Nonsurgical treatment of diplopia.

Local experience with caruncular single injection peribulbar anesthesia

Ophthalmic Surgical Procedures , by Peter S. Hersh, MD, is an easy-to-read and well-illustrated textbook on the commonly performed ophthalmic surgical procedures. It has a very complete bibliography and index, and it appears to be nicely suited for the medical student rotating through ophthalmology as well as for the ophthalmology resident in training. There are general chapters that discuss surgical instrumentation, sutures, anesthesia, and preoperative and postoperative surgical care, and chapters that review the commonly performed ophthalmic surgical procedures with comments on the indications for the procedure, the preoperative preparation, instrumentation, postoperative care, and potential complications. The reader should realize that the procedures described and illustrated may not be the ones that might be encountered in his or her own particular hospital or training program. The reader of this text should also recognize that what is presented is not the only way that a

Vascular access ports were developed to overcome many of the problems associated with limited peripheral access, combined with the need for frequent venipuncture, in oncology patients receiving long-term intensive therapy. In this study, we compared the effectivity and acceptability of vascular access port with conventional needle application together with complication rates in ovarian cancer patients. Advanced-stage ovarian carcinoma cases under chemotherapy treatment were equally randomized into two groups, implantable vascular access ports applied to one group (22 cases) and conventional vascular access applied to the other (38 cases) as a control group. Anteroposterior thoracic X-rays of implantable port-applied cases were taken before and after the application. Vortex® reservoir ports (Horizon Medical Products, Inc., Manchester, GA) were used in the application to the subclavian vein. Classic peripheral venipuncture method (Medikit®, Mediflon™IV cannula with PTFE radiopaque catheter and injection valve, Eastern Medikit Ltd, Gurgaon, Haryana, India) was used in the control group. Vascular accesses of all cases were controlled just after the application, 12 h after the application, and during each drug or intravenous fluid application. Mean port insertion time was 26.3 min. Total port occlusion was observed in two of the port-applied cases (11.7%) and partial port occlusion was observed in five of the port-applied cases (29%). Heparin and saline combination was used in order to open the port tip, in five cases, two with total occlusion and three with partial occlusion. Infection was observed in only one case (5%) to whom appropriate therapy was given, and the port was taken out. Ports of two cases were also taken out because of skin dehiscence. No change in port tip position was observed in any of the cases. Total occlusion was observed in 16 of the 38 cases (42.1%) with conventional vascular access. In 12 cases (31.5%), a need arose to change the conventional vascular access. No vascular access was found in 13 of the 38 cases (34.2%). Application of reservoir ports especially to cases with advanced-stage carcinomas, under chemotherapeutic drug treatment, leads to minimal anxiety for the patient and his/her family and minimal risk of physical trauma to the patient with only one vascular access. Reservoir ports occlude or cause infection to a lesser extent than classic vascular access methods. Occlusion or infection rates of reservoir ports are statistically significant, lower than those of classic venipuncture.

We report one previously healthy patient diagnosed with COVID-19 presenting with a cranial nerve III palsy. CASE A 67-year-old man with COVID-19 diagnosed on March 30th presented to the Vanderbilt Emergency Department on April 20th with complaints of double vision and left ptosis beginning on April 4th. The patient described concomitant symptoms of fever, fatigue, myalgias, and diarrhea. He denied recent trauma, eye redness, orbital pain, headache, motor sensory changes, ataxia, or weakness. His medical history was negative for hypertension, diabetes, hypercoagulable risk factors, or family history of hypercoagulable disorder. He had a remote history of Lyme disease diagnosed 9 years before. Examination was notable for left ptosis and supraduction, adduction, and infraduction deficits. The left pupil was 1 mm larger than the right and similar in light and dark. Both eyes were white without proptosis. Anterior segment and fundus examination were unremarkable. Head computed tomographic angiography did not demonstrate an aneurysm. MRI brain showed scattered nonspecific T2/fluid-attenuated inversion recovery hyperintensities that could be reflective of microvascular ischemic changes vs inflammatory lesions. There was no contrast enhancement of left third cranial nerve. D-dimer was elevated >500. Prothrombin time and international normalized ratio were normal. C-reactive protein, erythrocyte sedimentation rate, Lyme disease polymerase chain reaction, acetylcholine binding antibody, angiotensin-converting enzyme , and anti-GQ1b immunoglobulin G and immunoglobulin M were normal. The patient was discharged home with close follow-up. At his 1 month visit his diplopia had improved, and after 2 months, his third nerve palsy had resolved. Given his negative laboratory workup, elevated D-dimer, and the lack of typical comorbidities predisposing a patient to microvascular disease, the possibility of COVID-19–related third nerve palsy was postulated. Multiple recent studies have reported an association between COVID-19 and cranial neuropathies. Several mechanisms have been theorized, including direct viral involvement, inflammatory response, immune mechanisms, and microvascular disease. Neurologic manifestations occurring because of an aberrant immune response to COVID-19 has been reported (1,2). A single case of pupil sparing oculomotor nerve palsy in the setting of the novel coronavirus was reported; however, the patient had multiple risk factors for vascular disease, including hypertension, diabetes, and cigarette smoking (3). Direct viral invasion into the central nervous system through severe acute respiratory syndrome coronavirus 2 viral interaction with the angiotensin-converting enzyme 2 receptor in the nervous system leading to a cranial neuropathy has also been postulated (2). In our patient, the elevated D-dimer level suggests another possible etiology. Elevated concentrations of plasma D-dimer indicate recent or ongoing intravascular coagulation and fibrinolysis (4). A common theme seen in COVID-19 infection is coagulopathy (5). COVID-19 patients have high venous thromboembolism rates, elevated D-dimer levels, and pulmonary microvascular thrombosis (6). The occurrence of thrombotic phenomenon in COVID-19 has been supported by recent autopsy reports showing microthrombi in the pulmonary vasculature (7). The mechanism of microthrombi formation in COVID-19 is unclear and may involve hypercoagulability, complement activation, or direct endothelial injury. Microthrombi formation secondary to COVID-19 infection should be considered as a possible etiology of the acute cranial nerve palsy as reported in this patient.

Aim: Sinonasal Hemangiopericytomas are rare Uncommon Soft Tissue Tumor of perivascular myoid differentiation with hemangiopericytoma-like vasculature.The clinical behaviour of the tumor is difficult to predict and surgical excision remains the treatment of choice.We present one such case of Sinonasal Hemangiopericytoma operated at our centre recently.Materials and Method: 28 year old female presented with a painless swelling over the forehead since 6 months with history of gradual increase in size of the swelling and complaints of double vision in left eye and anosmia.Radiological evaluation showed a T1 isointense T2 hyperintense lesion arising in the left nasal cavity with an intracranial extension.Patient was operated upon for the same and Histopathological evaluation suggested the lesion to be a sinonasal hemangiopericytoma.Post operative period was uneventful. Conclusion:Sinonasal Hemangiopericytoma are rare vascular tumors with a variable clinical discourse and a difficult diagnosis.Surgical excision is the treatment of choice and patients require long term follow ups.

Thirty-four cases of blow-out fracture were evaluated by high-resolution CT, Hess test for red and green color and synoptophore. The results of these tests were compared with the final outcome of the fractures. The fractures were classified on the basis of the location (floor, medial wall or roof), extent (total, partial or linear) and type of fragments (punched-out or trapdoor). The medial wall type included many cases (33%) with no complaint of double vision, and many cases with a combination of disturbances in ocular mobility in both the horizontal and vertical directions. The floor type showed a low incidence of disturbances in ocular movement in the horizontal directions. Regarding the extent of the fracture, all cases with the total type showed disappearance of double vision within three months. Many of the partial and linear types had a poor outcome. With regard to the type of fragments, all of the trapdoor type cases showed a favorable result with disappearance of double vision within three months. Some of the punched-out type cases, however, showed a poor outcome.

When children under 8 yr. old draw an object occluded by another, they depict each object separately either horizontally or vertically. This study examined whether children aged 4-6-yr.-old intended to draw occluding and occluded objects separately at the planning stage like their drawn product. 25 4-yr.-olds (boys=14, girls=11), 28 5-yr.-olds (boys=14, girls=14), and 29 6-yr.-olds (boys=19, girls=10) were presented two cups, set one behind another, with handles visible at the side in partial occlusion and invisible in total occlusion. They were asked to draw the cups as they saw them and to select one among five picture cards (circle, horizontal, orientation-centered, vertical, view-specific) that matched their drawing plan. Analysis showed in both partial and total occlusions in the drawing 4-yr.-olds more often drew either a circle or the two cups horizontally; 5-yr.-olds drew the two cups vertically, while 6-yr.-olds made view-specific drawings, that is, drew the cups as seen. On the planning task for partial and total occlusions 4-yr.-olds selected the picture card representing a circle or two horizontally drawn cups, 5-yr.-olds tended to pick the card of two vertically drawn cups, while 6-yr.-olds chose the view-specific picture card, like their drawn products. These results suggested that planning and drawing were similar within and across age groups and that children's drawing reflected the representation of their planning.

Research progress in surgery-related meibomian gland dysfunction

BackgroundThe COVID-19 pandemic had a profound impact on healthcare and ophthalmology services globally. Numerous studies amongst various medical and surgical specialties showed a reduction in patient attendance and surgical procedures performed. Prior published ophthalmic literature focused on specific types of procedures and were usually single centre. The current study attempts to quantify the impact on a larger scale, namely that of sub-Saharan Africa, and to include all ophthalmic subspecialties.MethodsThis is a retrospective analysis of the surgical records from 17 ophthalmology centres in seven countries located in East, Central, West and Southern Africa. The date of declaration of the first lockdown was used as the beginning of the pandemic and the pivot point to compare theatre records one year prior to the pandemic and the first year of the pandemic. We examined the total number of surgical procedures over the two year period and categorized them according to ophthalmic subspecialty and type of procedure performed. We then compared the pre-pandemic and pandemic surgical numbers over the two year period.ResultsThere were 26,357 ophthalmic surgical procedures performed with a significant decrease in the first year of the pandemic (n = 8942) compared to the year prior to the pandemic (n = 17,415). The number of surgical procedures performed was lower in the first year of the pandemic compared to the year prior to the pandemic by 49% [Incidence rate ratio (IRR) 0.51, 95% CI 0.41–0.64), 27% (0.73, 0.55–0.99), 46% (0.54, 0.30–0.99), 40% (0.60, 0.39–0.92) and 59% (0.41, 0.29–0.57) in sub-Saharan Africa (4 regions combined), West, Central, East and Southern Africa, respectively]. The number of surgical procedures in the different sub-specialty categories in sub-Saharan Africa (4 regions combined) was significantly lower in the first year of the pandemic compared to the year prior to the pandemic, except for glaucoma (IRR 0.72, 95% CI 0.52–1.01), oncology (0.71, 0.48–1.05), trauma (0.90, 0.63–1.28) and vitreoretinal (0.67, 0.42–1.08) categories.ConclusionThis study provides insight into the impact of the COVID-19 pandemic in multiple regions and countries on the African continent. The identification of which surgical subspecialty was most affected by the COVID-19 pandemic in each region allows for better planning and resource allocation to address these backlogs.

To assess the clinical experience of using a three-dimensional (3D) system for ophthalmic surgical procedures. We retrospectively analysed video recordings of patients who underwent 3D ophthalmic surgery, using the NGENUITY® 3D visualization system, or traditional microsurgery at our hospital, from August 2017 to February 2018. Patients underwent phacoemulsification or phacoemulsification combined with vitrectomy. Diagnoses, operation type, duration of continuous curvilinear capsulorhexis (CCC), number of forceps nips during CCC and capsulorhexis complications were recorded. Five surgeons and four assistants answered a 3D surgery questionnaire. Twenty-six of 46 patients who underwent 3D surgery, and 31 of 51 patients who underwent traditional microsurgery (control group) were enrolled. The mean CCC duration in the study and control groups was 31.2±10.8 and 28.7±13.2seconds (p=0.071), and the mean number of forceps nips was 5±2 and 5±2 (p=0.634), respectively. The anterior capsular rupture rate of phacoemulsification under 3D and traditional conditions was 3.85% (1/26 cases) and 3.23% (1/31 cases), respectively. The complication rate was similar between the two groups (p>0.999). Four of five surgeons and two of four assistants believed the clarity of 3D surgery was similar or better than that of traditional microsurgery. The occurrence of dizziness (p>0.999), shoulder and neck pain (p=0.262), backache (p=0.471) and visual fatigue (p=0.347) did not differ significantly between the two methods. The 3D surgical system facilitated similar operation speed and stability as the traditional microscope and provided reliable support for ophthalmic surgery.

Age-Related Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction

To provide estimates of patient-level annual ophthalmologist work times for the care of common ophthalmic conditions and patient-level global surgical care time for common or important ophthalmic procedures. A random sample of the domestic membership (excluding members-in-training) of the American Academy of Ophthalmology, stratified by self-designated practice concentration, was surveyed in 1994 to provide estimates of work times for common ophthalmic services. Comprehensive and subspecialty-specific results were obtained for ophthalmic diagnoses, services, and surgical procedures. For ophthalmic diagnoses and services, initial and follow-up visit work times are reported for comprehensive and subspecialty ophthalmologists separately. For common surgical procedures, aggregate results based on comprehensive and subspecialist survey responses are reported. These ophthalmology-specific survey results can be used for a variety of purposes, including practice management, "benchmarking," health plan administration and national workforce planning. Such surveys should be repeated as techniques and practice patterns change over time.

To elucidate the association between medical procedures and sporadic Creutzfeldt-Jakob disease (sCJD), we analyzed medical procedures (any surgical procedure, neurosurgery, ophthalmic surgery, and blood transfusion) for patients registered by the CJD Surveillance Committee in Japan during 1999-2008. We conducted an age-stratified case-control study with 753 sCJD patients and 210 controls and a study of patients who underwent neurosurgical or ophthalmic surgical procedures at the same hospital. Although the control group was relatively small, no evidence was found that prion disease was transmitted through the investigated medical procedures before onset of sCJD. After onset of sCJD, 4.5% of the sCJD patients underwent operations, including neurosurgical for 0.8% and ophthalmic for 1.9%; no special precautions against transmission of prion diseases were taken. Fortunately, we have not identified patients with prion disease attributed to these operations. Our findings indicate that surgical procedures or blood transfusion had little effect on the incidence of sCJD.

PurposeDue to the shortage of human corneas for research purposes, our aim was to develop and optimize a bovine ex vivo model for the simulation of corneal storage and ophthalmic...

Neuroscience, which covers the molecular mechanisms employed by the brain to cause neurological diseases and how they can be treated, remains current as the subject of high-budget investigations to develop early diagnosis and new treatment modalities with multidisciplinary approaches. For this purpose, creating the appropriate model with the correct modality and anesthesia in neurological in vivo experimental models is the most important phase to obtain accurate results and ensure animal welfare. To manage anesthesia in rodents, knowing the physiological characteristics of anesthetics and their risks will strengthen experimental procedures. Among the injectable anesthetics, ketamine, xylazine, and pentobarbital are the most frequently preferred agents for general anesthesia in short surgical procedures. Isoflurane and sevoflurane are inhaler anesthetics that are administered through a vaporizer because they are liquids. Important advantages of inhaled anesthetics, such as rapid induction and rapid withdrawal, make inhaled anesthetics stand out in neuroscience studies. In this review, the properties of frequently used anesthetic agents in rodents, their usage methods, and which model they are preferred will be discussed. For this purpose, the selection of appropriate anesthetics in animal models such as epilepsy, Alzheimer's disease, ischemia-reperfusion injury, traumatic brain injury, ischemic stroke, experimental autoimmune encephalomyelitis, and ophthalmic surgical procedures and their side effects will be reviewed.