencies of the blood-aqueous barrier, phacoemulsification through a clear-corneal tunnel incision with implantation of a 5 mm PMMA posterior chamber intraocular lens was performed. Patients were randomly assigned to one of 5 treatment groups, each consisting of 30 patients: 1) preservative-free diclofenac 0.1% eyedrops (DICpf) pre- and postop.; 2) diclofenac 0.1% eyedrops with preservative (DICp) pre- and postop.; 3) DICpf only postop.; 4) DICpf pre- and postop. in combination with dexamethasone-21-dihydrogenphosphate 0.1% eyedrops (DEXA); 5) DEXA postoperatively. For prevention of postoperative intraocular pressure (IOP) elevation, carbachol 0.01% (for intraocular application) was injected into the anterior chamber intraoperatively, and dichlorphenamide (50 mg/d per os) was applied until day 1 postoperatively. - Aqueous flare (laser flare-cell meter FC-1000), IOP (Gold-mann applanation tonometer) and best-corrected visual acuity were determined on the day before surgery as well as 6 hrs (only flare and IOP), 1 day, 3 and 7 days postoperatively. RESULTS: Aqueous flare (photon counts/ms) in treatment group 1 increased from 10.8 +/- 1.7 (means +/- SE) preoperatively to only 14.7 +/- 3.1 in the afternoon of the day of surgery. Already on day 1 postoperatively, the flare decreased to 9.3 +/- 0.9, and remained relatively constant on days 3 and 7 after surgery. The flare in group 3 (DICpf only postop.) was significantly higher (p = 0.03; ANOVA) than in group 1. There were no other significant group differences concerning flare (group 1 vs. 3;1 vs. 4;4 vs. 5). -IOP (mm Hg) dropped from 16.3 +/- 0.2 preoperatively to 15.8 +/- 0.6 already 6 hrs postoperatively (group means). On days 1 and 3, the IOP continued to drop to 13.2 +/- 0.3 and 12.7 +/- 0.3, respectively. Not before day 7, the IOP tended to increase again (14.2 +/- 0.3). The IOP showed no significant group differences. - Visual acuity increased from 0.25 +/- 0.01 preoperatively to 0.73 +/- 0.02 already on day 1 postoperatively (group means). On days 3 and 7, the acuity amounted to 0.83 +/- 0.24 and 0.92 +/- 0.02, respectively. DISCUSSION: Under the conditions of the present study (with specific pharmacological therapy and patient selection), clear-corneal phacoemulsification leads to an extremely low and short-lasting intraocular inflammation, especially under pre- and postoperative treatment with preservative-free diclofenac eyedrops. Thus, the aim of minimally inflammatory cataract surgery (MICS) is realized. As secondary phenomenon, a postoperative IOP increase, often observed in the early postoperative period, is lacking, and the visual acuity rises very fast postoperatively.
Adult↗
[The anti-inflammatory effect of heparin-containing infusion solutions during phacoemulsification].
UNLABELLED: The use of heparin prevented postoperative intraocular fibrin-clot formation in the rabbit after vitrectomy and cyclocryotherapy. A low rate of postoperative intraocular inflammation was observed in our patients receiving phacoemulsification with heparin infusion solution (slit-lamp examination). To verify this effect a randomized, prospective study was performed using laser-flare cell photometry (LFCP) for measuring protein concentration in the anterior chamber. PATIENTS AND METHODS: Seventy-two patients (49-87 years of age) were randomly assigned to one of the following two surgical groups (temporal clear corneal tunnel incision with phacoemulsification): group A: foldable silicone IOL (Chiron C10), no stitch (3.5 mm incision); group B: PMMA-IOL (Pharmacia 809P) with one radial suture (5 mm incision). Fifty percent of the patients in each group received, in addition to the regular phaco infusion, 1 ml of heparin sodium (-H = without heparin; +H = with heparin). Aqueous flare was measured preoperatively as well as on days 1 and 3 following phaco + IOL with LFCP (Modell FC-1000; Kowa Company). RESULTS: In group A1 (-H) or B1 (-H) the mean flare values (in photon counts/ms) increased from a preoperative value of 7.0 +/- 1.7 (mean +/- SD) or 6.9 +/- 1.2 to 20.2 +/- 3.1 or 20.1 +/- 3.0 on the 1st postoperative day, whereas they decreased again to 13.8 +/- 2.9 or 14.8 +/- 3.1 on day 3 following surgery. In groups with heparin sodium A2(+H) and B2(+H) the flare values only increased from 7.2 +/- 1.3 or 7.1 +/- 1.3 to 12.9 +/- 4.0 or 13.8 +/- 3.8 on day 1, and decreased to 8.0 +/- 2.8 or 8.8 +/- 3.0 on the 3rd postoperative day. The mean postoperative flare values were significantly lower in the groups with additional heparin (p < 0.01). CONCLUSIONS: Heparin sodium in the infusion solution during small incision cataract surgery showed an antiinflammatory effect in the early postoperative period. There was no significant difference between the two IOL materials.
Aged↗
[Is subconjunctival steroid administration in addition to local therapy after cataract operations necessary? A laser tyndallometric study].
UNLABELLED: Subconjunctival steroids are often injected at the end of cataract surgery. In the present laser flare-cell meter study, we investigated whether this procedure improves the anti-inflammatory effect of steroid eye drops. PATIENTS AND METHODS: Thirty patients (69-81 years of age) without preexisting deficiencies of the blood-aqueous barrier were investigated preoperatively and after ECCE with PC-IOL implantation. The laser flare-cell meter (model FC 1000; Kowa Company) used for examination permits sensitive and exact determination of aqueous flare. The patients were randomly assigned to one of the following two treatment groups: group A: topical therapy with prednisolone 1% eye drops (Inflanefran forte) 5 times per day; group B: subconjunctival injection of 4 mg dexamethasone (Fortecortin) immediately at the end of surgery; topical therapy as in group A. In addition, all patients received antibiotic therapy using gentamicin eye drops. Oral steroids were not administered. RESULTS: Under topical therapy with prednisolone 1% (group A), the aqueous flare (in photon counts/millisecond) increased from a preoperative value of 10.2 +/- 2.5 (mean +/- SD) to 37.3 +/- 11.1 in the afternoon after surgery (8 h postoperatively) and decreased to 30.9 +/- 38.7 and 27.8 +/- 3.2 on days 1 and 3 after surgery. With additional steroid injection (group B), the flare accounted to 31.7 +/- 8.7 in the afternoon after surgery and to 31.3 +/- 5.9 and 27.1 +/- 4.7 on days 1 and 3 after surgery, respectively. There was no significant group difference (P > 0.3). CONCLUSIONS: After uncomplicated cataract surgery, subconjunctival steroid injection (4 mg dexamethasone) does not improve the effect of potent anti-inflammatory topical therapy (prednisolone 1% eye drops).
Aged↗
[Motor blockade by retrobulbar anesthesia. Phenomenology and mechanism of action].
UNLABELLED: The aim of this study was to analyze quantitatively the phenomenology and mechanisms of motor blockade induced by retrobulbar anesthesia (RETRO). PATIENTS AND METHODS: Prior to cataract surgery, 34 patients received RETRO using the intraconal technique of Atkinson. Four milliliters of mepivacaine 2% (Scandicain), prilocaine 2% (Xylonest) or lidocaine 2% (Xylocain) were injected in randomized order. Prior to injection, as well as 5, 30, 90, 120, 180, 300 and 420 min after injection, the following variables were determined: deviation of the eye from the primary position (Krimsky test), horizontal and vertical ocular motility (Kestenbaum limbustest), and rotatory ocular motility (presence of in- or excycloductions). RESULTS: The directions in which the eye deviated after RETRO were abduction and depression. The maximum deviations amounted to 7-8 degrees abduction and 3-4.5 degrees depression and were observed 30 min after injection. Horizontal and vertical ocular motility was nearly completely and symmetrically reduced 30 min after RETRO. There were no significant differences between the three local anesthetics used. DISCUSSION: The present findings may be interpreted as temporary palsy of N.III and N.VI during RETRO (symmetrical blockade of horizontal and vertical recti eye muscles) with unaffected function of N.IV and superior oblique muscle (maintained incycloduction ability; hypotropia and exotropia). An additional possible mechanism to account for the observed downward deviation is that the eye assumes its physiological divergent resting position during RETRO.
Adult↗
[Monotherapy vs combination therapy with topical prednisolone and indomethacin].
UNLABELLED: The anti-inflammatory effects of topical steroids and nonsteroidal anti-inflammatory drugs (NSAID) are claimed to be additive, according to fluorophotometric measurements. This finding was reevaluated using laser flare-cell photometry. PATIENTS AND METHODS: Thirty patients (61-79 years of age) without pre-existing deficiencies of the blood-aqueous barrier were investigated preoperatively as well as on day 1 and 3 after ECCE with IOL implantation. The laser flare-cell photometer (model FC-1000; Kowa Company) which was used for examination enables sensitive and exact in vivo determination of aqueous flare. The patients were randomly assigned to one of the following three treatment groups: group A, monotherapy with prednisolone 1% eyedrops (Inflanefran forte); group B, monotherapy with indomethacin 1% eyedrops (Chibro Amuno); group C, combination therapy with prednisolone 1% + indomethacin 1% eyedrops. One drop of either drug was administered five times per day to each patient, beginning immediately after completion of surgery. In addition, all patients received antibiotic therapy with gentamicin. Parabulbar or oral steroids were not administered. RESULTS: Under monotherapy with prednisolone, the flare (photon counts/ms) on days 1 and 3 postoperatively averaged 30.9 and 27.8, respectively. Under indomethacin monotherapy, the flare values were similar (no significant differences). Under combination therapy with prednisolone+indomethacin, however, the flare values were significantly lower both on day 1 (24.2) and on day 3 (20.6). CONCLUSIONS: Combination therapy with topical prednisolone+indomethacin thus seems superior to monotherapy with either of these agents. This confirms the previous fluorophotometric finding that the anti-inflammatory effects of topical steroids and NSAID are additive, a phenomenon attributable to different pharmacological sites of action.
Aged↗
[Peribulbar anesthesia versus retrobulbar anesthesia with facial nerve block. Techniques, local anesthetics and additives, akinesia and sensory block, complications].
BACKGROUND: Retrobulbar anesthesia (RETRO), combined with a facial block, is the most frequently employed method of anesthesia in cataract surgery. There is, however, an increasing tendency to use peribulbar anesthesia (PERI), which is claimed to provide the same degree of anesthesia and akinesia as RETRO while reducing many of the complications. OBJECTIVES OF THE STUDY: Survey of the principal techniques of RETRO, facial block and PERI as well as of the most important local anesthetics and additives; quantitative investigation of resulting akinesia and sensory blockade; comparison of systemic and local complications (literature review). TECHNIQUES OF LOCAL ANESTHESIA: A) RETRO: 1) Atkinson technique: injection within the orbital muscle cone, superonasal eye position during injection; 2) Unsöld technique: primary eye position during injection (advantage: lower risk of optic nerve lesion). - B) Facial block: 1) O'Brien technique: injection anterior to the tragus of the ear, just above the condyloid process of the mandible (disadvantage: frequently blockade of the upper portion only of the peripheral facial nerve); 2) Nadbath/Rehman technique (modified O'Brien block): injection just inferior to the earlobe (advantage: better orbicularis akinesia due to blockade of upper and lower portions of peripheral facial nerve); 3) van Lint technique: infiltration anesthesia at the temporal orbital margin, aiming at the short zygomatic branches of the facial nerve (disadvantage: bad orbicularis akinesia). - C) PERI: 1) Technique with two injections outside the muscle cone (inferotemporally and superonasally), just past the equator; 2) one-injection technique, mostly inferotemporally (disadvantage: worse akinesia). LOCAL ANESTHETICS: A) Short and weak action: lidocaine and prilocaine; advantages: good tissue penetration, low toxicity. - B) Intermediate duration and potency of action: mepivacaine; advantage: pronounced vasoconstrictor activity, alternative to adrenaline. - C) Long and strong action: 1) etidocaine; advantage: pronounced motor blockade, particularly suitable for facial block; 2) bupivacaine; advantage: pronounced sensory blockade, excellent postoperative analgesia; disadvantage: relatively toxic (cave: cardiac and respiratory arrest). - D) Mixtures of local anesthetics: mostly lidocaine-bupivacaine mixture; combines the advantages short-onset action (lidocaine) and long-duration action (bupivacaine). ADDITIVES TO LOCAL ANESTHETICS: Adrenaline: prolongs the action of local anesthetics with short and intermediate duration of action, reduces the incidence of hemorrhages and of intraoperative vitreous bulging. - Hyaluronidase: highly effective for prevention of vitreous bulging. AKINESIA AND SENSORY BLOCKADE: In randomized order, 160 cataract patients received PERI (technique with 2 injections) with 6, 8 or 10 ml of a bupivacaine-lidocaine-hyaluronidase mixture (without facial block) or RETRO (Unsöld technique) with 5 ml of the above mixture, combined with a Nadbath/Rehman facial nerve block (5 ml etidocaine-lidocaine mixture). Measured 20 min after injection (intervening period of oculopression), the smallest ocular motility (Kestenbaum limbus test) was left after RETRO. After administration of PERI - even with a volume of 10 ml - the range of residual ocular motility was always higher, i.e., there was a less reliable globe akinesia than after RETRO. The lid closure force (Straub technique) averaged zero after all methods of anesthesia; however, the smallest spread (highest reliability) was observed after PERI. Complete corneal anesthesia (Draeger esthesiometer) was found in nearly all cases, i.e., RETRO and PERI are comparably effective concerning sensory blockade...
Adult↗
[Systemic complications and side effects of retrobulbar anesthesia in risk patients].
BACKGROUND: Serious systemic complications with possibly lethal exit after retrobulbar anesthesia have been reported. The present study was performed to evaluate the incidence of complications after anesthesia in risk patients with pre-existing diseases. 2.8% of 3000 cataract operations in our department during October 1991 to April 1993 were performed under general anesthesia, 97.2% under local anesthesia. PATIENTS AND METHODS: 1000 anesthesia protocols of these cataract operations under retrobulbar anesthesia and facial block with anesthesia stand-by were analyzed retrospectively. After retrobulbar injection in Atkinson technique we performed a modified O'Brien facial block. The patients were assigned to five different risk groups on the basis of a special point system. RESULTS: The mean age of the patients increased with the risk group from 60.4 years in group 1 to 77.1 years in group 5. Cardiovascular, pulmonary and general risk factors appeared more frequently in the groups of higher risk. The frequency of cardiovascular complications was dependent on affiliation to risk group. The percentual frequency of cardiovascular complications increased from 1.7% in risk group 1 to 7.7% in risk group 5. Decrease of heart rate or blood pressure of more than 30%, or in combination, with the necessity of medical treatment occurred absolutely and relatively most frequently. The frequency of cardiovascular complications amounted 2.2% in the mean. Life-threatening complications with the need of endotracheal intubation or other occurred in 0.1%. CONCLUSION: The relatively high total frequency of systemic complications of 2.4% is related with age and preexisting diseases. The results underline the necessity of anesthesia stand-by in risk patients with the essential requirements for treatment of typical complications.
Aged↗