Effects of a Novel Erectogenic Condom on Men and Women's Sexual Pleasure: Randomized Controlled Trial.

We tested whether CSD500 (Futura Medical; Guildford, UK), a novel condom containing erectogenic gel designed to increase penile firmness, penile size, and erection duration, results in greater sexual pleasure. In 2017-2020, we randomized heterosexual couples in Thanh Hoa, Vietnam to use CSD500 (N = 248) or standard condoms (N = 252) and followed them up for six months. Women completed the Quality of Sexual Experience (QSE) scale; men completed the QSE, Sexual Experience Questionnaire (SEX-Q), and 11 condom acceptability items. Female participants' mean age was 32.1 years (SD = 0.24; range 21-46). QSE scores were higher among women (B, 0.12; 95% CI, 0.03-0.21) and men (B, 0.21; 95% CI, 0.08-0.35) in the CSD500 relative to the control arm. SEX-Q scores were higher among men in the CSD500 compared to the control arm (B, 3.22; 95% CI, 1.53-4.91). Higher proportions of men in the CSD500 relative to the control arm reported the condom felt "natural" during sex (68.6% vs. 32.3%; p < .01) and that sex with the condom felt "a lot better" than condomless sex (15.5% vs. 5.3%; p < .01). Compared with standard condoms, CSD500 use was associated with higher reports of sexual pleasure and condom acceptability.

Changes in the sarcoplasmic reticulum and transverse tubular system of fast and slow skeletal muscles of the mouse during postnatal development.

The sarcoplasmic reticulum (SR) and transverse tubular system (TTS) of a fast-twitch muscle (extensor digitorum longus-EDL) and a slow-twitch muscle (soleus-SOL) of the mouse were examined during postnatal development. Muscles of animals newborn to 60 days old were fixed in glutaraldehyde and osmium tetroxide and examined with an electron microscope. At birth the few T tubules were often oriented longitudinally, but at the age of 10 days most of them had a transverse orientation. In the EDL, the estimated volume of the TTS increased from 0.08% at birth to 0.4% in the adult; corresponding values for the SOL were 0.04% at birth and 0.22% in the adult. A similar relative change was observed in surface area of the TTS during development. Calculated on the basis of a 30 microm diameter fiber, the surface area of the TTS in the EDL increased from 0.60 cm(2) TTS/cm(2) fiber surface in the newborn to 3.1 cm(2)/cm(2) in the adult, compared with 0.15 cm(2)/cm(2) at birth to 1.80 cm(2)/cm(2) in the adult for the SOL. The SR in the newborn muscles occurred as a loose network of tubules that developed rapidly within the subsequent 20 days, especially at the I band level. The volume of the SR increased in the EDL from 1.1% of fiber volume at birth to 5.5% in the adult. In the SOL the change was from 1.7% to 2.9%. The SOL approached the adult values more rapidly than the EDL, although the EDL had more SR and T tubules. Fibers of both EDL and SOL muscles showed variation in Z line thickness, mitochondrial content, and diameter, but over-all differences between the two muscles in amount of SR and TTS were significant. It is considered that the differing amounts of SR and TTS are closely related to the differing speeds of contraction that have been demonstrated for these two muscles.

The universality of bioenergetic disease and amelioration with redox therapy.

Overt mitochondrial diseases associated with mitochondrial DNA mutations are characterized by a decline in mitochondrial respiratory function. Similarly, a progressive decline in mitochondrial respiratory function associated with mitochondrial DNA mutations is clearly evidenced in aged human subjects. This communication is concerned with the development of a rat model for the study of bioenergy decline associated with the ageing process and overt mitochondrial diseases. The model involves the treatment of young rats with AZT to induce skeletal and cardiac myopathies. It has shown that there is a decline in soleus muscle function in vivo and that this decline is mirrored in the capacity of heart sub-mitochondrial particles to maintain bioenergy function. Coenzyme Q10 and several analogs were administered with AZT as potential therapeutics for the re-energization of affected tissues. Coenzyme Q10 and especially decyl Q were found to be therapeutically beneficial by both in vivo improvement in soleus muscle function and in vitro cardiac mitochondrial membrane potential capacity. Sub-mitochondrial particles were also prepared from heart mitochondria of young and aged rats. The particles prepared from the aged rats were found to have a decreased ability to maintain membrane potential as compared to those derived from the young rats.

Effect of cross-reinnervation on physiological parameters and on properties of myosin and sarcoplasmic reticulum of fast and slow muscles of the rabbit.

Cross-reinnvervation of fast (extensor digitorum longus) and slow (soleus) twitch muscles of the rabbit showed essentially complete fast to slow and slow to fast conversion, respectively, 11-12 mo after surgery with respect to a number of physiological parameters including intrinsic shortening, velocity, and isometric twitch time to peak. There was pronounced bu incomplete biochemical conversion as judged by Ca2+ uptake by sarcoplasmic reticulum, myosin ATPase, alkali lability, and light chain complement. The question of trophic substances of neural origin is discussed in light of the fact that chronic stimulation for 15 wk of a fast muscle produces complete biochemical and physiological conversion to the slow type.

Retinal pigment epithelium transplantation: concepts, challenges, and future prospects.

The retinal pigment epithelium (RPE) is a single layer of cells that supports the light-sensitive photoreceptor cells that are essential for retinal function. Age-related macular degeneration (AMD) is a leading cause of visual impairment, and the primary pathogenic mechanism is thought to arise in the RPE layer. RPE cell structure and function are well understood, the cells are readily sustainable in laboratory culture and, unlike other cell types within the retina, RPE cells do not require synaptic connections to perform their role. These factors, together with the relative ease of outer retinal imaging, make RPE cells an attractive target for cell transplantation compared with other cell types in the retina or central nervous system. Seminal experiments in rats with an inherited RPE dystrophy have demonstrated that RPE transplantation can prevent photoreceptor loss and maintain visual function. This review provides an update on the progress made so far on RPE transplantation in human eyes, outlines potential sources of donor cells, and describes the technical and surgical challenges faced by the transplanting surgeon. Recent advances in the understanding of pluripotent stem cells, combined with novel surgical instrumentation, hold considerable promise, and support the concept of RPE transplantation as a regenerative strategy in AMD.

Surgical treatment for infarct-related ventricular septal defects. Improved early results combined with analysis of late functional status.

A total of 101 patients (mean age 64.9 years) underwent surgical correction of postinfarction ventricular septal defect at this institution over a 15-year period (1973 to 1988). The overall early mortality rate was 20.8%, although the most recent experience with 36 patients (January 1987 to October 1988) has seen this decline to 11.1%. Factors found to influence early death significantly, when analyzed univariately, were as follows: (1) site of infarction (anterior 12.1%, inferior 32.6%, p = 0.02); (2) time interval between infarction and operation (less than 1 week 34.1%, greater than 1 week 10.5%, p = 0.008); (3) cardiogenic shock (present 38.1%, absent 8.5%, p = 0.001). Nonsignificant variables included preoperative renal function, age, and concomitant coronary artery bypass, although older age (greater than 65 years) became significant when examined in a multivariate fashion. Of the 80 hospital survivors, eight were subsequently found to have a recurrent or residual defect necessitating reoperation, with survival in seven. Late follow-up is 99% complete and reveals an actuarial survival rate for 100 patients of 71.1% at 5 years (95% confidence interval 60.6 to 80.0), and 40.0% at 10 years (95% confidence interval 21.7 to 58.4). A significant recent change in policy of not using coronary angiography in patients with a ventricular septal defect caused by anterior wall infarction has not resulted in any increase in either the early mortality or in the late prevalence of angina. The functional status of 38 surviving patients has been analyzed by a graded treadmill exercise protocol, whereas left ventricular functional assessment was by nuclear scan with additional information on mitral valve function by echocardiogram. Color Doppler flow mapping has been used to determine the presence of a residual defect. Most late survivors have limited exercise tolerance related to both cardiac and noncardiac factors. Left ventricular function is moderately impaired (mean ejection fraction = 0.39). However, many patients are elderly and have adapted to their residual symptoms without significant changes in life-style.

Age-associated changes in the innervation of muscle fibers and changes in the mechanical properties of motor units.

In both humans and animals there is a progressive loss of muscle strength with age. Tests of handgrip and knee extension in men show that some decline in strength is evident by the age of 55 years and is pronounced by the age of 65, compared with the 25- to 35-year period when strength is at a maximum. A comparable age-related decline in peak force development has also been shown in hind-limb muscles of aged rats. Motoneurons and consequently motor units are lost with age, and this is apparent in man after the age of 60. Again, a comparable decline has been demonstrated in the motoneuron population of hindlimb muscles of rats aged 20-24 months. Loss of motoneurons in young adults (through either injury or disease) results in the remaining intact motoneurons sprouting to innervate the denervated fibers. This capacity for sprouting has been shown to be seriously impaired in the hindlimb muscles of aged rats. Furthermore, the well-established relationship between motor unit size and fatigability (smaller units tend to be more fatigue resistant) also tends to break down, with large units just as likely to be fatigable as fatigue resistant. The normally large, fatigable motor units also appear to be reduced in size in the aged muscles. The age-related loss of motoneurons and associated loss of muscle fibers accounts in part for the reduced functional capacity of muscle with age. The reason for the impairment of the aged motoneuron remains to be investigated, but it may relate to the integrity of the oxidative metabolic pathways within the cell, given that mitochondrial respiratory chain function is known to be reduced with age.

Force-velocity properties of fatigue-resistant units in cat fast-twitch muscle after fatigue.

The isometric and force-velocity properties of an identified and uniform population of fast-twitch, fatigue-resistant (FR) fibers within the flexor digitorum longus (FDL) muscle were investigated before, immediately after, and during recovery from a fatiguing repetitive isometric stimulus regime (40 Hz for 330 ms every s for 180 s) in the anesthetized cat. It was necessary to determine the smallest fraction of muscle that had the same force-velocity properties as the whole muscle. This was approximately 15% for FDL; if the fraction was less, the maximum speed of shortening was depressed and the a/Po value increased. Motor units were enlarged by partial denervation of the muscle, causing the intact motoneurons to sprout and incorporate more muscle fibers; FR units showed the greatest increase. Immediately after the fatigue regime, maximum isometric tetanic tension declined to 67% but subsequently recovered to 90% of the control value by the end of the 60-min recovery period. Maximum speed of shortening dropped to 71% of the control but after 30 min had recovered and did not differ significantly from control values. It is concluded that the capacity for recovery from fatigue is greater for FR units than for a whole muscle, which also contains fast-fatiguable units, and that the mechanisms involved in the recovery of the maximum isometric tension and maximum speed of shortening are independently regulated.

Contractile properties of cat skeletal muscle after repetitive stimulation.

The isometric and force-velocity properties of the fast-twitch flexor digitorum longus (FDL) and slow-twitch soleus muscles were investigated immediately after and during recovery from a fatiguing stimulus regime (40 Hz for 330 ms every second for 180 s) in the anesthetized cat. The amplitude of the isometric twitch of FDL was unaffected but in soleus it remained depressed for much of the recovery period. Immediately after stimulation the twitch time to peak of FDL increased to 140% of the control (prefatigue) value and then reverted to control values. The maximum isometric tetanic tension (Po) developed by FDL was reduced to 67% of control values immediately after the stimulus regime, whereas soleus declined to 93% of control. Recovery of maximum force development was achieved after 45 min in FDL and after 15 min in soleus. The maximum speed of shortening of FDL was reduced to 63% of control values immediately after fatigue; despite some recovery within the first 30 min, it remained depressed during the remainder of the recovery period (up to 300 min). Maximum speed of shortening was unaltered in soleus. The a/Po value transiently increased to 176% of control values in FDL immediately after the fatigue regime but promptly returned to control values. Force-velocity properties of soleus were not affected by the stimulus regime. It is concluded that in FDL changes in the maximum speed of shortening and maximum isometric tension as a result of the stimulus regime are attributable to changes in the intrinsic behavior of cross-bridges and the metabolic status of the fibers, particularly in the fast-twitch fatigue-resistant fibers.

Activity and motor unit size in partially denervated rat medial gastrocnemius.

The aim of the study was to determine whether increased motoneuron activity induced by treadmill walking would alter the extent of motoneuron sprouting in the partially denervated rat medial gastrocnemius muscle. An extensive partial denervation was effected by unilateral section of the L5 ventral root, and it is very likely that all units remaining in the medial gastrocnemius were used in treadmill walking. Rats were trained for 1.5 h/day and after 14 days were walking at least 1 km/day. Motor unit characteristics were determined 24 days after the partial denervation and were compared with units from partially denervated control (PDC) animals and with units from normal (control) animals. In PDC rats, force developed by slow, fast fatigue-resistant, and fast intermediate-fatigable motor units increased substantially compared with control animals; that of fast-fatigable units did not increase. In partially denervated exercised animals, force developed by slow and fast-fatigue-resistant units showed no further increase, but fast-intermediate- and fast-fatigable units showed significant increases compared with those in PDC animals. The changes in force were closely paralleled by changes in innervation ratios. We concluded that neuronal activity is an important factor in determining the rate of motoneuron sprouting.

Effect of vertical jumping on the medial gastrocnemius and soleus muscles of rats.

Ten rats were trained to perform approximately 30 jumps/day, 5 days/wk for at least 8 wk, from a force platform that enabled the number and height of jumps to be quantified. There was considerable variation in height jumped during an activity session both within and between rats. The two highest-jumping rats attained a displacement of center of mass of approximately 30 cm, estimated to be approximately 67% of the maximum attainable. The two lowest-jumping rats jumped to approximately 30% of the estimated maximum. The activity was described as "habitual activity" rather than "training" because there were no significant increases in the height of jumping by any rat over the period of activity. The isometric properties of medial gastrocnemius (MG) and soleus muscles were studied in terminal experiments on anesthetised rats. Five significant effects on MG were evoked by this pattern of exercise ("habituation"): 1) a 15-18% increase in force at frequencies of stimulation between 60 and 150 Hz and a 15% increase in maximum tetanic tension to 14.9 N, 2) a 3% increase in the maximum rate of rise of tetanic force to 3.4% of maximum tetanic tension per millisecond, 3) an increase in fatigability expressed as a smaller fatigue index in active rats (33%) than in controls (58%), 4) a decrease of 4% in the percentage of type IIa muscle fibers, and 5) an increase of 6% in the percentage of type II fibers that could not be classified with certainty as IIa or IIb.(ABSTRACT TRUNCATED AT 250 WORDS)

Alterations in the contractile properties of motor units within the ageing rat medial gastrocnemius.

The decline in muscle force accompanying senescence is associated with a loss of motor nerves which provides some opportunity for collateral reinnervation and alterations in the mechanical properties of surviving motor units. The contribution of the different motor unit types to this neuromuscular reorganization was investigated by determining the isometric contractile properties of single motor units within the medial gastrocnemius of rats aged 791 +/- 39 days. These were compared with a group of similarly isolated and classified units within young adult rats aged between four and five months. The estimated number of units decreased significantly from 93 +/- 28 in young adults to 66 +/- 19 in senescent animals. There was a preferential loss of fast motor units and a significant loss of myelinated axons within the muscle nerve. The maximum tetanic force developed by FF motor units decreased with age while that of the more fatigue resistant FI and FR motor units increased. Other contractile properties were unaltered and there was no change in any contractile parameter for S unit types. Alterations in the cross-sectional areas and proportions of histochemically classified muscle fibres reflected these changes. The proportion of FG fibres declined with age and there was evidence of denervation, particularly within the peripheral rim of fast type fibres. The number of muscle fibres within the medial gastrocnemius decreased with age. These results indicate that fast motor units are most severely affected during the early stages of senescence. Within this population the FF motor units which have the largest innervation ratios in the young adult may suffer preferential degeneration.

Effect of partial denervation on motor units in the ageing rat medial gastrocnemius.

The ageing neuromuscular system is thought to undergo a continual process of reorganization as motoneurones are lost and surviving motor nerves reinnervate neighbouring denervated muscle fibres. However, the extent to which collateral reinnervation is able to compensate for neural deficits in the ageing individual is unknown. The ability of the senescent motoneurone to increase the size of its peripheral field was therefore investigated following transection of the right L5 ventral root in male Sprague Dawley rats aged 775 +/- 50 days. This procedure resulted in an extensive partial denervation of the right medial gastrocnemius muscle. After a recovery period of between 28 and 31 days the isometric contractile properties of surviving motor units were compared to control motor units from both the contralateral muscle and a group of unoperated control animals aged 791 +/- 39 days. Motor unit force was found to be unchanged after partial denervation and the absence of any alteration in motor unit size was confirmed by histological analysis. However, the time course of the isometric twitch was significantly longer for both fast and slow motor unit types and the conduction velocity of motoneurones innervating fast units was decreased following partial denervation. These results demonstrate that senescent motor nerves are unable to substantially increase the size of their peripheral fields by extensive collateral reinnervation.

Survey of colour contrast sensitivity in non-ophthalmic users of blue-green wavelength argon lasers.

BACKGROUND: Previous studies have shown that ophthalmologists using blue-green argon laser may suffer subtle defects in their colour vision. A reduction in colour contrast sensitivity in the tritan colour confusion axis, an early manifestation of blue cone photoreceptor injury by the high energy photons of the laser, has been demonstrated and has prompted a reappraisal of laser safety in ophthalmology. Argon laser is also frequently used in scientific research, often at higher power output and for longer periods than is used in clinical practice. The scientists operating these lasers are at risk of developing similar phototoxic retinal injury. METHODS: The colour contrast sensitivity of 18 scientists who regularly use short wavelength argon laser was investigated. RESULTS: Eye protection was infrequently used and individuals had been subjected to between 580 and 7200 hours of cumulative laser exposure during the course of their research. CONCLUSION: The use of blue-green argon laser by the scientists investigated was not associated with a significant reduction in colour contrast sensitivity.

The effect of pilocarpine on the glaucomatous visual field.

Patients with chronic open angle glaucoma are traditionally managed by medical therapy during the early stages of the disease. Pilocarpine is a well established topical agent, but suffers troublesome sequelae, the most apparent of which is pupillary constriction. This study assesses the effect of miosis (produced by one drop of 2% pilocarpine) on the static threshold perimetry of 20 subjects with chronic open angle glaucoma and documented visual field loss, using the 30-2 program of the Humphrey field analyser. Following miosis, the Statpac mean defect deteriorated by an average of -1.49 dB compared with baseline (p = 0.004). This dB deterioration is twice that reported in studies on younger normal subjects following miosis. The decrease in mean defect showed a positive correlation with the degree of pupillary constriction, the correlation being greater in those eyes with a miosed pupil diameter of 2 mm or less. There was no significant decrease in the other Statpac global indices following miosis. A parallel study using the fellow eye of the same glaucoma patients showed a high degree of intertest variability, but no significant learning or fatigue effect. We conclude that pilocarpine-induced miosis causes a significant deterioration in visual field in a population of patients with chronic open angle glaucoma: this factor should be considered when choosing therapy for glaucoma particularly in cases where field loss approaches the permitted legal minimum for driving.

Current practice of cataract extraction and anaesthesia.

A questionnaire regarding preferred methods of cataract extraction and anaesthesia was sent to 456 consultant ophthalmologists in England and Wales. Replies were received from 86% (n = 392), 83% (n = 380) having completed the questionnaire in full. The most frequently employed surgical approach was non-automated extracapsular cataract extraction. Only 2% of surgeons (n = 8) used phacoemulsification routinely and 2% (n = 7) used intracapsular extraction. Intraocular lens implantation was the standard practice of 99% of surgeons (n = 376). There has been a dramatic increase in the popularity of local anaesthesia, which was employed routinely (in more than three-quarters of their cases) by 20% of surgeons (n = 76). Retrobulbar infiltration remains the most common method of administration. Sedation was given routinely by 45% of surgeons (n = 171) when using local anaesthesia. Medical contraindications and patient preference were considered the most important reasons for selecting local anaesthesia rather than general. The exclusive use of general anaesthesia in cataract surgery appears to be diminishing.

Effect of digital image compression on screening for diabetic retinopathy.

BACKGROUND/AIMS: Digital imaging is widely used for diabetic retinopathy screening. The storage and transmission of digital images can be facilitated by image compression. The authors aimed to assess the effect of image compression on the accuracy of grading diabetic retinopathy. METHODS: Forty nine 35 mm transparencies (17 with no retinopathy, eight with background, five with preproliferative, and 19 with proliferative retinopathy) were digitised and subjected to JPEG compression by 90%, 80%, 70%, and 0%. The 196 images were randomised and graded on a portable computer. Two masked graders assessed the images for grade of retinopathy and image quality (0-10). The sensitivity and specificity of retinopathy grading were calculated with a weighted kappa for grading agreement between levels of compression. RESULTS: The sensitivity of retinopathy grading was reduced by JPEG compression. At 90%, 80%, 70%, and 0% compression the sensitivities were 0.38, 0.50, 0.65, and 0.72, respectively; the specificity results were 1.00, 1.00, 0.83, and 0.84, respectively; and the weighted kappa scores were 0.60, 0.75, 0.77, and 0.84, respectively. The quality scores for 90%, 80%, 70%, 0% compression were 2.9 (SD 1.1, 95% CI; 2.7-3.2), 4.6 (SD 1.1, 95% CI; 3.0-5.6), 5.8 (SD1.5, 95% CI 5.0-6.6), 6.3 (SD1.4, 95% CI; 5.4-7.2) (p<0.01 for each intergroup comparison). CONCLUSION: The results demonstrate significant loss of sensitivity to the features of diabetic retinopathy with JPEG compression; this was compounded by the thin film transistor (TFT) screen. The authors found the quality of uncompressed images on TFT screens too poor to give grading sensitivities which reach current guidelines for diabetic retinopathy screening.

Functional development of fetal limb muscles: a review of the roles of activity, nerves and hormones.

Animals that are immature at birth with respect to postural and locomotor control (e.g. cats, rats) possess incompletely differentiated 'fast-twitch' and 'slow-twitch' muscles at birth; full development proceeds slowly in the postnatal period and involves myogenic, hormonal, neural and behavioural factors. The gradual emergence of specific motor patterns and the exercise of individual muscle groups is thought to play a major role in the final development of each muscle and the fibre types which comprise them. In contrast, precocial species such as the sheep are born with skeletal muscles, especially those of the limbs, which are fully differentiated at birth. The relative importance of neural and hormonal factors in allowing this functional specialization to occur in the presumed absence of significant load-bearing exercise in the intrauterine environment is unclear. In this brief review, the changes which occur in contractile function and fibre type differentiation during the last one-third of gestation in fetal sheep are described, and some of the factors which influence this development are considered.

Force--sarcomere-length relation and filament length in rat extensor digitorum muscle.

Relations between sarcomere length (SL) and force (F) were studied in ten fiber bundles (six to twenty fibers) from rat extensor digitorum muscles. A bundle (60 micron by 200-300 microns) was mounted in a glass covered perfusion chamber containing modified Krebs Henseleit buffer at 25 degrees C, oxygenated with 95% O2, 5% CO2 and pancuronium bromide (8 mg/1). F ( Disa 51E 01 transducer) and SL (laser diffraction and light microscopy) were measured; the latter could be controlled by a servomotor system. 200-500 ms tetanic stimulus trains were applied via platinum electrodes parallel to the muscle with 20% above maximal intensity, 160 Hz frequency and 1 ms duration of pulses. Tetani were at 2 min intervals. F attained a steady value 100 ms after the start of the tetanus at 2.0-2.5 microns SL and 350 ms at 3.5 microns SL. Active force, measured during tetani in which sarcomere length was held constant, was maximal between SL = 2.15 microns and 2.65 microns and declined in linear fashion with SL to zero at SL = 3.90 microns. Active force at SL = 2.00 microns was 95% of maximal force. Passive force was manifest above SL = 3.10 microns and was 10% of maximal force at 3.80 microns. Eight similar bundles were processed conventionally for electron microscopy (Philips EM 201A ) while SL was measured during the processing steps. Measurements were made from micrographs of longitudinal sections. SL measured from the micrographs were consistent with the observed shrinkage (5%). Actin periodicity was 41.5 +/- 0.19 nm; twenty-seven periods per actin filament were found. Filament lengths were corrected for an assumed actin periodicity of 39 nm. Actin length was 1.13 +/- 0.013 micron; myosin length was 1.53 +/- 0.015 micron. Bare zone was 0.17 micron +/- 0.01 micron. These filament lengths would give optimum overlap at SL between 2.26 and 2.43 microns and a linear decrease to zero with increasing SL from 2.43 microns to 3.79 microns. Actual force was consistently higher than predicted by overlap and force was maintained to both the left and the right of the predicted plateau.

Local anaesthesia for vitreoretinal surgery: an audit of patient and surgical experience.

PURPOSE: Local anaesthesia for vitreoretinal surgery is little used as these procedures are deemed to be too long and uncomfortable for patients to tolerate. In this unit anterior intraconal local anaesthesia is used for most routine surgery. We undertook an audit to ensure that surgical standards and patient acceptability were not compromised. METHODS: A prospective observational audit was performed. Audit data included: Grade of anaesthetist and surgeon; details of anaesthetic and operation; compliance of patient; operating conditions and pain scores. Anaesthesia was provided with a combined peribulbar and intraconal anaesthetic, using bicarbonate buffered lignocaine and bupivacaine 50:50 mixture. RESULTS: 135 (76%) had local anaesthesia alone, 13 (7%) had local anaesthesia with sedation and 29 (16%) had general anaesthesia. 96.4% of patients were compliant and 98.8% of operating conditions were good or excellent. The mean perioperative pain score was 0.1 (range of 0-1), 97% said they would choose local anaesthesia again. CONCLUSIONS: LA for vitreoretinal surgery is a useful and flexible method of anaesthesia, which has been shown to have excellent patient tolerance.