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J Refract Surg ; 37(9): 582-589, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34506240


PURPOSE: To compare the efficacy of oral codeine plus acetaminophen versus oxycodone plus acetaminophen for severe pain control following photorefractive keratectomy (PRK). METHODS: This single-center trial randomized 200 patients to receive codeine 30 mg/acetaminophen 325 mg (codeine group) or oxycodone 5 mg/acetaminophen 325 mg (oxycodone group)every 4 hours as needed for severe pain for 4 days following PRK. Patients recorded postoperative pain, tablet consumption, and tetracaine use. Patients were monitored at postoperative 1 day, 1 week, and 1, 3, and 6 months for visual acuity and follow-up. Study outcomes were mean postoperative pain, treatment and tetracaine use, and visual acuity. RESULTS: Analysis of 197 patients who completed the trial (97 codeine group and 100 oxycodone group) showed mean pain scores were lower in the codeine group throughout the intervention period. Mean pain scores were higher in the oxycodone group than the codeine group on postoperative days 2 and 4 (P = .017 and P = .034, respectively). The oxycodone group consumed more tablets than the codeine group, with a difference on postoperative day 2 (P = .019), and used a greater number of tetracaine drops (P = .015). Repeated measures analysis of variance showed significant improvement in visual acuity in both groups with no difference in visual outcomes (P = .81). CONCLUSIONS: Codeine/acetaminophen is as effective and safe as oxycodone/acetaminophen for pain control following PRK, with no clinical difference in overall pain control and long-term visual outcomes. This implies that treating postoperative pain after PRK with a Schedule III opioid (codeine) is effective and potentially decreases the risk of misuse by a higher regulated Schedule II opioid (oxycodone), lowering the potential for abuse and dependence. [J Refract Surg. 2021;37(9):582-589.].

Oxicodona , Ceratectomia Fotorrefrativa , Codeína , Método Duplo-Cego , Humanos , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos
J Burn Care Res ; 42(5): 1023-1025, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-33528572


An 18-year-old woman developed Stevens-Johnson syndrome (SJS) with ocular involvement after taking ibuprofen. She was admitted to another hospital, received saline flushes and bacitracin ophthalmic ointment to the eyes, and became unable to open them. Upon transfer to this burn center 3 weeks after symptom onset, there was complete fusion of both eyelids with no visible cornea or sclera. She underwent bilateral operative scar release. After opening the lids, meticulous debridement of cicatricial membranes and release of symblephara were performed with subsequent placement of amniotic membrane grafts. Her vision slowly improved, though her long-term visual prognosis remains guarded. Early recognition and treatment of SJS or toxic epidermal necrolysis (TEN) with ocular involvement is imperative. Even mild cases may require intensive topical lubrication, steroids, and antibiotics, with early placement of amniotic membrane grafts in severe cases. Prompt intervention and daily evaluation are paramount in preventing lifelong visual disability.

J Cataract Refract Surg ; 45(11): 1612-1618, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31585850


PURPOSE: This study sought to assess the frequency of refractive surgery complications in HIV+ individuals and related risk factors. SETTINGS: Multiple centers in the United States. DESIGN: Prospective observational cohort study. METHODS: The U.S. Military HIV Natural History Study is a prospective observational cohort study of HIV+ service members and beneficiaries. Participants were selected who had Current Procedural Terminology codes for laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and other refractive surgeries. The frequency of complications was determined using International Classification of Diseases-9 codes. Covariates included age, sex, antiretroviral therapy, time since HIV diagnosis, history of AIDS, and CD4 (T lymphocytes) count and viral load. Statistical analysis was completed using univariate (χ2 and Wilcoxon-Mann-Whitney tests) and multivariate analyses. RESULTS: Seventy-nine of 2073 participants had refractive surgery. Fifty-three patients underwent PRK, 23 LASIK, 2 radial keratotomy (RK), and 1 astigmatic correction. Complications occurred in 6 (7.6%) of 79 participants, including 5 patients who underwent PRK and 1 after RK, occurring between 8 and 217 days after surgery. Five ulcers and 1 unspecified keratitis were noted. In the univariate analysis, type of surgery (P = .02) and history of AIDS (P = .02) were risk factors for complications. In logistic regression analysis, no variables were found to be risk factors for complications. CONCLUSION: Complications were infrequent among HIV+ participants after refractive surgery. Point estimates suggest that PRK might have more complications than LASIK and that advanced HIV, reflected by previous AIDS, might be associated with an increased risk for complications. Further study will be required to confirm these findings.

Córnea/cirurgia , Infecções por HIV/complicações , HIV , Lasers de Excimer/uso terapêutico , Militares , Miopia/cirurgia , Ceratectomia Fotorrefrativa/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miopia/complicações , Estudos Prospectivos , Fatores de Risco , Estados Unidos , Acuidade Visual
J Cataract Refract Surg ; 44(9): 1155-1157, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30055957


A 24-year-old man was involved in a high-velocity motor vehicle accident with polytrauma 2 years after implantation of a copolymer phakic IOL (pIOL) (Visian ICL). After being released from the intensive care unit, he reported decreased vision, pain, glare, and photophobia and was treated for hyphema without globe rupture. He was found to be aniridic during anterior chamber washout of the hyphema. In the first reported case, to our knowledge, of aniridia after pIOL placement, blunt trauma likely caused expulsion of the iris through dehiscence of the previously placed wound for pIOL implantation.

Acidentes de Trânsito , Traumatismos Oculares/etiologia , Iris/lesões , Traumatismo Múltiplo/etiologia , Lentes Intraoculares Fácicas , Ferimentos não Penetrantes/etiologia , Remoção de Dispositivo , Traumatismos Oculares/cirurgia , Traumatismos Cranianos Fechados/etiologia , Humanos , Pressão Intraocular/fisiologia , Implante de Lente Intraocular , Lesão Pulmonar/etiologia , Masculino , Traumatismo Múltiplo/cirurgia , Fraturas Orbitárias/etiologia , Fraturas da Coluna Vertebral/etiologia , Acuidade Visual/fisiologia , Ferimentos não Penetrantes/cirurgia , Adulto Jovem