scholarly journals Globe Perforation During Peribulbar Anesthesia: Experience of Half a Million Consecutive Injections

2021 ◽  
Author(s):  
Naresh Babu ◽  
Jayant Kumar ◽  
Piyush Kohli ◽  
Ashish Ahuja ◽  
Prerna Shah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retinal Detachment ◽  
Vascular Complications ◽  
Vitreous Hemorrhage ◽  
Ocular Surgery ◽  
Retinal Breaks ◽  
Peribulbar Block ◽  
The Mean ◽  
Group 2 ◽  
Vascular Occlusions

Abstract Aim: To evaluate the risk factors, clinical presentation, management and outcome of inadvertent globe perforation during peribulbar anaesthesia.Methods: This retrospective study evaluated the medical records of all the patients treated for globe perforation secondary to peribulbar block preceding ocular surgery from 2012 to 2020. The patients were divided into three groups; Group 1 - clear media with no retinal detachment (RD); group 2 - vitreous hemorrhage (VH) without RD; and group 3 - RD with/without VH.Results: Twenty-five patients (25 eyes) were identified. The incidence of globe perforation was 0.002 %. The mean axial length (AL) was 24.7±2.7mm (Range, 20.9-31.2mm). Eleven eyes (45.8%) had AL≥24mm. The most common presenting features were VH (n=14), ocular hypotony (n=7) and RD (n=7). The treatment included laser photocoagulation for the retinal break(s) (n=7) and vitrectomy (n=17). Retinal breaks were identified in all the patients (total breaks, 37). Other complications included full-thickness macular hole (n=5), subretinal haemorrhage (n=4) and retinal vascular occlusions (n=4). Mean presenting best-corrected visual acuity (BCVA) in group 1,2 and 3 were logMAR 0.79±0.73, 1.82±0.78 and 2.13±0.59 respectively. All the patients, except one who did not undergo surgery due to advanced proliferative vitreoretinopathy, had an attached retina at the time of last follow-up. The mean final BCVA was logMAR 0.59±0.79, 0.48±0.26 and 1.25±0.64 respectively. Conclusion: Early intervention can help manage the eyes with inadvertent perforation successfully. The presence of retinal detachment, as well as macular and vascular complications are risk factors for poor prognosis.

scholarly journals Effect of Varying Duration of Ocular Compression on Raised Intraocular Pressure following Fractionated Peribulbar Anaesthesia for Cataract Surgery

1970 ◽  
Vol 12 (4) ◽  
pp. 197-200
Author(s):  
Jaichandran Venkatakrishnan ◽  
Lingam Vijaya ◽  
Ronnie J. George ◽  
Thennarasu Maruthamuthu
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Local Anaesthetic ◽  
Ocular Surgery ◽  
Peribulbar Anaesthesia ◽  
Peribulbar Block ◽  
Digital Compression ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Aim: To evaluate the effect of fractionated peribulbar anaesthesia and varying digital ocular compression time on intraocular pressure.Methods: Forty non-glaucomatous patients aged 40 years and older planned for cataract surgery were randomly divided into 2 groups based on the duration for which the globe was compressed digitally following each injection. Patients with a history of glaucoma or those who had had previous ocular surgery were excluded. Group 1 underwent 1 minute of compression and group 2 underwent 2 minutes of compression. Local anaesthetic (2% lidocaine 5 mL, 0.5% bupivacaine 5 mL, and hyaluronidase 25 IU/mL) was injected into the inferotemporal and superomedial quadrants. Intraocular pressure was measured (3 readings with <5% SD) before peribulbar block, after inferotemporal injection, following digital compression, after superomedial injection, following digital compression again, and at 1-minute intervals without compression until the globe attained normotension.Results: The mean (SD) intraocular pressure in group 1 was significantly elevated compared with the baseline mean intraocular pressure of 19.21 mm Hg (SD, 2.82 mm Hg) throughout the procedure (p < 0.0001). In group 2, the mean intraocular pressure was not significantly elevated from the baseline mean intraocular pressure of 19.13 mm Hg (SD, 3.27 mm Hg) following compression after each injection.Conclusions: Intraocular pressure rises significantly following each 5 mL of local anaesthetic injected into the peribulbar space at both the inferotemporal and superomedial sites. Digital ocular compression given for 2 minutes after each injection makes the globe normotensive.

scholarly journals Drain fluid cryo-explant technique for treatment of superior bullous rhegmatogenous retinal detachment in young adults

2021 ◽  
Vol 13 ◽  
pp. 251584142098821
Author(s):  
Kamal A.M. Solaiman ◽  
Ashraf Mahrous ◽  
Hesham A. Enany ◽  
Ashraf Bor’i
Keyword(s):  
Young Adults ◽  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Subretinal Fluid ◽  
Secondary Outcome ◽  
Eligibility Criteria ◽  
Retinal Breaks ◽  
Complicated Cataract ◽  
Drain Fluid ◽  
The Mean

Purpose: To evaluate the efficacy of the drain fluid cryo-explant (DFCE) technique for the management of uncomplicated superior bullous rhegmatogenous retinal detachment (RRD) in young adults. Patients and methods: A retrospective study that included eyes with uncomplicated superior bullous RRD in patients ⩽40 years old. DFCE technique consists of sequential drainage of subretinal fluid, intravitreal fluid injection, cryotherapy, and placement of a scleral explant(s). The primary outcome measure was anatomical reposition of the retina after a single surgery. Secondary outcome measures included improvement in best corrected visual acuity (BCVA) and any reported complication related to the procedure. Results: The study included 51 eyes which met the study eligibility criteria. The mean duration of detachment was 19.7 ± 6.4 days. A single retinal break was found in 31 eyes (60.8%), and more than one break were found in 20 eyes (39.2%). The mean number of breaks per eye was 1.72 ± 1.04. The mean detached area per eye was 7.21 ± 3.19 clock hours, and the macula was detached in 22 eyes (43.1%). Flattening of the retina and closure of all retinal breaks was achieved in all eyes after a single surgery. Late recurrence of retinal detachment occurred in two eyes (3.9%) due to proliferative vitreoretinopathy (PVR). No complicated cataract or iatrogenic retinal breaks were detected in all eyes. Conclusion: DFCE technique could be effectively used for treatment of uncomplicated superior bullous RRD in adults ⩽40 years. It is safe and provides good visualization during surgery with no iatrogenic retinal breaks or complicated cataract.

Risk Factors For Recurrent Myopic Macular Hole Retinal Detachment After Silicone Oil Removal In Patients With Open Flat Macular Hole

2021 ◽  
Author(s):  
Hamouda Hamdy Ghoraba ◽  
Hosam Othman Mansour ◽  
Mohamed Ahmed Abdelhafez Elsayed ◽  
Adel Galal Zaky ◽  
Mohamed Amin Heikal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retinal Detachment ◽  
Macular Hole ◽  
Silicone Oil ◽  
Significant Risk ◽  
Minimum Diameter ◽  
Univariate Logistic Regression Analysis ◽  
Macular Hole Retinal Detachment ◽  
Myopic Macular Hole ◽  
Group 2

Purpose: To evaluate the risks that might be associated with recurrent macular hole retinal detachment (Re MHRD) after silicone oil (S.O) removal in myopic patients with open flat macular hole (MH). Methods: In this retrospective series, we assessed the different factors that might be associated with recurrent MHRD after S.O removal in 48 eyes with open flat MH that underwent S.O removal after successful MHRD repair by dividing the enrolled eyes into 2 groups: group 1 included 38 eyes with flat open MH and flat retina after S.O removal and group 2 included 10 eyes with flat open MH and recurrent MHRD after S.O removal. Results: Ten of 48 eyes (20.8%) with open flat MH developed recurrent MHRD after S.O removal. Univariate logistic regression analysis revealed that MH at the apex of PS, MH minimum diameter, hole form factor (HFF) and MH index (MHI) were significant risk factors for recurrent MHRD after S.O removal in myopic patients with open flat MH. Conclusions: If there is a "flat open" MH that is large, located at the apex of PS or with HHF or MHI of less than 0.9-0.5, it has a high chance of recurrent MHRD after S.O removal.

scholarly journals Risk factors for macular pucker after rhegmatogenous retinal detachment surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Toshiaki Hirakata ◽  
Yoshimune Hiratsuka ◽  
Shutaro Yamamoto ◽  
Koki Kanbayashi ◽  
Hiroaki Kobayashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retinal Detachment ◽  
Surgical Technique ◽  
Regression Models ◽  
Rhegmatogenous Retinal Detachment ◽  
Surgical Repair ◽  
Macular Pucker ◽  
Logistic Regression Models ◽  
Retinal Breaks ◽  
Increased Risk

AbstractMacular pucker, also known as an epiretinal membrane, sometimes forms after surgical repair of a rhegmatogenous retinal detachment (RRD) and can decrease visual acuity and cause aniseikonia. However, few reports are evaluating the risk factors of macular pucker using multivariate analysis. To evaluate the risk factors for macular pucker after RRD surgery, 226 patients who underwent RRD surgery and were monitored for greater than 12 months (23.2 ± 6.4 months) after surgery were analyzed retrospectively. Of these cases, macular pucker developed in 26 cases. Multiple logistic regression models of 22 clinical characteristics were performed. An increased risk of macular pucker after RRD surgery was significantly associated with preoperative vitreous haemorrhage (Odds ratio (OR), 4.71; 95% CI 1.19–18.62), multiple retinal breaks (OR, 8.07; 95% CI 2.35–27.71), re-detachment (OR, 19.66; 95% CI 4.87–79.38), and retinal detachment area (OR, 12.91; 95% CI 2.34–71.19). Macular pucker was not associated with the surgical technique. Regardless of the surgical technique used, careful observation for postoperative macular pucker is needed after RRD surgery in high-risk cases. These findings can be used to improve the surgical management of patients with RRD. (183 words).

scholarly journals Vascular Occlusions following Ocular Surgical Procedures: A Clinical Observation of Vascular Complications after Ocular Surgery

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Charlotte Fischer ◽  
Anne Bruggemann ◽  
Annette Hager ◽  
Josep Callizo Planas ◽  
Johann Roider ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retinal Vein Occlusion ◽  
Optic Neuropathy ◽  
Central Retinal Artery Occlusion ◽  
Case Series ◽  
Vascular Complications ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Vein Occlusion ◽  
Vascular Occlusions

Background. Ocular vascular occlusions following intraocular procedures are a rare complication. We report a case series of patients with retinal vascular occlusions or anterior ischemic optic neuropathy (AION) after anterior and posterior segment surgery and demonstrate possible risk factors. Methods. Observational case series. Results. In ten patients, vascular occlusions were observed within ten weeks after intraocular surgery: branch retinal arterial occlusion (BRAO) (n=2), central retinal artery occlusion (CRAO) (n=2), central retinal vein occlusion (CRVO) (n=1), branch retinal vein occlusion (BRVO) (n=1), anterior ischemic optic neuropathy (AION) (n=3), and combined central artery and vein occlusion (n=1). AION occurred later (27–69 d) than arterial occlusions (14–60 d) or venous occlusions (1-2 d). In all cases, either specific surgical manipulations or general vascular disorders were identified as risk factors. In addition to general cardiovascular risk factors (arterial hypertension n=6, diabetes mellitus n=4), internal workup disclosed bilateral stenosis of the carotid arteries (n=1) and myeloproliferative syndrome (n=1). Conclusion. Vascular occlusions after surgical ocular procedures seem to be more frequent when cardiovascular diseases coexist. Surgical maneuvers and intra- or postoperative pressure changes may act as a triggering mechanism in patients with underlying systemic cardiovascular disorders. Affected patients should undergo thorough internal examination to identify possible underlying diseases.

scholarly journals Exercise in a Healthy Heart Program: A Cohort Study

2013 ◽  
Vol 7 ◽  
pp. CMC.S12654 ◽  
Author(s):  
J. Meikle ◽  
A. Al-Sarraf ◽  
M. Li ◽  
K. Grierson ◽  
J. Frohlich
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Lipid Profile ◽  
Retrospective Chart Review ◽  
Secondary Outcome ◽  
The Mean ◽  
Group 2 ◽  
Prevention Clinic ◽  
Group 1

Objective To assess the effects of exercise on resting heart rate (RHR), weight, lipid profile, and blood pressure. We hypothesized that the participants who increased their physical activity would show improvement in their cardiovascular risk factors compared to those who did not. Design Retrospective chart review over the mean duration of 4.9 years of follow-up. Setting Healthy Heart Program Prevention Clinic at St. Paul's Hospital, Vancouver, British Columbia, Canada. Participants We reviewed 300 charts of patients randomly selected from those who attended the Prevention Clinic between 1984 and 2009. 248 (82.7%) patients were referred for primary prevention and 52 (17.3%) for secondary prevention. Primary and secondary outcome measures Weight, RHR, lipid profile, and blood pressure were recorded at the initial and last visit. Results During a mean of 4.9 years of follow-up, 55% of participants improved their exercise. The mean decrease in the RHR for these patients (group 1) was 5.9 beats per minute (bpm) versus the mean increase of 0.3 bpm for the “no change” group (group 2) ( P < 0.01). The mean net weight increase in group 1 was 0.06 kg/year versus 0.25 kg/year in group 2. Because of medications, all patients had a significant improvement in their lipid profiles. Furthermore, there was a statistically significant greater reduction in Framingham Risk Score (FRS) in group 1 versus group 2 (11.8% versus 15.1%, P < 0.01). Conclusion Participation in the program significantly reduces modifiable risk factors for cardiovascular disease. Improved exercise regimen results in lower RHR and greater reduction in FRS. However, even in a Prevention Program, despite strong advocacy of the importance of exercise, a significant percentage of participants does not improve their exercise habits.

scholarly journals Suprachoroidal hemorrhage associated with pars plana vitrectomy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bin Mo ◽  
Song-Feng Li ◽  
Yi Liu ◽  
Jun Zhou ◽  
Shao-Li Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Axial Length ◽  
Onset Time ◽  
Visual Prognosis ◽  
Related Risk ◽  
Suprachoroidal Drainage ◽  
Suprachoroidal Hemorrhage ◽  
Pars Plana ◽  
The Mean ◽  
Group 2

Abstract Purpose To analyze the characteristics, related risk factors, and prognosis of suprachoroidal hemorrhage (SCH) associated with pars plana vitrectomy (PPV). Methods Cases of SCH associated with PPV excluding trauma were retrospectively analyzed in Beijing Tongren Hospital between January 2010 and June 2020. The data collected included general data, myopia status, axial length, state of the crystalline lens, SCH onset time, range, treatment method, visual prognosis, and methods of operation and anesthesia. Patients were divided into those with SCH related to the first PPV (Group 1), and SCH related to second intraocular surgery in the vitrectomized eye (Group 2). Patients were also classified by the SCH onset time into either the expulsive suprachoroidal hemorrhage group (ESCH) and the delayed suprachoroidal hemorrhage group (DSCH). The general data, related risk factors, and the visual prognosis of SCH in the different groups were analyzed. Results SCH associated with PPV was studied in 28 cases with an incidence of 0.06 %; 16 males and 12 females. The mean age of the patients was (53.51 ± 10.21) years old, the mean follow-up time was (24.94 ± 14.60) days, and the mean axial length was (28.21 ± 3.14) mm. Of these cases, 21 were classified as high myopia, 25 as aphakia/ pseudophakic, and 7 as focal hemorrhage. Silicone oil removal occurred in 12 cases (43 %). Patients in Group 2 were younger than Group 1 (P = 0.005). In terms of treatment and prognosis, 5 eyes were simply closely observed, 4 were given single suprachoroidal drainage, 15 were given suprachoroidal drainage combined with silicone tamponade, 2 underwent anterior chamber puncture, and 2 gave up treatment. A follow-up vision: NLP ~ 20/30; among them, 2 eyes with NLP (7.14 %), 6 of ≥ 20/200 (21.43 %). The final outcomes presented a significantly positive correlation with baseline vision but no significant correlation with age or axial length. Conclusions SCH has a higher incidence rate after a second intraocular surgery in a vitrectomized eye which is associated with the lack of vitreous support and easier fluctuation of intraocular pressure. SCH associated with PPV is more localized and has a relatively good prognosis; high myopia and aphakic/ pseudophakic eyes are risk factors. Active treatment can effectively improve visual prognosis. Trial registration Retrospective case series study, not applicable.

scholarly journals Prevalence of Vitreous & Retinal Disorders among Sudanese Diabetic Patients: A B-Scan Ultrasonography Study

2021 ◽  
Vol 29 (2) ◽  
Author(s):  
Mohamed Yousef ◽  
Safaa Bashir ◽  
Awadalla Wagealla ◽  
Mogahid Zidan ◽  
Mahmoud Salih Babiker ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
High Frequency ◽  
Analytical Study ◽  
Age Groups ◽  
Vitreous Hemorrhage ◽  
Diabetic Patients ◽  
Eye Disorders ◽  
Retinal Disorders ◽  
The Mean ◽  
Retinal Pathologies

Retina and vitreous abnormalities represent the most common eye disorders in diabetic patients; they may be associated with severe complications. Therefore, this study aimed to study the prevalence of vitreous and retinal pathologies in diabetic patients using B-Scan ultrasound (U/S). A total of two hundred and three Sudanese diabetic patients with long diabetic disease duration (mean 16.28 ± 4.830) years were enrolled in a descriptive-analytical study. 55% (n = 112) were males and 45% (n = 91) were females. The mean age of the participants was 62.28 ± 8.041(range between 30-79 years -old). The study was conducted in a Sudanese ophthalmologic hospital in Khartoum, during the period from 2016–2019. A Nidek (Echoscan US–4000) - B-scan ultrasound unit with 10 MHZ transducer was used. A high-frequency direct contact technique was applied. The inclusion criteria included adult diabetic patients. The vitreous and retina disorders were more prevalent in diabetic hypertensive participants 55 % (n = 112). The high frequency of the disorders was observed in age groups: 60–69 and 50–59 years-old. The most common disorder was retinal detachment which was detected in30.5% (n = 62) followed by vitreous changes in16.3% (n = 33). Posterior vitreous was observed in 15.8% (n = 32), vitreous hemorrhage seen in 15.3% (n = 31), both retinal detachment with vitreous hemorrhage were detected in 11.3%) (n = 23), retinal detachment with cataract were reported in 3.4% (n = 7), retinal detachment with Vitreous changes were seen in 3% (n = 6), and other changes were noted in 4.4% (n = 9) of the participants. There is no significant a statistical association between gender/diabetic duration and age with the disorders (P = 0.2, 0.43, and 0.5) respectively. Vitreous & Retinal disorders were more prevalent in diabetic hypertensive patients. The high frequency of the disorders was observed in the age group (50–70). The ultrasound is a useful method in diagnosing Vitreous & Retinal disorders among the diabetics.

Retinal Detachment after Vitrectomy; Risk Factors, Pathogenesis, Clinic, and Management

2020 ◽  
pp. 201-205
Keyword(s):  
Risk Factors ◽  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Surgical Instruments ◽  
Entry And Exit ◽  
Retinal Breaks ◽  
Entry Points ◽  
Retinal Tears ◽  
Vitreous Traction ◽  
Pars Plana

Intraoperative iatrogenic retinal tears leading to postoperative retinal detachments secondary to vitrectomy are an important sight-threatening complication of pars plana vitrectomy. Peripheral vitreous traction and retinal tears that incompletely removed, surgical instruments causing shrinkage on the basis of vitreous and incarceration of the vitreous to the entry points of the surgical instruments during entry and exit can be counted among the main causes of tears. In addition, small ruptures that may have been missed before the operation may cause retinal detachment after PPV. In order to reduce postoperative RD, it is based on the principle of detecting and treating the retinal breaks, if it is formed. Removing the peripheral vitreous completely without traction during PPV is important in preventing the formation of new tears.

Vitreous Changes and Retinal Detachment in Highly Myopic Eyes

1996 ◽  
Vol 6 (1) ◽  
pp. 50-58 ◽  
Author(s):  
M. Stirpe ◽  
K. Heimann
Keyword(s):  
Retinal Detachment ◽  
Vitreoretinal Surgery ◽  
Vitreoretinal Interface ◽  
Clinical Appearance ◽  
Giant Retinal Tear ◽  
Macular Holes ◽  
Retinal Breaks ◽  
Group A ◽  
Smooth Membrane ◽  
Group 2

This report on 496 highly myopic eyes that underwent transcleral or vitreoretinal surgery for retinal detachment (RD) focuses particularly on how changes in the vitreous gel and the resulting modifications of the vitreoretinal interface produce typical characteristics and complications. According to the pattern of vitreous modifications the 496 eyes were divided into five groups: 1) eyes with uniform PVD (108 eyes) 2) eyes with PVD spreading towards the upper quadrants (231 eyes) 3) eyes with extensive vitreous liquefaction (EVL) and condensations of the vitreous base (51 eyes) 4) eyes with posterior vitreous lacuna (PVL, 87 eyes) 5) eyes with very limited PVD (19 eyes). Age, degree of myopia, surgical procedures and final results are reported for each group. A strong correlation was observed between vitreous changes and clinical picture of RD especially in the group of PVL and EVL. In the PVL group a higher degree of myopia was found and more pronounced posterior staphyloma. Frequently the posterior hyaloid, in the form of a thin, extremely smooth membrane, was hard to separate from the inner posterior retina during surgery. Posterior retinal breaks, including macular holes, were found in 56% of eyes. The presence of EVL with condensation of the vitreous base was correlated with giant retinal tear (GRT) in 70% of cases (36 of 51 eyes). Sixteen GRT were also found in the group of uniform PVD, but these were less extensive and located more posteriorly than in the EVL group. In the former group there were better surgical results because of a lower incidence of PVR. In 46% of the eyes of our series (group 2), PVD extended mostly in the upper quadrants with no vitreous detachment inferiorly. In these cases there was a clinical appearance of inferior vitreous collapse. These eyes had 92% of peripheral superior retinal breaks. Relapses of RD in this group almost invariably occurred in the inferior quadrants.

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