Asunto(s)
Conjuntivitis/terapia , Fibrinolíticos/uso terapéutico , Heparina/uso terapéutico , Plasma , Enfermedades Cutáneas Genéticas/terapia , Administración Tópica , Anciano , Terapia Combinada , Conjuntivitis/diagnóstico , Femenino , Hospitales Universitarios , Humanos , Ontario , Soluciones Oftálmicas , Plasminógeno/deficiencia , Enfermedades Cutáneas Genéticas/diagnóstico , Agudeza VisualRESUMEN
To evaluate the use of combined topical and intracameral anesthesia for Descemet's stripping automated keratoplasty (DSAEK). This was a retrospective comparative cohort analysis consisting of 10 eyes in 10 consecutive patients undergoing DSAEK surgery with combined topical and intracameral anesthesia. These cases were compared with 21 randomly selected controls during the same time period undergoing DSAEK surgery performed under retrobulbar anesthesia. Incidence of intraoperative and postoperative complications, and endothelial cell counts were compared. In all cases, DSAEK was completed without intraoperative complications. All patients tolerated the procedure well. There were 6 cases of postoperative graft dislocation requiring rebubbling, and no cases of primary failure or endophthalmitis. No significant difference in endothelial cell counts was found at final follow-up. Short-term results suggest that combined topical and intracameral anesthesia is as safe and effective for DSAEK in cooperative patients when compared to retrobulbar anesthesia. It may thereby be an alternative anesthetic modality for patients in whom retrobulbar or peribulbar anesthesia may be risky or contraindicated.
Asunto(s)
Anestesia Local/métodos , Anestésicos Combinados/administración & dosificación , Anestésicos Locales/administración & dosificación , Cámara Anterior/efectos de los fármacos , Queratoplastia Endotelial de la Lámina Limitante Posterior , Anciano , Anciano de 80 o más Años , Anestésicos Combinados/efectos adversos , Anestésicos Locales/efectos adversos , Recuento de Células , Estudios de Cohortes , Endotelio Corneal , Femenino , Humanos , Lidocaína/administración & dosificación , Lidocaína/efectos adversos , Masculino , Persona de Mediana Edad , Propoxicaína/administración & dosificación , Propoxicaína/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
CASE REPORT: Infectious keratitis after laser-assisted in situ keratomileusis (LASIK) is a rare complication that may be challenging to diagnose and treat. We discuss some of the reasons for difficulties diagnosing postoperative atypical or nontuberculous mycobacterial infection and establishing an effective treatment, with reference to reports of comparative antibacterial activity of the most commonly used antibiotics. COMMENTS: To the best of our knowledge, we are the first to report the use of the fourth-generation fluoroquinolone moxifloxacin in combination therapy for the successful treatment of this condition.
Asunto(s)
Antibacterianos/uso terapéutico , Compuestos Aza/uso terapéutico , Úlcera de la Córnea/tratamiento farmacológico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Queratomileusis por Láser In Situ , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Complicaciones Posoperatorias , Quinolinas/uso terapéutico , Claritromicina/uso terapéutico , Úlcera de la Córnea/microbiología , Quimioterapia Combinada , Femenino , Fluoroquinolonas , Humanos , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Moxifloxacino , Micobacterias no Tuberculosas/efectos de los fármacos , Micobacterias no Tuberculosas/aislamiento & purificación , Colgajos Quirúrgicos , Tobramicina/uso terapéuticoRESUMEN
BACKGROUND: The standard of care for penetrating keratoplasty (PKP) is either retrobulbar or peribulbar anesthesia combined with seventh cranial nerve akinesia or general anesthesia. These methods are known to be associated with rare but potentially serious adverse ocular and systemic events. PURPOSE: To determine the safety and efficacy of combined topical and intracameral anesthesia in addition to intravenous sedation for repeat penetrating keratoplasty (PKP). SETTING: Tertiary-care university hospital. METHODS: In this prospective study, combined topical tetracaine 0.5% and 0.2 cc intracameral 1% lidocaine along with i.v. sedation with midazolam and fentanyl were used for patients undergoing repeat PKP in 15 eyes of 15 selected patients. The indication for surgery was failed corneal graft. Verbal pain scale (VPS, 0-3) was recorded preoperatively, intraoperatively at 3 time-points (after trephination, after placing 8 interrupted sutures, and after placing the running suture), and postoperatively (1 hour postoperatively, overnight pain, and 1 day postoperatively). Patient and surgeon satisfaction were assessed postoperatively using a scale (1-5). After surgery patients were asked for their preferences comparing the current use of topical anesthesia compared with retrobulbar anesthesia used for their initial PKP. RESULTS: The mean intraoperative VPS score was 0.51 +/- 0.32 (range 0-1.33), and the mean postoperative VPS score was 0.47 +/- 0.50 (range 0-1.67). There were no serious intraoperative or postoperative complications. All patients reported high mean satisfaction score of 4.67 +/- 0.49 (range 4-5). The mean satisfaction score reported by the surgeon was 4.47 +/- 0.63 (range 3-5). All patients but 1 (93.3%) preferred combined topical over retrobulbar anesthesia, which they had in their previous surgery. CONCLUSIONS: We found combined topical and intracameral anesthesia to be safe and effective in our selected group of patients undergoing repeat PKP, and it may provide a satisfactory alternative anesthetic modality for patients in whom general, retrobulbar, or peribulbar anesthesia may be contraindicated.