Asunto(s)
Glaucoma/terapia , Mitomicina/uso terapéutico , Trabeculectomía/métodos , Niño , Endoftalmitis/microbiología , Endoftalmitis/prevención & control , Humanos , Masculino , Educación del Paciente como Asunto , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
We report a case of acute angle-closure glaucoma 1 year after hyperopic laser in situ keratomileusis (LASIK). The glaucoma was resolved with laser iridotomy, and a prophylactic iridotomy was performed in the fellow eye. Corneal topography was performed 2, 5, and 18 weeks after the acute episode. A myopic shift occurred after the episode and resolved within 3 months. Hyperopic patients with narrow angles are at risk for angle closure and should be carefully monitored.
Asunto(s)
Córnea/cirugía , Glaucoma de Ángulo Cerrado/etiología , Hiperopía/cirugía , Queratomileusis por Láser In Situ/efectos adversos , Enfermedad Aguda , Córnea/patología , Topografía de la Córnea , Femenino , Glaucoma de Ángulo Cerrado/patología , Glaucoma de Ángulo Cerrado/cirugía , Humanos , Hiperopía/patología , Presión Intraocular , Iris/cirugía , Terapia por Láser , Persona de Mediana Edad , Agudeza VisualRESUMEN
PURPOSE: To eliminate stress as a variable in assessing the frequency of the oculocardiac reflex during laser in situ keratomileusis (LASIK). SETTING: Merida Ophthalmological Hospital and Oftalmedica, Mexico City, Mexico. METHODS: A pulse oximeter registered the heart rate of 30 sedated patients having LASIK. Sedation was accomplished with a combination of midazolam and fentanyl. The heart rate was noted before and during suction. The results in 1 eye of each patient were recorded. Oculocardiac reflex was defined as a decrease of 10% or more of the basal heart rate. RESULTS: Fourteen patients (46.7%) had a 10% or more decrease in heart rate when suction was applied. Ten of the 14 had a decrease in heart rate between 10% and 19%, 3 between 20% and 29%, and 1 of more than 30%. Two patients (6.6%) had an increase in the basal heart rate of more than 10%. CONCLUSIONS: The findings suggest that the oculocardiac reflex occurs more frequently in sedated patients than in nonsedated patients.
Asunto(s)
Anestésicos Combinados/efectos adversos , Bradicardia/inducido químicamente , Sedación Consciente/efectos adversos , Córnea/cirugía , Queratomileusis por Láser In Situ , Miopía/cirugía , Reflejo Oculocardíaco , Adulto , Anestésicos Intravenosos , Femenino , Fentanilo/efectos adversos , Frecuencia Cardíaca , Humanos , Masculino , Midazolam/efectos adversos , OximetríaRESUMEN
PURPOSE: To evaluate the occurrence of oculocardiac reflex during laser in situ keratomileusis (LASIK). SETTING: Merida Ophthalmological Hospital, Mexico City, Mexico. METHODS: This study included 20 patients who were given an electrocardiogram prior to, during, and after LASIK. Heart rate was noted before the procedure and during the preparation, placement of the patient under the microscope light, blepharostat application, and suction and laser treatment. The results in 1 eye of each patient were recorded. RESULTS: In 4 of the 20 patients (20%), the heart rate decreased during suction. In 2 of the 4, the decrease was 30% of baseline. In an additional 4 patients (20%), the heart rate increased more than 20% of baseline. This increase was detected prior to application of the suction ring. In the remaining 12 patients (60%), the heart rate did not change. CONCLUSIONS: Electrocardiographic changes compatible with oculocardiac reflex occurred in 20% of patients in this study. The same percentage showed an increase in heart rate attributable to surgical stress.
