ABSTRACT
Objetivo do estudo: avaliar se a titulação de drogas guiada pelo índice bispectral em pacientes submetidos à cirurgia oftalmológica ambulatorial está associada a uma redução no tempo de alta. Método: foram selecionados 111 pacientes submetidos a procedimentos oftalmológicos realizados sob sedação intravenosa associada ao bloqueio peribulbar. Ospacientes foram randomizados em dois grupos. Nos pacientes do grupo controle, o anestesista responsável administrou a sedação de acordo com parâmetros clínicos: manter o paciente entre 2 a 4 pontos na escala de sedação de Ramsay. No outro grupo, o índice bispectral foi monitorizado e a sedação foi administrada para manter os valores entre 70 e 85. Foram comparados entre os grupos os dados demográficos, a dosagem de drogas, a duração dos procedimentos, as complicações pós-operatórias e o tempo de alta. Resultados: os grupos não apresentaram diferenças estatísticas em relação aos dados demográficos, à dosagem das drogas intravenosas e à dose administrada de anestésico local. Não se observou diferença entre os grupos em relação à duração dos procedimentos e ao tempo de alta para casa. As complicações pós-operatórias detectadas foram náuseas e vômitos e dor pós-operatória, no entanto, sem diferença estatística significante entre os grupos. Conclusões: a monitorização com o índice bispectral não foi mais eficaz que à monitorização clínica, em reduzir o tempo de alta para casa de pacientes submetidos a cirurgias oftalmológicas ambulatoriais sob sedação e bloqueio peribulbar.
Study objective: assessing whether drug titration guided by the bispectral index in patients submitted to outpatient ophthalmological surgeries is associated with a decreased time of hospital discharge. Method: one hundred and eleven patients submitted to outpatient ophthalmological procedures performed under intravenous sedation associated with peribulbar block were selected for this study. Patients were randomized in two groups. In the control group, the anesthetist in charge administered sedation according to clinical parameters: maintaining the patient between 2 and 4 points in the Ramsay?s sedation scale. In the other group, the bispectral index was monitored and sedation was performed with the purpose of maintaining its values between 70 and 85. Demographic data, drug dosage, length of procedures, post-surgical complications and time of hospital discharge were compared between the two groups. Results: groups have not shown statistical differences regarding demographic data, dosage of intravenous drugs and the dosage of local anesthetic administered. No difference was observed between groups regarding the length of the procedures, and the time of hospital discharge. The post-surgical complications detected were nausea and vomiting and post-surgical pain, however, with no statistically significant difference between groups. Conclusions: bispectral index monitoring has not been more effective than clinical monitoring to reduce the time of hospital discharge of patients submitted to outpatient ophthalmological surgeries under sedation and peribulbar block.
Subject(s)
Ophthalmologic Surgical Procedures , Anesthesia Recovery Period , Consciousness Monitors/statistics & numerical data , Anesthesia, Intravenous/methods , Patient Care Team , Patient Discharge , Electromyography , Ambulatory Care , Anesthesia, GeneralABSTRACT
BACKGROUND: The purpose of this study was to determine any difference in dynamic contour tonometry and ocular pulse amplitude in asymmetric glaucoma patients with the same applanation intraocular pressure. METHODS: This is a prospective, observational study of 30 glaucoma patients and 11 controls from June 2007 to February 2008. Most of the glaucoma patients were on prostaglandin analog treatment. RESULTS: Mean applanation intraocular pressure in the control group was 14.28 mmHg for the right eye and 14.10 mmHg for the left eye (P > 0.05). Corneal thickness was 519.10 µm for the right eye and 511.07 µm for the left eye (P > 0.05). Mean dynamic contour tonometry intraocular pressure was 17.28 mmHg for the right eye and 17.25 mmHg for the left eye (P > 0.05). Mean ocular pulse amplitude was 2.80 mmHg for the right eye and 2.92 mmHg for the left eye (P > 0.05). CONCLUSION: No differences in ocular pulse amplitude were found between the two groups and between the worst and the best eye. In spite of there being no difference in ocular pulse amplitude, dynamic contour tonometry intraocular pressure was 2.44 mmHg higher in the worst eye than in the best eye in the glaucoma patients, even with the same applanation intraocular pressure. Further studies are needed to confirm if this difference is related to glaucoma progression or a worst prognosis and whether it can be considered to be a new risk factor.
ABSTRACT
Ocular melanomas correspond to 5% of all melanomas and 85% of them have its origin in the uveal tract. Uveal melanoma is the most common primary intraocular malignant tumor in the adult. In this article, a case of uveal melanoma in a 31 year-old female patient, with photopsia, hyperemia and low visual acuity in the left eye with evolution of 4 months is presented. In the ophthalmologic examination, visual acuity was lower than 20/400, a large tumoral mass was noted at the nasal region behind the iris with anterior lens displacement, anterior chamber narrowing and serous retinal detachment. The ocular echography suggested a large tumoral mass as a choroidal melanoma extending to the ciliary body. The confirmation diagnosis was possible through the histopathologic examination.
Subject(s)
Choroid Neoplasms/diagnosis , Ciliary Body , Melanoma/diagnosis , Adult , Choroid Neoplasms/pathology , Choroid Neoplasms/surgery , Ciliary Body/pathology , Eye Enucleation , Female , Humans , Melanoma/pathology , Melanoma/surgery , Neoplasm Invasiveness , Visual AcuityABSTRACT
PURPOSE: The purpose of this study was to compare travoprost (TRAV; travoprost 0.004%) and the fixed-combination of dorzolamide/timolol (DTFC; dorzolamide 2.0%/timolol maleate 0.5%) ophthalmic solutions for reducing intraocular pressure (IOP) in patients with primary open-angle glaucoma (OAG) or ocular hypertension (OHT). METHODS: This was a randomized single masked, study with parallel controls. The TRAV group (n = 29) dosed once daily at 9:00 PM while the DTFC group (n = 27) dosed twice daily at 9:00 AM and 9:00 PM. IOP was measured at baseline, and following 3 weeks and 6 weeks of treatment at 8:00 AM, 12:00 PM, 4:00 PM, and 8:00 PM. RESULTS: Mean average IOP reductions from baseline during the course of the day were 7.5 (32.7%) and 7.1 (30.7%) mmHg for TRAV and 4.8 (23.1%) and 4.5 (21.7%) mmHg for DTFC at 3 weeks and 6 weeks, respectively. The greater IOP reduction for patients receiving TRAV was statistically significant at both the 3 and 6 week visits when averaged across all four time points (p < 0.01). The two products were well-tolerated over the course of the 6 week study. Some factors such as taste perversion were reported more often in the DTFC group. CONCLUSIONS: Travoprost monotherapy provided better efficacy in terms of IOP reduction and percentage of IOP reduction compared to dorzolamide 2.0%/timolol maleate 0.5% fixed combination.
Subject(s)
Cloprostenol/analogs & derivatives , Glaucoma, Open-Angle/drug therapy , Ocular Hypertension/drug therapy , Sulfonamides/therapeutic use , Thiophenes/therapeutic use , Timolol/therapeutic use , Cloprostenol/adverse effects , Cloprostenol/therapeutic use , Drug Combinations , Female , Glaucoma, Open-Angle/physiopathology , Humans , Intraocular Pressure/drug effects , Male , Middle Aged , Ocular Hypertension/physiopathology , Ophthalmic Solutions/administration & dosage , Single-Blind Method , Sulfonamides/adverse effects , Thiophenes/adverse effects , Timolol/adverse effects , TravoprostABSTRACT
OBJETIVO: Comparar a eficácia entre duas modalidades de tratamento das abrasões corneanas após a retirada de corpo estranho da córnea: curativo oclusivo e sem curativo. MÉTODOS: Cinqüenta e quatro pacientes com abrasão corneana após retirada de corpo estranho foram randomizados, de forma alternada, em dois grupos: um grupo com curativo oclusivo e o outro sem curativo. Os pacientes foram avaliados diariamente até a cura, em relação aos seguintes parâmetros: área da abrasão corneana, intensidade de dor, presença de fotofobia, lacrimejamento, sensação de corpo estranho e visão turva. RESULTADOS: Não houve diferença estatisticamente significativa entre os dois grupos quanto a: área da abrasão corneana, tempo para se obter a cura, dor, fotofobia, lacrimejamento, sensação de corpo estranho e visão turva. Não ocorreu nenhuma complicação ocular ou sistêmica durante o tratamento em ambos os grupos. CONCLUSAO: Abrasão corneana após retirada de corpo estranho, menor que 9 mm² , pode ser tratada apenas com antibiótico tópico de largo espectro e colírio cicloplégico, sem a necessidade do curativo oclusivo, tornando o tratamento mais simples e menos dispendioso.
