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One of the most common problems following otoplasty is that the bandage applied at the time of surgery slips prematurely, falling over the patient's eyes and thereby requiring replacement. We present a simple technique which prevents this from occurring.
A new flexible support for ophthalmic drapes with the possibility of continuous oxygen supplementation was designed for use in patients undergoing eye surgery under local anesthesia. This new equipment is easy to handle and prevents contact between the patient's face and the ophthalmic drape. To prevent hypoxia of spontaneously breathing patients, the ambient air under the drapes can be supplemented with oxygen using this new equipment and no other devices. The equipment described here is advantageous for practical use in patients undergoing eye surgery under retrobulbar anesthesia.
CONTEXT: Aphakic glaucoma is a serious, sight-threatening complication in children who remain aphakic following congenital cataract surgery. The reported incidence varies from 15% to 45% and it has a higher incidence in small eyes and in babies who undergo surgery before 4 weeks of age. Most cases take the form of open-angle glaucoma. Despite careful monitoring, diagnostic difficulties in children may lead to delayed treatment. Aphakic children require ongoing monitoring, including examinations carried out under general anaesthesia. MANAGEMENT: Contrary to earlier optimism, it is unlikely, according to current clinical information, that intraocular lenses provide protection against the development of glaucoma. It is likely that the lower incidence of glaucoma in pseudophakic eyes results from selection bias for lens insertion. Both medical and surgical treatments have a role in glaucoma management. Trabeculectomy with mitomycin C or Seton implantation (glaucoma drainage device) form the mainstay of surgical treatment. The success rate with Seton implants is better in the short term and more promising in the longer term than that of trabeculectomy. Cyclodestructive procedures play a role in refractory glaucoma. Success rates for surgery range from 14% to 44% and many children require additional medical treatment. Children with aphakic glaucoma need lifelong care. Despite our best efforts, many have poor vision, poor glaucoma control and ultimately become blind.
Since cardiac interventional procedures deliver high doses of radiation to the physician, radiation protection for the physician in cardiac catheterization laboratories is very important. One of the most important means of protecting the physician from scatter radiation is to use additional lead shielding devices, such as tableside lead drapes and ceiling-mounted lead acrylic protection. During cardiac interventional procedures (cardiac IVR), however, it is not clear how much lead shielding reduces the physician dose. This study compared the physician dose [effective dose equivalent (EDE) and dose equivalent (DE)] with and without additional shielding during cardiac IVR. Fluoroscopy scatter radiation was measured using a human phantom, with an ionization chamber survey meter, with and without additional shielding. With the additional shielding, fluoroscopy scatter radiation measured with the human phantom was reduced by up to 98%, as compared with that without. The mean EDE (whole body, mean+/-SD) dose to the operator, determined using a Luxel badge, was 2.55+/-1.65 and 4.65+/-1.21 mSv/year with and without the additional shielding, respectively (p=0.086). Similarly, the mean DE (lens of the eye) to the operator was 15.0+/-9.3 and 25.73+/-5.28 mSv/year, respectively (p=0.092). In conclusion, although tableside drapes and lead acrylic shields suspended from the ceiling provided extra protection to the physician during cardiac IVR, the reduction in the estimated physician dose (EDE and DE) during cardiac catheterization with additional shielding was lower than we expected. Therefore, there is a need to develop more ergonomically useful protection devices for cardiac IVR.
Research is pointing the way to new therapies for the eye diseases of aging. A gene that appears related to glaucoma has been identified, and a safe and effective inhibitor for aldose reductase is being sought for patients with diabetic retinopathy. Refinements in cataract surgery continue to improve the high success rate of this procedure. Physicians can educate their patients to participate in vision protection, through control of blood sugars, compliance with glaucoma medications, and the use of the Amsler grid by those at risk for macular degeneration. When vision cannot be corrected to the normal range, low vision rehabilitation offers magnification and new high-tech devices for optimizing independent patient function.
Details of injuries and exposures to body fluids while handling tissue that were sustained by 36 pathologists (nine residents and 27 staff pathologists) were ascertained by retrospective questionnaire. In the preceding year 56% (20/36) had sustained a cut or needlestick injury. A total of 72 individual injuries occurred and corresponded to one injury for every 2629 surgical specimens handled and for every 37 autopsies performed. Residents reported a five-fold excess in injuries compared with staff pathologists. The lesions described predominantly (67%) involved the oppositional area consisting of the distal thumb, index, and middle fingers of the nondominant hand; during dissection, when opposed to hold or retract tissue, these digits form a surface that is directly exposed to the cutting edge, and injury to this area may be termed dissector's digital injury. Injuries to other areas of the nondominant hand were much less numerous and the dominant hand was rarely injured. Splashes to the face and eyes and glove punctures were frequent. These injury and exposure rates are probably broadly representative of practice in areas of low acquired immunodeficiency syndrome prevalence and may be improved on with increasing concern about human immunodeficiency virus infection. It is likely, however, that development of comfortable protective devices, based on knowledge of the pattern and circumstances of injury, will be necessary to eliminate these occupational hazards.
We describe a surgical complication with the Alcon silicone irrigation/aspiration (I/A) tip. In 2 consecutive cases, the posterior capsule was torn because of a misalignment between the inner metallic shaft and the hole in the silicone I/A tip. To achieve the protective benefits of this device, the surgeon must visually confirm proper alignment of the outer silicone and inner metallic portion of the tip.
An analysis was made of all the cases of eye disease in welders caused by infrared radiation which have been recognized as occupational disease Bk 52 in the GDR by now. A comparative study was conducted and proposals for the definition of criteria for recognition as occupational disease were derived. The determination of exposure by means of suitable radiation measurement devices is described. Both the problems of measurement value acquisition and the evaluation of radiation loads are dealt with. The infrared radiation load of the eyes is quantified for several frequently used welding techniques. Various measuring values obtained in other industries and in the transport sector are given for comparison. Protective measures and the use of suitable face protections are discussed. Conclusions are drawn with regard to the health protection of welders against infrared radiation exposure.
In the early years of diagnostic cardiac catheterization, strict sterile precautions were required for cutdown procedures. Thirteen years ago, when the original guidelines were written, the brachial arteriotomy was still frequently utilized, femoral closure devices were uncommon, "implantables," such as intracoronary stents and PFO/ASD closure devices, were in their infancy, and percutaneous valve replacement was not a consideration. In 2005, the cardiac catheterization laboratory is a complex interventional suite with percutaneous access routine and device implantation standard. Despite frequent device implantation, strict sterile precautions are often not observed. Reasons for this include a decline in brachial artery cutdown, limited postprocedure follow-up with few reported infections, limited use of hats and masks in televised cases, and lack of current guidelines. Proper sterile technique has the potential to decrease the patient infection rate. Hand washing remains the most important procedure for preventing infections. Caps, masks, gowns, and gloves help to protect the patient by maintaining a sterile field. Protection of personnel may be accomplished by proper gowning, gloving, and eye wear, disposal of contaminated equipment, and prevention and care of puncture wounds and lacerations. With the potential for acquired disease from blood-borne pathogens, the need for protective measures is as essential in the cardiac catheterization laboratory as is the standard Universal Precautions, which are applied throughout the hospital. All personnel should strongly consider vaccination for hepatitis B. Maintenance of the cardiac catheterization laboratory environment includes appropriate cleaning, limitation of traffic, and adequate ventilation. In an SCAI survey, members recommended an update on guidelines for infection control in the cardiac catheterization laboratory. The following revision of the original 1992 guidelines is written specifically to address the increased utilization of the catheterization laboratory as an interventional suite with device implantation. In this update, infection protection is divided into sections on the patient, the laboratory personnel, and the laboratory environment. Additionally, specific CDC recommendation sections highlight recommendations from other published guidelines.
PURPOSE: To investigate the effect of sodium hyaluronate molecular weight on corneal endothelial cells and intraocular pressure after penetrating keratoplasty in rabbits. MATERIAL AND METHOD: Rotating autokeratoplasty was carried out on rabbits using six groups of sodium hyaluronate in which the molecular weight differed. Then the endothelial cell density, hexagonal cell rate, corneal thickness, and intraocular pressure were measured. The intraocular pressure in the rabbit eyes after aqueous exchange with six groups of sodium hyaluronate was also measured. RESULTS: The endothelial cell density and hexagonal cell rate in the hyaluronate group of molecular weight 1.53-2.13 million and 1.9-3.9 million were the same as in the eye groups receiving no manipulation. As for the intraocular pressure after aqueous exchange, the highest intraocular pressure was more than 40 mmHg in the group treated with hyaluronate over 1.9 million and the group treated with hyaluronate and chondroitin sulfate compounding agent. CONCLUSION: Endothelial protection was considered to be superior when hyaluronate with a molecular weight of 1.5-3.9 million was used in rabbits. However, it is grossible that leaving a large amount of hyaluronate with a molecular weight over 1.9 million in the eye may lead to a remarkable increase in the early postoperative intraocular pressure.
A clear plastic, full-face visor is described which gives face, eye and neck protection during surgery. It has proved comfortable and light to wear, providing excellent, unobstructed vision and, unlike protective goggles and spectacles, it is not prone to condensation.
BACKGROUND: Although the automobile air bag is a safety device used to protect drivers from death and moderate-to-severe injury, recently it also has been reported to be associated with some ophthalmic injuries. The authors have encountered a case in which a normal air bag may have caused a driver's corneal endothelial cell loss. In this study, the authors evaluate corneal endothelial cell loss caused by several types of air bags in the hope that air bag technology may be improved. METHODS: The authors performed impact tests with whole pig eyes fixed in a crash test dummy, using five different types of air bags. The area of damaged corneal endothelial cell was analyzed quantitatively. RESULTS: The authors found that corneal endothelial cell loss was correlated with the inflator power of the air bag but not with its weight. CONCLUSION: Although greater inflator power is needed for rapid air bag expansion, the effect on the eye should be considered in further refining this device. There may be greater latitude in the selection of air bag material. The authors believe their technique is applicable to the assessment of many air bag or passenger variables.
Improvised explosive devices and mines pose a formidable threat to military convoys traveling in Iraq. This study evaluated battle injuries sustained by a mechanized battalion operating against this threat. The objective was to gain insight into injury profiles and prevention. In the period examined, 32 attacks injured 120 Marines, causing 188 injuries. Upper extremity and head injuries (70%) were common, whereas lower extremity injuries (11%) were rare (as expected, given the threat and the body areas exposed). Shoulder and axilla protectors may be beneficial, but lower arm and hand injuries remain difficult to combat. Ear injury was the most common single injury type (23%). Combat earplugs may reduce ear blast injuries. Eye injuries were uncommon (0.5%), likely because of ballistic eye protection. Injury to the torso (11%) was generally mild, because of body armor vests. The majority of wounds were minor, allowing > 80% of the injured Marines to return to duty.
Animal methodology for investigating photosensitization is of interest because of the potential of some photodynamic chemicals to produce adverse skin reactions. A system has been developed that provides procedural flexibility and the ability to standardize individual guinea-pig exposures to ultraviolet light (UVA and UVB). It consists of a non-stressful restraining method that also protects the animals' eyes from the harmful effects of UV light while allowing reproducible exposure of the backs of the guinea-pigs. The procedure is described in detail and the qualitative and quantitative aspects of the system are presented. In addition, some quantitative aspects of the phototoxic variation in response to 8-methoxypsoralen are investigated.
Patients with ocular melanoma have been treated since June 1991 at the medical cyclotron of the Centre Antoine Lacassagne (CAL). Positions and sizes of the ocular nozzle elements were initially defined based on experimental work, taking as a pattern functional existing facilities. Nowadays Monte Carlo (MC) calculation offers a tool to refine this geometry by adjusting size and place of beam modeling devices. Moreover, the MC tool is a useful way to calculate the dose and to evaluate the impact of secondary particles in the field of radiotherapy or radiation protection. Both LINAC and cyclotron producing x rays, electrons, protons, and neutrons are available in CAL, which suggests choosing MCNPX for its particle versatility. As a first step, the existing installation was input in MCNPX to check its aptitude to reproduce experimentally measured depth-dose profile, lateral profile, output-factor (OF), and absolute dose. The geometry was defined precisely and described from the last achromatic bending magnet of our proton beam line to the position of treated eyes. Relative comparisons of percentage depth-dose and lateral profiles, performed between measured data and simulations, show an agreement of the order of 2% in dose and 0.1 mm in range accuracy. These comparisons, carried out with and without beam-modifying device, yield results compatible to the required precision in ocular melanoma treatments, as long as adequate choices are made on MCNPX input decks for physics card. Absolute dose and OF issued from calculations and measurements were also compared. Results obtained for these two kinds of data, carried out in the simplified situation of an unmodulated beam, indicate that MC calculation could effectively complement measurements. These encouraging results are a large source of motivation to promote further studies, first in a new design of the ocular nozzle, and second in the analysis of the influence of beam-modifying devices attached to the final patient collimator, such as wedge or compensators, on dose values.
Restoration of the ability to blink and protect the eye in the patient with facial paralysis remains a challenge. Although many treatments exist, no one approach corrects all the deficits associated with the loss of orbicularis oculi function. In this study, the author investigated the feasibility of restoring function by direct electrical stimulation of the paralyzed orbicularis oculi muscle in the rabbit model. Using a pacing device developed by the author, functional restoration of a normal-appearing blink was produced throughout 30 days of continuous pacing in six rabbits with transected facial nerves. Histologic evaluations of the paced tissues demonstrated no evidence of detrimental effects attributable to the electrical stimulation. The findings of this study support the feasibility of employing direct electrical stimulation to restore the function of paralyzed orbicularis oculi muscles. Potential applications may also exist in other areas in which peripheral denervation creates functional impairment.
Machine vision is an important component of medical systems engineering. Inexpensive miniature solid state cameras are now available. This paper describes how these devices can be used as artificial retinas, to take snapshots and moving pictures in monochrome or color. Used in pairs, they produce a stereoscopic field of vision and enable depth perception. Macular and peripheral vision can be simulated electronically. This paper also presents the author's design of an artificial orbit for this synthetic eye. The orbit supports the eye, protects it, and provides attachment points for the ocular motion control system. Convergence and image fusion can be produced, and saccades simulated, along with the other ocular motions. The use of lenses, filters, irises and focusing mechanisms are also discussed. Typical camera-computer interfaces are described, including the use of "frame grabbers" and analog-to-digital image conversion. Software programs for eye positioning, image manipulation, feature extraction and object recognition are discussed, including the application of artificial neural networks.
(1) Infections following invasive endoscopy are rare and are usually of endogenous origin. Nevertheless, infections do occur due to inadequate cleaning and disinfection and the use of contaminated rinse water and processing equipment. (2) Rigid and flexible operative endoscopes and accessories should be thoroughly cleaned and preferably sterilized using properly validated processes. (3) Heat tolerant operative endoscopes and accessories should be sterilized using a vacuum assisted steam sterilizer. Use autoclavable instrument trays or containers to protect equipment during transit and processing. Small bench top sterilizers without vacuum assisted air removal are unsuitable for packaged and lumened devices. (4) Heat sensitive rigid and flexible endoscopes and accessories should preferably be sterilized using ethylene oxide, low temperature steam and formaldehyde (rigid only) or gas plasma (if appropriate). (5) If there are insufficient instruments or time to sterilize invasive endoscopes, or if no suitable method is available locally, they may be disinfected by immersion in 2% glutaraldehyde or a suitable alternative. An immersion time of at least 10 min should be adopted for glutaraldehyde. This is sufficient to inactivate most vegetative bacteria and viruses including HIV and hepatitis B virus (HBV). Longer contact times of 20 min or more may be necessary if a mycobacterial infection is known or suspected. At least 3 h immersion in glutaraldehyde is required to kill spores. (6) Glutaraldehyde is irritant and sensitizing to the skin, eyes and respiratory tract. Measures must be taken to ensure glutaraldehyde is used in a safe manner, i.e., total containment and/or extraction of harmful vapour and the provision of suitable personal protective equipment, i.e., gloves, apron and eye protection if splashing could occur. Health surveillance of staff is recommended and should include a pre-employment enquiry regarding asthma, skin and mucosal sensitivity problems and lung function testing by spirometry. (7) Possible alternative disinfectants to glutaraldehyde include peracetic acid (0.2-0.35%), chlorine dioxide (700-1100 ppm) and superoxidized water. These are very effective, killing vegetative bacteria, including mycobacteria, and viruses in 5 min and bacterial spores in 10 min. An endorsement of compatibility with endoscopes, accessories and processing equipment is required from both the solution/device manufacturer and the endoscope manufacturer. Other important considerations are stability, cost and safety from the user and environmental standpoints. (8) Cleaning and disinfection or sterilization should be undertaken by trained staff in a dedicated area, e.g., SSD or TSSU. A suitable training programme is described. (9) If endoscopes are processed by immersion in disinfectants, harmful residues must be removed by thorough rinsing. Sterile or bacteria free water is essential for rinsing all invasive endoscopes and accessories to prevent recontamination. (10) If an automated washer disinfector is used it must be effective, non-damaging, reliable, easy to use and its performance regularly monitored. (11) If used, washer disinfectors and other processing equipment should be disinfected on a regular basis, i.e., between patients or at the start of each session. This will prevent biofilm formation and recontamination of instruments during rinsing. Disinfection should include the water treatment system, if present. (12) To comply with the Medical Devices Directive, manufacturers are obliged to provide full details on how to decontaminate the reusable devices they supply. This should include details of compatibility with heat, pressure, moisture, processing chemicals and ultrasonics. (13) The Infection Control Team should always be involved in the formulation and implementation of decontamination policies. Wherever possible, the national good practice guidelines produced by the Medical Devices Agency and/or professional societies shoul