Effect of intravenous sedation on patients' visual experience and vital signs during cataract surgery under topical anesthesia: A randomized controlled trial.

Purpose: Effect of intravenous sedation on patients' visual experience and vital signs during cataract surgery under topical anesthesia: a randomized controlled trial. Design: Prospective, double masked, randomized controlled trial. Methods: 150 eyes of 150 patients undergoing phacoemulsification and IOL implantation under topical anesthesia were randomized to receive either intravenous midazolam (0.015 â€‹mg/kg) or normal saline. The patients' experience was evaluated using a questionnaire. Vital signs including blood pressure and heart rate were measured before, during and after surgery. Mean arterial pressure (MAP) was calculated. Results: Both groups were comparable except that fewer patients in the control group were pseudophakic in the fellow eye (25.3% vs. 41.3%). More patients in the control group perceived hand movements (p â€‹< â€‹0.01), surgeon/medical staff (p â€‹= â€‹0.04) and sudden increase in vision during surgery (p â€‹< â€‹0.01) compared to midazolam group. More control group patients experienced fear (p â€‹< â€‹0.001), pain (p â€‹= â€‹0.06) and unpleasant surgical experience (20.3% vs. 1.3%, p â€‹< â€‹0.001). They also experienced greater fluctuation in MAP (16.9 â€‹± â€‹7.9 vs.7.2 â€‹± â€‹5.3, p â€‹< â€‹0.001) and this was accentuated in hypertensives. After adjusting for age, gender, hypertension status and other eye lens status, multivariable logistic regression analysis revealed that subjects in the control arm (OR â€‹= â€‹11.7, 95% [CI] â€‹= â€‹1.3-108, p â€‹= â€‹0.03), had a longer duration of surgery, experienced pain and more likely to report unpleasant experience. Adjusting for similar covariates, multivariable linear regression analysis showed that control group patients (ߠ​= â€‹8.5 â€‹mmHg, 95% CI â€‹= â€‹6.2-10.8, p â€‹= â€‹0.03) had hypertension, experienced fear during surgery and greater fluctuations in the MAP. Conclusions: A sedative dose of intravenous midazolam during phacoemulsification under topical anesthesia significantly reduces patients' visual experience, fear and fluctuations in MAP and improves overall surgical experience.

Corneal fibroma: An uncommon stromal tumor.

A 56-year-old male patient presented with a slow-growing, elevated, smooth, white corneal mass. The mass was excised by performing an alcohol-assisted keratoepitheliectomy and sent for histopathological examination. Subepithelially, closely packed spindle cells in "feather-stitched" or storiform pattern were seen. Immunohistochemically, the cells stained negatively for CD-34 and S-100 and focal positivity was seen for vimentin. Based on the morphology and immunochemical staining, a diagnosis of corneal fibroma was made. No recurrence was seen. Corneal fibroma is an exceedingly rare, benign tumor and possibly lies on the same spectrum as corneal keloid and hypertrophic cicatrix. Surgical resection is usually curative.

Unilateral partial limbal stem cell deficiency: contralateral versus ipsilateral autologous cultivated limbal epithelial transplantation.

PURPOSE: To report the outcomes of autologous cultivated limbal epithelial transplantation using the healthy part of the affected eye or the fellow eye as a source of limbal stem cells in patients with unilateral, partial limbal stem cell deficiency (LSCD). DESIGN: Retrospective, nonrandomized, interventional case series. METHODS: setting: L. V. Prasad Eye Institute, Hyderabad, India. study population: Patients with unilateral, partial LSCD who underwent autologous cultivated limbal epithelial transplantation between 2001 and 2011. intervention: The limbal biopsy was taken either from the healthy part of the limbus of the same eye (ipsilateral group) or from the healthy fellow eye (contralateral group). Cells were cultivated using a xeno-free explant culture technique, and cultivated cells were transplanted onto the affected surface. primary outcome measure: Success of cultivated limbal epithelial transplantation, defined as a completely epithelialized, avascular, and clinically stable corneal surface. RESULTS: Seventy eyes of 70 patients were studied. The mean follow up was 17.5 ± 7 months. In 34 eyes the limbal biopsy was taken from the ipsilateral eye and in the remaining 36 eyes from the contralateral eye. Clinical success was achieved in 70.59% of eyes in the ipsilateral group and 75% of eyes in the contralateral group (P = .79). Limbal transplant survival rates at the final follow-up visit were 65.1% ± 0.09% in the ipsilateral group and 53.6% ± 0.12% in the contralateral group (P = .74). CONCLUSIONS: Ocular surface restoration in partial LSCD is possible with cell-based therapy. Outcomes are similar irrespective of whether the limbal biopsy is taken from the healthy part of the ipsilateral eye or the contralateral eye.

Incidence and long-term outcomes of toxic anterior segment syndrome at Aravind Eye Hospital.

PURPOSE: To determine the incidence and long-term outcomes of toxic anterior segment syndrome (TASS) at a single institution. SETTING: Aravind Eye Hospital, Pondicherry, India. DESIGN: Case series. METHODS: The records of all eyes developing TASS during a 1-year period after cataract surgery were retrospectively reviewed. Clinical outcomes, including corrected distance visual acuity (CDVA), intraocular pressure, and complications, were recorded at the 1-month and 6-month follow-up visits. RESULTS: Toxic anterior segment syndrome occurred in 60 eyes (0.22%) in 26 408 consecutive cataract surgeries. Although there were 2 identifiable clusters of TASS, 52% of cases were sporadic. The mean duration until resolution of severe iridocyclitis was 6.11 days ± 2.19 (SD). Of the 24 eyes (40%) with a follow-up of at least 6 months (mean 11.24 ± 2.3 months), 6 (24%) had atrophic iris changes, 1 (4%) had cystoid macular edema, 3 (12.5%) developed anterior capsule phimosis, and 4 (16%) had posterior capsule opacification (PCO). There was no statistically significant difference between the mean CDVA at 1 month (0.08 ± 0.06 logMAR) (n = 60) and the mean final CDVA (0.11 ± 0.1 logMAR, minimum 6 months; n = 24) (P=.42). CONCLUSIONS: Although it is impossible to generalize for all etiologies, this study found that TASS is uncommon but not rare, responded to intensive topical antiinflammatory medication, and was usually associated with a good visual outcome. Anterior capsule contraction and PCO were the principal delayed-onset complications beyond those present 1 month postoperatively.