Inadvertent intracorneal injection of local anesthetic during lid surgery.

PURPOSE: To report a case of inadvertent intracorneal injection of anesthetic agents during lid anesthesia and corneal penetration without full-thickness perforation. METHOD: Case report. RESULTS: Corneal edema with acute loss of vision was noted. The patient was treated with topical, antibiotic, cycloplegic, hyperosmotic agent and lubricant. While the edema slowly subsided, a loss in endothelial cell count was noted. CONCLUSIONS: The effects of intracorneal injection of lignocaine, bupivacaine, and its preservatives have not previously been reported in the literature. A lower postinjection endothelial cell count and associated clinical features in our case indicate that endothelial toxicity occurred. This potential complication should be kept in mind with necessary precautions taken during injection of the eyelid, particularly in cases with preexisting lid laxity.

Severe acute corneal hydrops in a patient with Down syndrome and persistent eye rubbing.

We report a case of severe acute corneal hydrops in an 11-year-old boy with keratoconus associated with Down syndrome and vigorous eye rubbing. Complete resolution of the corneal edema and a central corneal scar was seen in the 8th week of final follow-up. Eye-rubbing may play a role in the pathogenesis of acute hydrops, and conventional therapy can be successful in its management, even in severe cases.

Uso del cloruro de sodio al 5 en el tratamiento del edema corneal / Use of the sodium chlorides 5

En el presente estudio se evalúo la eficacia del cloruro de sodio al 5 por ciento en solución para reducir o eliminar el edema corneal de diversas etiologías, como cirugía de catarata, presión intraocular elevada y distrofias corneales. También se analiza la tolerancia al medicamento. El estudio se dividió en una fase experimental y otra clínica. Durante la primera fue aplicado el medicamento en ojos de conejo para valorar la irritabilidad. En la fase clínica se incluyeron 56 pacientes; 23 de ellos fueron asignados al azar para ser tratados con cloruro de sodio al 5 por ciento, y los otros 23 se usaron como grupo control y fueron tratados con solución salina al 0.9 por ciento. Los resultados del estudio demuestran que el cloruro de sodio al 5 por ciento es bien tolerado tanto en conejos como en humanos. Los pacientes tratados con cloruro de sodio al 5 por ciento mostraron disminución del edema corneal en un 91.3 por ciento y sintomatología en 87 por ciento de los casos. Estos resultados justifican el uso clínico del cloruro de sodio al 5 por ciento para el control sintomático del edema corneal leve a moderado.

The effects of UW solution and its components on corneal thickness during and after storage.

The ability of rabbit corneas to undergo energy-dependent deturgescence was examined after the corneas were stored at 4 degrees C in UW solution, M-K media, or selected modifications of these media. All corneas slowly increased in thickness during storage, despite the presence of colloidal osmotic agents. Corneas stored for 2.5 days in M-K became slightly thinner when cultured over a 24-hour period. Corneas stored in UW swelled quickly in culture and became too opaque to measure within three hours. Corneas stored in UW with 1.8 mM CaCl2 swelled transiently, then maintained their thickness and exhibited deturgescence in the latter stages of the culture period. Deturgescence of corneas stored for 7 days in M-K was only slightly worse than those stored for 2.5 days. Corneas stored for 7 days in UW, however, became opaque almost immediately in culture and those stored in calcium-supplemented UW became opaque within 4.5 hours. Replacement of the dextran in M-K with hydroxyethyl starch produced a slower rate of corneal swelling during storage and a substantially better corneal deturgescence profile during culture. Use of high concentrations of potassium ion in the M-K formulation had no significant effect on post-storage deturgescence. Replacement of glucose in M-K with the impermeable sugar, raffinose had a slight deleterious effect on corneal deturgescence in subsequent culture. Use of the impermeable anions gluconate or lactobionate to replace chloride ion caused profound corneal swelling during culture, compared with those stored in M-K. These experiments show that UW solution is inferior to M-K at preserving post-storage corneal function.(ABSTRACT TRUNCATED AT 250 WORDS)

pH, ionized calcium and osmotic artifacts can affect determination of rabbit corneal deturgescence in vitro.

Freshly isolated stroma-endothelial preparations were perfused with a glucose, adenosine and glutathione-supplemented Ringer solution at 37 degrees C at a hydrostatic pressure of 20 cm H2O. The composition (tCO2, pH, Ca2+ and osmolality) of the stromal-side bathing solution was analyzed during a 90-min equilibration period during which this solution was covered or deliberately left open to the atmosphere. If exposed to the atmosphere, even for a few minutes, substantial changes in pH, osmolality and ionized calcium occurred such that, when silicone oil was subsequently applied to the stromal surface, significant increases in both the rate and amplitude of deturgescence were observed. The rates and amplitude were proportional to the corneal thickness prior to silicone oil application. The results further indicate that the physicochemical state of the stroma is an important determinant in the corneal deturgescence mechanism.