Investigation of the effects of temporomandibular joint arthrocentesis on blood volume of the retinal structures

OBJECTIVE: Arthrocentesis is a minimally invasive surgical procedure that is used to alleviate the symptoms of temporomandibular joint (TMJ) disorders. The aim of this study was to investigate the effect of arthrocentesis on the blood supply to the retinal structures. MATERIALS AND METHODS: Arthrocentesis was performed on 20 patients with TMJ disorders, and choroidal thickness (CT) in patients was measured to evaluate retinal blood circulation. The blood volume of the retinal structures was evaluated ipsilaterally before and after arthrocentesis, and these measurements were then compared with measurements obtained from the contralateral side. RESULTS: Before arthrocentesis, there were no differences in retinal blood volumes between the ipsilateral and contralateral sides (P = 0.96). When ipsilateral CT measurements taken before and after arthrocentesis were compared, retinal blood supply was found to have significantly decreased after arthrocentesis (P = 0.04). When contralateral CT measurements taken before and after arthrocentesis were compared, retinal blood supply was also found to have decreased after arthrocentesis, but not significantly (P = 0.19). CONCLUSION: The solution of local anesthesia with epinephrine applied before the arthrocentesis procedure was found to reduce the blood volume of the retinal structures. To the best of our knowledge, this is the first study that has investigated the blood volume of the retinal structures following arthrocentesis.

Evaluation of Anterior Segment Parameter Changes Using the Sirius after Uneventful Phacoemulsification

PURPOSE: To investigate changes in anterior chamber depth (ACD), corneal volume (CV), anterior chamber angle (ACA), anterior chamber volume (ACV), central corneal thickness (CCT), horizontal visible iris diameter (HVID), pupil diameter (PD), and intraocular pressure (IOP) after uneventful phacoemulsification cataract surgery with intraocular lens implantation. METHODS: A total of 132 eyes of 132 patients (87 men and 45 women) that underwent uneventful phacoemulsification cataract surgery and intraocular lens implantation were prospectively studied. The mean age of the patients was 63.68 ± 12.51 years. All patients were evaluated preoperatively and at 1 month postoperatively with the Sirius 3D Rotating Scheimpflug camera topography system. The ACD, CV, ACA, ACV, CCT, HVID, and PD measurements were recorded. IOP was measured using the Goldmann applanation tonometer, which was corrected for CCT of the Sirius device using Ehlers' formula. RESULTS: The preoperative mean ACD, ACV, ACA, CCT, CV, PD, HVID, and IOP were 2.79 ± 0.45 mm, 124.73 ± 25.72 mm³, 42.09 ± 7.49⁰, 523.87 ± 41.97 microns, 55.37 ± 4.89 mm³, 3.98 ± 1.23 mm, 11.72 ± 0.67 mm, and 14.74 ± 2.59 mmHg, respectively. Three months postoperatively, the mean ACD, ACV, ACA, CCT, CV, PD, HVID, and IOP were 3.45 ± 0.6 mm, 162.52 ± 23.79 mm³, 51.46 ± 5.63⁰, 526.21 ± 44.45 microns, 56.23 ± 5.12 mm³, 2.87 ± 0.45 mm, 11.91 ± 0.75 mm, and 12.02 ± 1.83 mmHg, respectively. There was a statistically significant increase in mean postoperative ACD, ACV, ACA, CV, and HVID compared with the corresponding preoperative values (p < 0.05). CCT remained stable after surgery. Postoperative PD and IOP were significantly decreased compared to corresponding preoperative values (p < 0.05). CONCLUSIONS: Preoperative measurements by the Sirius 3D Rotating Scheimpflug camera topography system might help surgeons to predict postoperative changes resulting from phacoemulsification and intraocular lens implantation. This is a noncontact, noninvasive, and comfortable system for patients that is highly reliable and repeatable for anterior segment measurements.

Assessment of Patient Pain Experience during Intravitreal 27-Gauge Bevacizumab and 30-Gauge Ranibizumab Injection

PURPOSE: To compare pain scores of patients during intravitreal 27-gauge bevacizumab and 30-gauge ranibizumab injection procedures. METHODS: Seventy eyes of 70 patients who had not previously undergone intravitreal anti-vascular endothelial growth factor therapy were included in this study. Thirty-five patients received ranibizumab and 35 patients received bevacizumab. The diagnoses of the patients were: 27 age related macular degeneration, 15 diabetic macular edema, 9 diabetic vitreous hemorrhage, 6 central retinal vein occlusion, 11 branch retinal vein occlusion and 2 central serous chorioretinopathy. Bevacizumab (1.25 mg/0.05 mL) was injected into the vitreous cavity using a 27-gauge needle, and ranibizumab (0.5 mg/0.05 mL) was injected with 30-gauge needle. Patients were asked just after the injection to rate their perceived pain during the injection using the visual analogue scale (VAS) of 0 (no pain) to 10 (unbearable/worst pain). The average of these scores was used as the primary outcome. RESULTS: The VAS pain scores in the ranibizumab and bevacizumab groups were 1.06 +/- 0.91 (range, 0 to 3) and 1.94 +/- 1.55 (range, 0 to 7), respectively, a significant difference (p = 0.005). Patients or =65 years of age in both the ranibizumab and bevacizumab groups were then compared. For patients or =65 years, there was not a significant difference in the average VAS pain scores between groups (p = 0.238). Female and male patients in both ranibizumab and bevacizumab groups were also compared. For female patients, there was a significant difference in the average VAS pain scores between groups (p = 0.016), although not for male patients (p = 0.078). CONCLUSIONS: Thirty-gauge intravitreal injection is more comfortable than 27-gauge injection. Injection of bevacizumab with 30-gauge needle syringes may be more tolerable for patients.

Assessment of Patient Pain Experience during Intravitreal 27-Gauge Bevacizumab and 30-Gauge Ranibizumab Injection

PURPOSE: To compare pain scores of patients during intravitreal 27-gauge bevacizumab and 30-gauge ranibizumab injection procedures. METHODS: Seventy eyes of 70 patients who had not previously undergone intravitreal anti-vascular endothelial growth factor therapy were included in this study. Thirty-five patients received ranibizumab and 35 patients received bevacizumab. The diagnoses of the patients were: 27 age related macular degeneration, 15 diabetic macular edema, 9 diabetic vitreous hemorrhage, 6 central retinal vein occlusion, 11 branch retinal vein occlusion and 2 central serous chorioretinopathy. Bevacizumab (1.25 mg/0.05 mL) was injected into the vitreous cavity using a 27-gauge needle, and ranibizumab (0.5 mg/0.05 mL) was injected with 30-gauge needle. Patients were asked just after the injection to rate their perceived pain during the injection using the visual analogue scale (VAS) of 0 (no pain) to 10 (unbearable/worst pain). The average of these scores was used as the primary outcome. RESULTS: The VAS pain scores in the ranibizumab and bevacizumab groups were 1.06 +/- 0.91 (range, 0 to 3) and 1.94 +/- 1.55 (range, 0 to 7), respectively, a significant difference (p = 0.005). Patients or =65 years of age in both the ranibizumab and bevacizumab groups were then compared. For patients or =65 years, there was not a significant difference in the average VAS pain scores between groups (p = 0.238). Female and male patients in both ranibizumab and bevacizumab groups were also compared. For female patients, there was a significant difference in the average VAS pain scores between groups (p = 0.016), although not for male patients (p = 0.078). CONCLUSIONS: Thirty-gauge intravitreal injection is more comfortable than 27-gauge injection. Injection of bevacizumab with 30-gauge needle syringes may be more tolerable for patients.