Operating conditions for ocular surgery under general anaesthesia: an eccentric problem.

PURPOSE: To describe and examine the observation that eccentric eye positions may develop under certain general anaesthetic conditions and negatively impact upon operating conditions during ocular surgery. METHODS: A case series description with historical review followed by a 2-week prospective observational survey examining the general anaesthetic techniques utilized during ocular surgery and the associated development of an eccentric eye position. RESULTS: A total of 52 cases were studied, of which four developed eccentric eye positions. 50% of patients received effective muscle relaxation. Without muscle relaxants, the incidence of eccentric eye positioning was 18%. CONCLUSIONS: Eccentric ocular positions are likely to occur in light planes of general anaesthesia. In the case of ocular surgery, this phenomenon may create surgical difficulty and increase the risk of complication and patient morbidity. Arguments for the planned use of balanced general anaesthesia with non-depolarizing muscle relaxants are presented.

Vitrectomy for phacolytic glaucoma in a patient with ectopia lentis et pupillae.

This case report highlights the successful management, by vitrectomy alone, of a case of chronic phacolytic glaucoma secondary to a dislocated hypermature lens in the vitreous of a patient with ectopia lentis et pupillae (ELP). The features and complications of ELP are discussed.