Biomedical subjects

W J Rand

Publications and source records attributed to W J Rand.

5 recordsLinked to original sources

PubMed2000

Rand-Stein analgesia protocol for cataract surgery.

OBJECTIVE: To describe the safety and efficacy of an analgesia protocol that enables the surgeon to maintain control over an alert patient experiencing seemingly painless ambulatory cataract surgery, while eliminating the risks and side effects associated with general, local, topical, and intracameral anesthesia. DESIGN: Noncomparative, interventional case series. PARTICIPANTS: Five thousand one hundred sixty-eight consecutive cataract surgery cases operated on by the same surgeon from April 1, 1993 through June 1, 1998. METHODS: This technique produces profound ocular analgesia, avoiding any undesired sedative effects, using very low-dose, titrated, intravenous alfentanil. Complete control of the uncooperative patient, including lid squeezing and ocular and general body movements, is obtainable whenever necessary using very low-dose, titrated, intravenous methohexital. MAIN OUTCOME MEASURES: Success was defined as surgery completed in a controlled manner without the need to convert to general, local, topical, or intracameral anesthesia and the patient's experience being perceived as pain free. RESULTS: One hundred percent of the cases were successful without ever deviating from the protocol. CONCLUSIONS: This analgesia protocol offers advantages for cataract surgery. It virtually eliminates the morbidity of cataract surgery associated with other anesthesia techniques while providing excellent and reliable control. It allows for an immediate postoperative recovery with instantaneous vision restoration. These patients are generally awake, alert, and retain their protective reflexes.

Adolescent↗

PubMed1992

Use of grafts smaller than the opening for keratoconic myopia and astigmatism. A prospective study.

A prospective study was conducted on 15 consecutive keratoconic eyes to evaluate the use of grafts smaller than the opening in keratoconic myopia and astigmatism. All surgeries were performed by the senior author. Average age of the patients was 41.1 years. Average follow-up was 1.6 years. After all sutures were removed, results showed an average decrease in myopia of 13.24 diopters (D) (range 1.75 to 23.25) principally from corneal flattening and a small reduction in axial length. Average postoperative spherical equivalent was -2.17 D (range +1.50 to -7.25). The average postoperative astigmatism was 3.78 D (range 1.75 to 6.00). This study and a previous retrospective study suggest that the use of grafts 0.25 mm smaller than the opening, i.e., 7.50/7.75 mm, for penetrating keratoplasty in keratoconus is justified.

Adult↗

PubMed1990

Subluxated (ectopic) lenses in adults. Long-term results of pars plana lensectomy-vitrectomy by ultrasonic fragmentation with and without a phacoprosthesis.

The long-term results of pars plana lensectomy-vitrectomy by ultrasonic fragmentation for 18 consecutive subluxated (ectopic) lenses were retrospectively reviewed. There were no serious operative or postoperative complications at the 16-year follow-up. Visual acuity of 20/15 to 20/50 was obtained in 16 (89%) of 18 eyes. Lensectomy-vitrectomy for subluxated lenses appears to be a relatively safe and effective procedure. The technique can be combined with a phacoprosthesis (intraocular lens implant) in adults.

Adult↗

PubMed1990

Immediate contralateral amaurosis after retrobulbar anesthesia.

Many potential complications associated with retrobulbar anesthesia have been reported. Of these, sudden loss of vision in the contralateral eye is the least expected. We report a case of immediate loss of vision in the fellow eye after retrobulbar anesthesia for cataract extraction. Possible etiology such as emboli thrown during ventricular fibrillation, direct optic nerve anesthetic injection with reflux to the chiasm, cortical stroke, amaurosis fugax, arterial injection of anesthetic material, and hysteric reaction are discussed.

Aged↗

PubMed1988

Cataract and ocular parameters: sexual comparison.

A retrospective study of 330 cataract surgery patients was undertaken to verify some of the differences between men and women. Six parameters were analyzed: the age of the patient at the time of surgery, the axial length, the lens implant power selected for emmetropia, the keratometry readings, and the corneal astigmatism. We found only one significant difference between the male and female groups. More women required cataract surgery than men by a 2:1 ratio. There were no significant differences in the other parameters. We conclude that these parameters need not be considered in the decision-making process regarding cataract and intraocular lens implant patients.

Age Factors↗