RESUMO
PURPOSE: The aim of the study was to determine whether subconjunctival anesthesia is effective at reducing pain associated with laser retinopexy. DESIGN: This was a single-center, prospective, patient-masked, randomized, controlled trial. PARTICIPANTS: In the primary study group, 65 patients were recruited. Thirty-two patients (32 eyes) received anesthetic injection, and 33 patients (33 eyes) received the sham injection. The crossover study group consisted of 28 patients (56 eyes). METHODS: Between February 2008 and April 2008, all patients who were consecutively booked to undergo panretinal photocoagulation (PRP) or peripheral laser retinopexy (PLR) were invited to participate in the study. Patients were randomized to receive subconjunctival lidocaine injection or a sham injection before their intended laser retinal treatment. These patients were defined as our primary study group. Patients who required a second laser treatment received the opposite injection in a masked fashion before laser retinal treatment. These patients were defined as our crossover group. Patients in both the primary study group and the crossover group were masked to the treatment given. After the laser treatment, patients completed a pain questionnaire. MAIN OUTCOME MEASURES: The primary outcome was incidence of pain. The secondary outcome was severity of pain. RESULTS: Primary study group: In the anesthetic treatment group, 19 patients (59%) experienced pain compared with 32 patients (97%) in the sham treatment group (P<0.001). Among the patients who did experience pain, the average pain score was 3.6 in the anesthetic treatment group and 4.1 in the sham treatment group (P=0.55). Crossover study group: In the anesthetic treatment group, 12 patients (43%) experienced pain compared with 28 patients (100%) in the sham treatment group (P<0.001). In patients who did experience pain, the average pain score was 3.3 in the anesthetic treatment group and 4.6 in the sham treatment group. Twenty patients (71%) preferred anesthetic to sham treatments, 1 patient (4%) preferred sham over anesthetic, and 7 patients (25%) thought both laser treatments were the same. CONCLUSIONS: Subconjunctival 2% lidocaine significantly reduces the incidence of pain in patients who receive PRP or PLR.
Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Fotocoagulação a Laser , Lidocaína/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Analgesia/métodos , Túnica Conjuntiva , Estudos Cross-Over , Crioterapia , Retinopatia Diabética/cirurgia , Método Duplo-Cego , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Estudos Prospectivos , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Inquéritos e QuestionáriosAssuntos
Angiofluoresceinografia/métodos , Fluoresceína/efeitos adversos , Corantes Fluorescentes/efeitos adversos , Náusea/induzido quimicamente , Idoso , Método Duplo-Cego , Feminino , Fluoresceína/administração & dosagem , Corantes Fluorescentes/administração & dosagem , Humanos , Incidência , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doenças Retinianas/diagnóstico , Fatores de TempoRESUMO
PURPOSE: To report a patient presenting with a symptomatic retinal pigment epithelial detachment (RPED) that resolved after successful treatment of a slow flow dural carotid cavernous fistula (CCF). Possible pathophysiological mechanisms are discussed. METHODS: Interventional case report. RESULTS: A 69-year-old female presented with left uniocular distortion, confirmed on fluorescein and indocyanine green angiography to be secondary to a non-vascularised serous RPED. Further examination revealed a long standing left VI nerve palsy, mild proptosis and conjunctival injection. Magnetic resonance and cranial angiography confirmed the presence of a dural CCF. Surgical closure of the CCF resulted in a rapid resolution of the clinical signs and improvement in visual symptoms. CONCLUSIONS: Patients with serous RPED and other signs or symptoms of a CCF may warrant neuroimaging of the orbit and/or angiography to evaluate for CCF, as correct diagnosis may lead to an excellent visual outcome.