Do Consecutive Phacoemulsification Surgeries Under Topical Anesthesia Differ in Terms of Pain Perception and Cooperation?

Background Although intraoperative ocular pain has been investigated extensively in the literature, few studies have evaluated the pain perception between consecutive surgeries. Determining the facts about pain perception during phacoemulsification will allow surgeons to decide the type of anesthesia that best fits the patient when planning the contralateral cataract surgery. The aim of this study was to determine the level of pain perception, factors affecting pain perception, level of patient cooperation, and perception of operation time during consecutive phacoemulsification surgeries. Methodology This study included 314 eyes of 157 patients with bilateral senile cataracts who underwent phacoemulsification surgery under topical anesthesia with an interval of no more than six months. All patients underwent complete ophthalmic examination. Operation time, phaco time, surgeon's comfort, and patient's cooperation were recorded. Immediately after the operation, the patients graded the pain they experienced via the Visual Analogue Scale (VAS) from 0 to 10 and estimated the operation time. Results The mean VAS score was 0.88 ± 0.97 for the first eye and 1.50 ± 1.27 for the second eye (p < 0.011) surgery. The perception of the mean operation time was significantly lower in the first eye surgery (p < 0.001), even though the real objective operation time and phaco time were lower in the second eye surgery. The surgeon reported significantly more comfort during the first eye surgery. VAS was found to be positively correlated with nonsteroidal anti-inflammatory drug use, intraocular pressure, axial length, anterior chamber depth, central corneal thickness, phaco time, and operation time perception, and inversely correlated with best-corrected visual acuity and mature cataract morphology. Conclusions Consecutive phacoemulsification surgeries appear to differ not only in terms of pain perception but also operation time perception, patient cooperation, and surgeons' comfort. Determining and controlling the factors that can influence patients' pain perception and comfort will increase the safety of the contralateral surgery.

Decreased retinal nerve fiber and choroidal thickness in chronic rhinosinusitis.

PURPOSE: The assessment of the retina and choroid of patients with chronic rhinosinusitis (CRS), via spectral domain-optical coherence tomography (SD-OCT), was aimed in this study. We proposed that chronic upper airway restriction caused by chronic sinusitis could deteriorate the retinal and choroid morphology. METHODS: This prospective controlled study included a total of 90 eyes of 90 patients, 30 of whom were CRS with nasal polyposis (CRSwNP), 30 of whom were CRS without nasal polyposis (CRSsNP) and 30 of whom were healthy controls (HC). Only the right eye of the patients were evaluated. All patients underwent full otorhinolaryngologic and ophthalmologic examinations, including SD-OCT. RESULTS: Average retinal nerve fiber layer (RNFL) and RNFL in superior and inferior quadrants were measured significantly lower in CRS patients compared to HC. Ganglion cell-inner plexiform layer (GCIPL) thickness in all sectors was thinner in patients with CRS than in HC with significantly lower values in all sectors except inferior. Mean average GCIPL thickness and GCIPL thickness in the inferior sector were significantly lower in CRSwNP than CRSsNP patients. CONCLUSION: CRS may lead to thinning in the choroidal thickness, RNFL thickness, especially in the superior and inferior quadrants and GCIPL thickness, presumably related with hypoxia, endothelial dysfunction, inflammation and vascular dysregulation. Ocular manifestations of the CRS should be taken in the consideration during the management of this disease.

Anterior Chamber Paracentesis Offers a Less Painful Experience During Intravitreal Anti-vascular Endothelial Growth Factor Administration: An Intraindividual Study.

INTRODUCTION: In order to improve comfort and compliance to treatment of the patient during the intravitreal injections (IVIs), relieving pain may help and provide getting better results. The purpose of the study was to evaluate the efficacy of anterior chamber paracentesis on pain perception and the factors related to pain perception during intravitreal injection procedures. MATERIAL AND METHODS: This prospective randomized study includes 212 eyes of 106 patients scheduled for bilateral IVI of ranibizumab 0.5 mg/0.05 cc under topical anesthesia. All patients underwent full ophthalmologic examination, including intraocular pressure (IOP), anterior chamber depth (ACD), and axial length (AL) measurements. Group 1 received IVI following anterior chamber paracentesis (ACP) and group 2 received IVI without ACP. Intraocular pressure was measured five minutes and 30 minutes after the procedure. Pain perception was assessed by visual analogue scale (VAS) grading from 0 to 10. RESULTS: Mean VAS score for groups 1 and 2 was recorded as 0.51±1.00 and 1.32±1.50, respectively. Correlation analysis revealed a positive correlation between VAS score and history of previous IVI, preinjection IOP values, and an inverse correlation with the presence of reflux in both groups, in addition to inverse correlation with ACD in group 2. CONCLUSIONS: ACP may offer a comfortable, effective, and less painful alternative to prevent the acute rise in IOP after IVI, especially in patients with small anterior chambers, small vitreous volumes, with a history of multiple injections, and in patients with advanced glaucomatous optic neuropathy.

Salvage of the retinal ganglion cells in transition phase in Alzheimer's disease with topical coenzyme Q10: is it possible?

PURPOSE: The evaluation of the short-term effect of topically applied coenzyme Q10 (CoQ10) on retina and choroid in Alzheimer's disease (AD) was aimed in this study. METHODS: Randomized controlled study included a total of 93 patients, 62 of whom with AD. Thirty (32.3%) AD patients received treatment (Group 1), 32 (34.4%) AD patients observed without treatment (Group 2), and Group 3 included 31 (33.3%) healthy controls (HC). Neurological and ophthalmological examinations including optical coherence tomography (OCT) were executed. RESULTS: Retinal nerve fiber layer (RNFL) thickness in all quadrants increased following CoQ10 treatment in Group 1; however significant rise yielded in average and temporal quadrant RNFL thickness. Average and superonasal sector ganglion cell-inner plexiform layer (GCIPL) thickness increased significantly following CoQ10 treatment. The correlation analysis between difference in pre- and posttreatment OCT values in Group 1 revealed that rise in average RNFL thickness was inversely correlated with duration of the disease and rise in average GCIPL thickness and superonasal sector thickness was inversely correlated with severity of the disease. CONCLUSION: Short-term topical CoQ10 resulted in improvement in AD related retinal ganglion cell (RGC) loss which may reflect the salvage of some RGCs in the reversible transitional phase. More bioavailability through intravitreal route of administration and longer duration of effect with sustained release forms may possibly help enhalting the RGC loss, especially incipience of neurodegenerative diseases.

Intraocular pressure changes associated with tracheal extubation: Comparison of sugammadex with conventional reversal of neuromuscular blockade.

OBJECTIVE: To compare the effects of neostigmine/atropine combination and sugammadex on intraocular pressure during tracheal extubation period. METHODS: The single-blind prospective randomised controlled study was conducted at Ordu University Research and Training Hospital from August to October 2014, and comprised patients who were randomly assigned to 2 groups according to the agent used for reversal of neuromuscular blockade. Group N received 0.05mgkg-1 neostigmine and 0.02 mgkg-1 atropine and the patients in Group S received 2mgkg-1 sugammadex intravenously. Heart rate, mean arterial pressure and intraocular pressure were measured at baseline, before the induction (T1), after the application of reversal agent (T2), and 1 (T3), 3 (T4), 5 (T5) and 10 (T6) minutes after the extubation. SPSS 16 was used for statistical analysis. RESULTS: There were 36 patients in the study; 18(50%) in each group. There was no significant difference between the groups in terms of age, gender and body mass index (p>0.05 each). Intraocular pressure was significantly higher when the baseline level was compared with all measurement intervals in Group N (p<0.05 each). In Group S, it showed no significant difference at T2 (p>0.05) whereas it was significantly higher at all other measurement intervals (p<0.05 each). Intergroup comparisons showed statistically significant difference in heart rate and mean arterial pressure levels at T2 interval which were higher in Group N (p<0.01). Intraocular pressure levels at T2 and T3 intervals were significantly higher in Group N (p<0.01). CONCLUSIONS: Lower end-extubation intraocular pressure levels were obtained when sugammadex was used as a neuromuscular block reversal agent in comparison with neostigmine-atropine combination. Sugammadex may be a better option for the reversal of neuromuscular blockade and intraocular pressure increase should be avoided in patients with glaucoma or penetrating eye injury.

Comparison of Dexmedetomidine Versus Ketamine-Propofol Combination for Sedation in Cataract Surgery.

OBJECTIVE: The aim of this study is to compare the sedative properties and haemodynamic and respiratory effects of dexmedetomidine and a ketamine-propofol combination (ketofol), which are expected to have minimal effects on spontaneous breathing. METHODS: Sixty patients were enrolled in this prospective randomised study. Patients were divided into 2 groups according to the administration of dexmedetomidine (Group D) and ketofol (Group K). Target sedation level was determined as a Ramsay Sedation Score of 3. In Group D, 0.5 mcg kg(-1) dexmedetomidine was administered via intravenous route in 10 minutes versus 0.125 mL kg(-1) of a solution containing 200 mg propofol and 100 mg ketamine in Group K. Haemodynamic and respiratory effects, postoperative awakening time, analgesic properties and satisfaction levels of the patients and surgeon were assessed. RESULTS: There was a statistically significant decrease in mean arterial pressures following drug administration compared to initial measurements in both groups. However, there was a statistically significant decrease in heart rate only in Group D. There was no significant difference between the two groups regarding respiratory rate and protection of spontaneous respiration. Although the time for Aldrete score to be 9 was 16.1 minutes for Group K, it was 24.9 minutes for Group D, and this difference was statistically significant (p<0.01). There was no significant difference between the two groups regarding adverse effects, pain scores and satisfaction levels of the patients and surgeon. CONCLUSION: Compared to dexmedetomidine, at similar sedation levels, sedation provided by ketofol enables satisfactory analgesia. Moreover, ketofol has a more rapid onset of action and a shorter recovery period from anaesthesia without causing significant haemodynamic or respiratory adverse effects.

Endoscopic intranasal surgery for congenital nasolacrimal duct obstruction--a new approach.

OBJECTIVE: Congenital nasolacrimal duct obstruction can be treated with a spectrum of techniques, starting with conservative massage to more invasive dacryocystorhinostomy. There has been controversy regarding the optimal treatment procedure. We introduced a unique technique to treat congenital nasolacrimal duct obstruction and analyzed its success rate and complications. METHODS: In a retrospective study, we introduced the results of our technique. This technique consisted of endoscope guided inspection of the Hasner valve area, trial of irrigation, incision of the imperforate Hasner valve and irrigation again. If these maneuvers were not effective, more invasive procedure, probing under endoscopic control was done. RESULTS: 48 children (55 eyes) were included in the study. Complete improvement was achieved in 51/55 eyes (92.72% success rate). We did not encounter any early or late complication. CONCLUSIONS: The great majority of the congenital nasolacrimal duct obstruction stem from Hasner valve area pathologies. The endoscopic intervention of this area is very effective and safe way of treatment. This technique should be added to the armamentarium of the congenital nasolacrimal duct obstruction treatment.