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Mano F, LoBue S, Tailor P, Olsen TW. Incisional choroidal surgery. Surv Ophthalmol 2024:S0039-6257(24)00096-1. [PMID: 39222800 DOI: 10.1016/j.survophthal.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 08/22/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
The choroid is a thin layer of highly vascular uveal tissue enclosed externally by sclera and internally by neurosensory retinal tissue. The choroid is a "middle layer" ocular tissue with anatomically challenging surgical access. The primary functional role of the choroid is to provide rapid, oxygenated, and nutrient-rich blood flow to both the highly metabolic retinal pigment epithelium and outer retina (i.e. photoreceptors) while simultaneously removing waste products. Historically, incisional choroidal surgery (ICS) has involved tumor biopsy or excision, removal of choroidal neovascular complex or autologous choroidal translocations; however, ICS also holds unique potential for novel and innovative approaches to address macular pathology. Using large-animal surgical studies, researchers have explored ICS with the objective of finding safer and more effective techniques to reduce surgical risks such as bleeding, tissue contraction, and scar tissue formation. We explore the relevant anatomy and embryology, existing surgical techniques, discuss the implications for retinal drug delivery, define ICS guiding principles, and offer a rationale for implementation of ICS into a vitreoretinal surgical practice. We also identify other future challenges and anticipate future innovations that will advance ICS.
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Affiliation(s)
- Fukutaro Mano
- Kindai University, Osaka Japan; Mayo Clinic, Rochester Minnesota
| | - Stephen LoBue
- LoBue Laser and Eye Medical Center, Murrieta California; Mayo Clinic, Rochester Minnesota
| | | | - Timothy W Olsen
- Chair Emeritus, Emory University, Atlanta, GA, Professor & Consultant, Mayo Clinic, Rochester, MN (2017-23), EyeMacular Regeneration, Inc., Rochester, MN, iMacular Regeneration, LLC, Rochester, MN; Mayo Clinic, Rochester Minnesota.
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Golzar B, Sarchahi AA, Azizzadeh M. Evaluation of lidocaine for auriculopalpebral nerve block in dogs: Onset, duration, and effects on intraocular pressure and eye examination. Vet Ophthalmol 2024. [PMID: 39207170 DOI: 10.1111/vop.13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/08/2024] [Accepted: 07/24/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES Accurate intraocular pressure (IOP) measurement is essential for managing glaucoma, requiring tonometry. Local anesthesia is typically used, but nerve blocks may be needed for blepharospasm. This study investigated the efficacy of auriculopalpebral nerve block with lidocaine in achieving eyelid akinesia and its influence on IOP in dogs. ANIMALS AND PROCEDURES In a randomized, blinded trial, 12 healthy adult mixed-breed dogs (24 eyes) received either auriculopalpebral nerve block with 2% lidocaine (n = 12 eyes) or no block (n = 12 eyes). Tetracaine drops were used for topical anesthesia in half of blocked/non-blocked eyes, and the rest of the eyes got artificial tears as control. The impact of nerve block was evaluated through assessments of menace response, palpebral reflex, and IOP before the block, after drop instillation, and at 15-min intervals until block dissipation. RESULTS Auriculopalpebral nerve block provided effective eyelid akinesia in 58.5% (7/12 eyes) at 15 min, reaching 91.7% (11/12 eyes) at 30 min, indicating peak efficacy. Subsequently, the block gradually diminished, with 66.7% (8/12 eyes) and 33.3% (4/12 eyes) maintaining akinesia at 45 and 60 min, respectively. Importantly, neither auriculopalpebral nerve block nor tetracaine administration significantly affected IOP measurements (p > .05). CONCLUSIONS Auriculopalpebral nerve block using lidocaine demonstrated efficient eyelid akinesia, peaking at 30 min postinjection. This technique proved to be safe with no notable alterations in IOP, suggesting its potential utility in canine ophthalmology for procedures requiring eyelid akinesia, particularly in the management of glaucoma where maintaining accurate IOP measurements is crucial for diagnosis, treatment, and monitoring the disease.
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Affiliation(s)
- Bahar Golzar
- Graduated from Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Ali Asghar Sarchahi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mohammad Azizzadeh
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
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Mascolini MV, Toniolo I, Carniel EL, Fontanella CG. Ex vivo, in vivo and in silico studies of corneal biomechanics: a systematic review. Phys Eng Sci Med 2024; 47:403-441. [PMID: 38598066 PMCID: PMC11166853 DOI: 10.1007/s13246-024-01403-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/08/2024] [Indexed: 04/11/2024]
Abstract
Healthy cornea guarantees the refractive power of the eye and the protection of the inner components, but injury, trauma or pathology may impair the tissue shape and/or structural organization and therefore its material properties, compromising its functionality in the ocular visual process. It turns out that biomechanical research assumes an essential role in analysing the morphology and biomechanical response of the cornea, preventing pathology occurrence, and improving/optimising treatments. In this review, ex vivo, in vivo and in silico methods for the corneal mechanical characterization are reported. Experimental techniques are distinct in testing mode (e.g., tensile, inflation tests), samples' species (human or animal), shape and condition (e.g., healthy, treated), preservation methods, setup and test protocol (e.g., preconditioning, strain rate). The meaningful results reported in the pertinent literature are discussed, analysing differences, key features and weaknesses of the methodologies adopted. In addition, numerical techniques based on the finite element method are reported, incorporating the essential steps for the development of corneal models, such as geometry, material characterization and boundary conditions, and their application in the research field to extend the experimental results by including further relevant aspects and in the clinical field for diagnostic procedure, treatment and planning surgery. This review aims to analyse the state-of-art of the bioengineering techniques developed over the years to study the corneal biomechanics, highlighting their potentiality to improve diagnosis, treatment and healing process of the corneal tissue, and, at the same, pointing out the current limits in the experimental equipment and numerical tools that are not able to fully characterize in vivo corneal tissues non-invasively and discourage the use of finite element models in daily clinical practice for surgical planning.
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Affiliation(s)
- Maria Vittoria Mascolini
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Ilaria Toniolo
- Department of Industrial Engineering, University of Padova, Padova, Italy.
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy.
| | - Emanuele Luigi Carniel
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Chiara Giulia Fontanella
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
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Oatts JT, Shen S, Zhu H, Gong Q, Yu Y, Ying GS, Han Y, Liu H. A Prospective Study of the Effects of General Anesthesia on Intraocular Pressure in Healthy Children. OPHTHALMOLOGY SCIENCE 2024; 4:100455. [PMID: 38313401 PMCID: PMC10837640 DOI: 10.1016/j.xops.2023.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 02/06/2024]
Abstract
Purpose To determine the effect of general anesthesia on intraocular pressure (IOP) in children with no intraocular pathology and determine which postanesthetic time point is most predictive of preinduction IOP. Design Prospective observational study. Participants Children with no intraocular pathology ≤ 18 years scheduled for general anesthesia as part of their routine care followed by a pediatric ophthalmologist at Nanjing Medical University. Methods Participants underwent a standardized general anesthetic protocol using a mask induction with sevoflurane and propofol maintenance. Intraocular pressure was measured at the following 7 time points: preinduction (taken in the preoperative area), postinduction minutes 1, 3, and 5, and postairway placement minutes 1, 3, and 5 for a total time period of 10 minutes after induction. A generalized estimating equation was used to evaluate the effect of anesthesia on IOP and the effect of patient factors (age, gender, vital signs, and airway type) on preanesthetic and postanesthetic IOP. An IOP prediction model was developed using the postanesthesia IOP measurements for predicting preinduction IOP. Main Outcome Measures Intraocular pressure and change in IOP at prespecified time points. Results Eighty-five children were enrolled with a mean ± standard deviation (SD) age of 7.5 ± 2.9 years. Mean ± SD preinduction IOP was 20.1 ± 3.7 mmHg. Overall, IOP was lowest at 3 minutes postinduction, decreased to a mean of 13.4 ± 3.7 mmHg (P < 0.001). After this, IOP rose 5 minutes postinduction to 16.5 ± 4.2 mmHg, which did not reach preinduction IOP levels (P < 0.001). The IOP prediction model showed that combining 1 minute postinduction and 3 minutes postairway was most predictive (R2 = 0.13), whereas 1 minute postairway was least predictive of preinduction IOP (R2 = 0.01). Conclusions After the induction of general anesthesia in children, IOP temporarily decreases with a trough at 3 minutes postinduction before increasing and remaining stable just below preinduction levels. Intraocular pressure measurements taken 1 minute after induction with 3 minutes after airway placement are most predictive of preinduction IOP, though predictive value is relatively low. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Julius T. Oatts
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Shiya Shen
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hui Zhu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Qi Gong
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yinxi Yu
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gui-shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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Chi J, Lu M, Wang S, Xu T, Ju R, Liu C, Zhang Z, Jiang Z, Han B. Injectable hydrogels derived from marine polysaccharides as cell carriers for large corneal epithelial defects. Int J Biol Macromol 2023; 253:127084. [PMID: 37769782 DOI: 10.1016/j.ijbiomac.2023.127084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 09/12/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
Injectable hydrogels have been employed for sutureless repair of corneal epithelial defects, which can perfectly fit the defect sites and minimize the associated discomfort. However, numerous hydrogels are ineffective in treating large corneal epithelial defects and still suffer from poor biocompatibility or weak applicability when used as cell carriers. Herein, hydroxypropyl chitin/carboxymethyl chitosan (HPCT/CMCS) temperature-sensitive hydrogels are fabricated, and their physicochemical properties and suitability for corneal epithelial repair are investigated. The results demonstrate that HPCT/CMCS hydrogels have excellent temperature sensitivity between 20 and 25 °C and a transparency of over 80 %. Besides, HPCT/CMCS hydrogels can promote cell proliferation and facilitate cell migration of primary rabbit corneal epithelial cells (CEpCs). A rabbit large corneal epithelial defect model (6 mm) is established, and CEpCs are transplanted into defect sites by HPCT/CMCS hydrogels. The results suggest that HPCT/CMCS/CEpCs significantly enhance the repair of large corneal epithelial defects with a healing rate of 99.6 % on day 8, while reducing inflammatory responses and scarring formation. Furthermore, HPCT/CMCS/CEpCs can contribute to the reconstruction of damaged tissues and the recovery of functional capacities. Overall, HPCT/CMCS hydrogels may be a feasible corneal cell carrier material and can provide an alternative approach to large corneal epithelial defects.
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Affiliation(s)
- Jinhua Chi
- Laboratory of Biochemistry and Biomedical Materials, College of Marine Life Sciences, Ocean University of China, Qingdao 266003, PR China
| | - Minxin Lu
- Laboratory of Biochemistry and Biomedical Materials, College of Marine Life Sciences, Ocean University of China, Qingdao 266003, PR China
| | - Shuo Wang
- Laboratory of Biochemistry and Biomedical Materials, College of Marine Life Sciences, Ocean University of China, Qingdao 266003, PR China
| | - Tianjiao Xu
- Laboratory of Biochemistry and Biomedical Materials, College of Marine Life Sciences, Ocean University of China, Qingdao 266003, PR China
| | - Ruibao Ju
- Laboratory of Biochemistry and Biomedical Materials, College of Marine Life Sciences, Ocean University of China, Qingdao 266003, PR China
| | - Chenqi Liu
- Laboratory of Biochemistry and Biomedical Materials, College of Marine Life Sciences, Ocean University of China, Qingdao 266003, PR China
| | - Zhenguo Zhang
- Laboratory of Biochemistry and Biomedical Materials, College of Marine Life Sciences, Ocean University of China, Qingdao 266003, PR China
| | - Zhen Jiang
- Laboratory of Biochemistry and Biomedical Materials, College of Marine Life Sciences, Ocean University of China, Qingdao 266003, PR China
| | - Baoqin Han
- Laboratory of Biochemistry and Biomedical Materials, College of Marine Life Sciences, Ocean University of China, Qingdao 266003, PR China; Laboratory for Marine Drugs and Bioproducts of Qingdao National Laboratory for Marine Science and Technology, Qingdao 266235, PR China.
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Treacy MP, Conway MP, Hammoud MA, Duignan ES, Ahearne M, Ezra E. Direct Exchange of PerfluoroCarbon Liquid for Silicone Oil: A Surgical Technique to Control Pressure and Avoid Retinal Slippage. Retina 2023; 43:2104-2108. [PMID: 35152247 DOI: 10.1097/iae.0000000000003422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Perfluorocarbon heavy liquid (PFCL) is used in vitreoretinal surgery to flatten the unsupported detached retina before insertion of silicone oil in cases of giant retinal tear or relaxing retinectomy. Direct exchange of PFCL for silicone oil is recommended to reduce retinal slippage when compared with fluid-air exchange, but it is commonly regarded as a difficult procedure. We describe our technique for direct PFCL-silicone oil exchange using a 20-gauge drainage cannula, reliably avoiding the complications of retinal slippage and high intraoperative intraocular pressure. METHODS We present a consecutive case series of patients undergoing PFCL-oil exchange and explain, using Poiseuille's equation for laminar fluid flow through a cannula, the rationale for using a 20-gauge drainage cannula rather than smaller gauges to avoid high intraocular pressure. RESULTS Twenty-six patients underwent PFCL-oil exchange from February 1, 2019, to September 30, 2019. There was no intraoperative retinal slippage or pressure-related complications. Postoperatively 20 patients underwent oil removal. Six suffered retinal redetachment, and 14 remained attached. The vision postoil removal ranged from 6/6 to hand movements. CONCLUSION We are confident that the PFCL-oil exchange technique described here is reliable and safe. The use of a 20-gauge drainage cannula is recommended regardless of vitrectomy gauge.
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Affiliation(s)
- Maxwell P Treacy
- Moorefields Eye Hospital, Ophthalmology Department, London, England, Medical Optics, Ophthalmology Department, Dublin, Ireland, and Royal Victoria Eye and Ear Hospital, Ophthalmology Department, Dublin, Ireland
| | | | | | - Emma S Duignan
- Moorefields Eye Hospital, Ophthalmology Department, London, England, and Royal Victoria Eye and Ear Hospital, Ophthalmology Department, Dublin, Ireland
| | - Mark Ahearne
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin; and
| | - Eric Ezra
- Moorefields Eye Hospital, Ophthalmology Department, London, England
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Tripathy KC, Siddharth A, Bhandari A. Image-based insilico investigation of hemodynamics and biomechanics in healthy and diabetic human retinas. Microvasc Res 2023; 150:104594. [PMID: 37579814 DOI: 10.1016/j.mvr.2023.104594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/22/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
Retinal hemodynamics and biomechanics play a significant role in understanding the pathophysiology of several ocular diseases. However, these parameters are significantly affected due to changed blood vessel morphology ascribed to pathological conditions, particularly diabetes. In this study, an image-based computational fluid dynamics (CFD) model is applied to examine the effects of changed vascular morphology due to diabetes on blood flow velocity, vorticity, wall shear stress (WSS), and oxygen distribution and compare it with healthy. The 3D patient-specific vascular architecture of diabetic and healthy retina is extracted from Optical Coherence Tomography Angiography (OCTA) images and fundus to extract the capillary level information. Further, Fluid-structure interaction (FSI) simulations have been performed to compare the induced tissue stresses in diabetic and healthy conditions. Results illustrate that most arterioles possess higher velocity, vorticity, WSS, and lesser oxygen concentration than arteries for healthy and diabetic cases. However, an opposite trend is observed for venules and veins. Comparisons show that, on average, the blood flow velocity in the healthy case decreases by 42 % in arteries and 21 % in veins, respectively, compared to diabetic. In addition, the WSS and von Mises stress (VMS) in healthy case decrease by 49 % and 72 % in arteries and by 6 % and 28 % in veins, respectively, when compared with diabetic, making diabetic blood vessels more susceptible to wall rupture and tissue damage. The in-silico results may help predict the possible abnormalities region early, helping the ophthalmologists use these estimates as prognostic tools and tailor patient-specific treatment plans.
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Affiliation(s)
- Kartika Chandra Tripathy
- Biofluids Research Lab, Department of Mechanical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad 826004, India
| | - Ashish Siddharth
- Biofluids Research Lab, Department of Mechanical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad 826004, India
| | - Ajay Bhandari
- Biofluids Research Lab, Department of Mechanical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad 826004, India.
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Weisheit CK, Geerling G, Holz FG, Coburn M. High-Impact Actions to Reduce the Carbon Dioxide Footprint in an Ophthalmic Operation Room: A Narrative Review. Ophthalmologica 2023; 246:169-173. [PMID: 37579736 DOI: 10.1159/000533444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023]
Abstract
Germany's health care footprint accounts for 5.2% of the national emissions footprint which results in 0.71 tons of CO2 emission per capita. Thus, the health sector has a responsibility to take climate action. Surgery is a resource-intensive health care activity, requiring expensive equipment, sterilization procedures, advanced operative technologies, and obligatory life support systems. We spotlight the situation in a department of ophthalmology with frequent anesthesia services and highly standardized procedures. This narrative review discusses high-impact actions which result in a major reduction of the CO2 footprint according to the global road map for health care decarbonization, considering both the ophthalmic and anesthesiologic point of view.
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Affiliation(s)
- Christina K Weisheit
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Gerd Geerling
- Department of Ophthalmology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Mark Coburn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Upadhyay P, Ichhpujani P, Solanki A. Recent trends in anesthetic agents and techniques for ophthalmic anesthesia. J Anaesthesiol Clin Pharmacol 2023; 39:343-348. [PMID: 38025549 PMCID: PMC10661636 DOI: 10.4103/joacp.joacp_555_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/01/2023] Open
Abstract
Effective and safe ophthalmic anesthesia is essential for the delivery of ophthalmic perioperative care both for children and adults. Recent years have seen a major change in form of smaller incisions for most ophthalmic surgical techniques, thus making them less invasive. Additionally, most ophthalmic surgeries are now day-care surgeries at ambulatory surgical centers. The parallel advancements in the field of anesthesiology have boosted the standard of perioperative care. The purpose of this narrative review was to evaluate current trends in anesthetic agents and techniques for ophthalmic anesthesia primarily centered around deep sedation and general anesthesia as per the concerns of practicing anesthesiologists while briefly acquainting with local anesthesia advances.
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Affiliation(s)
- Prateek Upadhyay
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Parul Ichhpujani
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Abhilasha Solanki
- Department of Anesthesiology, Weill Cornell Medicine, New York-Presbyterian Hospital, NY, USA
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Olmedilla Arnal LE, Cambronero OD, Mazzinari G, Pérez Peña JM, Zorrilla Ortúzar J, Rodríguez Martín M, Vila Montañes M, Schultz MJ, Rovira L, Argente Navarro MP. An Individualized Low-Pneumoperitoneum-Pressure Strategy May Prevent a Reduction in Liver Perfusion during Colorectal Laparoscopic Surgery. Biomedicines 2023; 11:891. [PMID: 36979870 PMCID: PMC10045598 DOI: 10.3390/biomedicines11030891] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023] Open
Abstract
High intra-abdominal pressure (IAP) during laparoscopic surgery is associated with reduced splanchnic blood flow. It is uncertain whether a low IAP prevents this reduction. We assessed the effect of an individualized low-pneumoperitoneum-pressure strategy on liver perfusion. This was a single-center substudy of the multicenter 'Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy II study' (IPPCollapse-II), a randomized clinical trial in which patients received an individualized low-pneumoperitoneum strategy (IPP) or a standard pneumoperitoneum strategy (SPP). Liver perfusion was indirectly assessed by the indocyanine green plasma disappearance rate (ICG-PDR) and the secondary endpoint was ICG retention rate after 15 min (R15) using pulse spectrophotometry. Multivariable beta regression was used to assess the association between group assignment and ICG-PDR and ICG-R15. All 29 patients from the participating center were included. Median IAP was 8 (25th-75th percentile: 8-10) versus 12 (12,12) mmHg, in IPP and SPP patients, respectively (p < 0.001). ICG-PDR was higher (OR 1.42, 95%-CI 1.10-1.82; p = 0.006) and PDR-R15 was lower in IPP patients compared with SPP patients (OR 0.46, 95%-CI 0.29-0.73; p = 0.001). During laparoscopic colorectal surgery, an individualized low pneumoperitoneum may prevent a reduction in liver perfusion.
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Affiliation(s)
| | - Oscar Diaz Cambronero
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Spanish Clinical Research Network (SCReN), SCReN-IIS La Fe, PT17/0017/0035, 46026 Valencia, Spain
| | - Guido Mazzinari
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
- Department of Statistics and Operations Research, University of Valencia, 46100 Valencia, Spain
| | - José María Pérez Peña
- Department of Anaesthesiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Jaime Zorrilla Ortúzar
- Department of Anaesthesiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Marcos Rodríguez Martín
- Department of Digestive Surgery, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Maria Vila Montañes
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Marcus J. Schultz
- Department of Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
| | - Lucas Rovira
- Department of Anaesthesiology, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Maria Pilar Argente Navarro
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- Department of Anaesthesiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
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Baskan C, Baskan S. Does Practitioner Experience Affect Intraocular Pressure After Endotracheal Intubation? Cureus 2023; 15:e36593. [PMID: 36992815 PMCID: PMC10042494 DOI: 10.7759/cureus.36593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
AIM Intraocular pressure (IOP) may decrease or increase during general anesthesia, depending on various factors. This study aimed to investigate the effects of the level of provider training period on post-intubation IOP values and hemodynamic response. METHODS This study was a cross-sectional observational study. Before inclusion in the study, informed consent was obtained from all participants. The study was approved by the local ethical committee. The study included 120 adult patients, both sexes, aged between 18 and 65, with physical statuses according to the American Society of Anesthesiologists (ASA) I or II, Mallampati score I. The research included 120 anesthesiologist resident doctors who received their training in our clinic. In this study, anesthesiology resident doctors were divided into three separate seniority groups (group 1, less than one-year residents in anesthesiology who had performed fewer than 10 intubations; group 2, one- to three-year residents; and group 3, more than three-year residents). After receiving a standard intravenous induction, direct laryngoscopy and endotracheal intubation techniques were performed. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and IOP were measured and recorded before pre-induction (T1), the first minute after induction (T2), and the first minute after laryngoscopy and intubation (T3). RESULTS There was no statistically significant difference (p > 0.05) between groups in the values of IOP, SBP, DBP, and HR measured at T1, T2, and T3. Measurements at T1, T2, and T3 were similar in all three groups. Comparisons within the groups revealed that IOP values at all measurement times (T1, T2, and T3) were different from each other in less than three-year resident groups. This difference was statistically significant (p < 0.001). The measurement values at T2 were the lowest and T3 were the highest in less than three-year resident groups. There was a significant increase in IOP after endotracheal intubation (T3) compared to baseline levels (T1) in less than three-year resident groups. IOP values at T2 were also significantly lower than the values at T1 and T3 (p < 0.001) in the more than three-year resident group (group 3). However, when we compared IOP measurements at T1 and T3 among themselves in the more than three-year resident group, no significant difference was found (p > 0.05). CONCLUSION This study showed that endotracheal intubation in general anesthesia practice is performed most effectively by resident doctors with more than three years of anesthesiology training, without changing the IOP value.
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Affiliation(s)
- Ceyda Baskan
- Ophthalmology, Ankara Bilkent City Hospital, Ankara, TUR
| | - Semih Baskan
- Anesthesiology and Reanimation, Ankara Bilkent City Hospital, Ankara, TUR
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Dogukan M, Bicakcioglu M, Yilmaz N, Duran M, Uludag O, Tutak A, Kaya R, Kilic R. The effect of spinal anesthesia that is performed in sitting or right lateral position on post-spinal headache and intraocular pressure during elective cesarean section. Niger J Clin Pract 2023; 26:90-94. [PMID: 36751829 DOI: 10.4103/njcp.njcp_401_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Although spinal anesthesia can be applied in different patient positions, the most frequently used positions are sitting and lateral positions. It is known that different patient positions during spinal anesthesia have effects on hemodynamic parameters, postdural puncture headache, and intraocular pressure. Aim The study aimed to determine the effect of spinal anesthesia performed in either sitting or right lateral position on postspinal headache and intraocular pressure during elective cesarean section. Patients and Methods The study was a randomized controlled study of 104 eligible pregnant women scheduled to undergo elective cesarean section. The women were randomized into two groups. Spinal anesthesia was performed either in the sitting (Group S, n = 53) or the right lateral position (Group L, n = 51). Heart rate and blood pressure were recorded throughout the operation. The participants were informed and monitored for postspinal headaches. Intraocular pressure before and after the operation was measured with Icare PRO. The obtained data were statistically compared between the two groups. Results There was no difference between the groups in terms of demographic data. Postdural puncture headache was observed in five patients in Group S and one patient in Group L (P =0.04). There was no difference between the groups in terms of intraocular pressure (P >.05). Heart rate was not significantly different between the groups; however, there was a significant difference in average blood pressure in 1, 5, 30, and 40 minutes (P <.05). The number of trials administered to patients for spinal anesthesia was significantly higher in Group L (P =0.01). Conclusion Spinal anesthesia performed in the sitting position for cesarean section caused a higher postspinal headache than in the right lateral position, but the position did not affect intraocular pressure.
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Affiliation(s)
- M Dogukan
- Deparment of Anesthesiology and Reanimation, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
| | - M Bicakcioglu
- Deparment of Anesthesiology and Reanimation, Inonü University Faculty of Medicine, Malatya, Turkey
| | - N Yilmaz
- Deparment of Anesthesiology and Reanimation, Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - M Duran
- Deparment of Anesthesiology and Reanimation, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
| | - O Uludag
- Deparment of Anesthesiology and Reanimation, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
| | - A Tutak
- Deparment of Anesthesiology and Reanimation, Adıyaman Park Hospital, Adiyaman, Turkey
| | - R Kaya
- Deparment of Anesthesiology and Reanimation, New Life Hospital, Osmaniye, Turkey
| | - R Kilic
- Deparment of Anesthesiology and Reanimation, Hatem Hospital, Gaziantep, Turkey
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13
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Shilo-Benjamini Y, Pe'er O, Abu Ahmad W, Ofri R. Effect of anesthetic induction with propofol, alfaxalone or ketamine on intraocular pressure in cats: a randomized masked clinical investigation. Vet Anaesth Analg 2023; 50:63-71. [PMID: 36528512 DOI: 10.1016/j.vaa.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the effect of propofol, alfaxalone and ketamine on intraocular pressure (IOP) in cats. STUDY DESIGN Prospective, masked, randomized clinical trial. ANIMALS A total of 43 ophthalmologically normal cats scheduled to undergo general anesthesia for various procedures. METHODS Following baseline IOP measurements using applanation tonometry, anesthesia was induced with propofol (n = 15), alfaxalone (n = 14) or ketamine (n = 14) administered intravenously to effect. Then, midazolam (0.3 mg kg-1) was administered intravenously and endotracheal intubation was performed without application of topical anesthesia. The IOP was measured following each intervention. Data was analyzed using one-way anova and repeated-measures mixed design with post hoc analysis. A p-value <0.05 was considered significant. RESULTS Mean ± standard error IOP at baseline was not different among groups (propofol, 18 ± 0.6; alfaxalone, 18 ± 0.7; ketamine, 17 ± 0.5 mmHg). Following induction of anesthesia, IOP increased significantly compared with baseline in the propofol (20 ± 0.7 mmHg), but not in the alfaxalone (19 ± 0.8 mmHg) or ketamine (16 ± 0.7 mmHg) groups. Midazolam administration resulted in significant decrease from the previous measurement in the alfaxalone group (16 ± 0.7 mmHg), but not in the propofol group (19 ± 0.7 mmHg) or the ketamine (16 ± 0.8 mmHg) group. A further decrease was measured after intubation in the alfaxalone group (15 ± 0.9 mmHg). CONCLUSIONS AND CLINICAL RELEVANCE Propofol should be used with caution in cats predisposed to perforation or glaucoma, as any increase in IOP should be avoided.
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Affiliation(s)
- Yael Shilo-Benjamini
- Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel.
| | - Oren Pe'er
- Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Wiessam Abu Ahmad
- Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Ron Ofri
- Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
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14
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Binter M, Lüdtke P, Langer F, Schigiel T, Framme C, Heider M, Tode J. Changes in Intraocular Pressure following Narcosis With Medetomidine, Midazolam, and Fentanyl in Association With Initial Intraocular Pressure in Mice. Curr Eye Res 2022; 47:1553-1558. [PMID: 35943353 DOI: 10.1080/02713683.2022.2101667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/30/2022] [Accepted: 07/06/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE This article describes the development of decreased intraocular pressure (IOP) under general anesthesia with medetomidine, midazolam, and fentanyl in mice with normal and elevated IOP. METHODS IOP was measured using the iCare Tonolab rebound tonometer. Twelve 3-4 months-old male and female C57BL/6J mice were randomized to a control group with physiological IOP and a high IOP group with experimentally induced ocular hypertension using tarsal injections of dexamethasone-21-acetate. For anesthesia, medetomidine and midazolam were used, subgroups additionally received fentanyl. IOP was measured every 2.5 min for 30 min. RESULTS Control group differed with 14.89 mmHg (SEM: 0.58) significantly (p = 0.0002) from the high IOP group with initial 20.44 mmHg (SEM: 0.75). All groups showed a significant (p < 0.05) decrease in IOP under general anesthesia. There was no significant difference in IOP development and decrease between the group additionally receiving fentanyl and the group without fentanyl. The decrease in IOP was highly dependent on the initial value, with the high IOP group showing a greater decrease. After 10 min, no significant difference in IOP could be detected between the high IOP and control group. CONCLUSIONS In mice, general anesthesia with medetomidine and midazolam leads to a declining IOP over time. Adding fentanyl to the anesthesia did not alter these effects. The decline is time-dependent and IOP-dependent.
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Affiliation(s)
- Maximilian Binter
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | - Philipp Lüdtke
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | - Fridolin Langer
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | - Thomas Schigiel
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | - Carsten Framme
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | - Miriam Heider
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - Jan Tode
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
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15
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Sun D, Wang B, Yang Z, Zhan Z, Li J, Lan Y. Protocol for laser-induced chronic ocular hypertension and intracameral injection in nonhuman primates. STAR Protoc 2022; 3:101801. [PMID: 36340883 PMCID: PMC9630776 DOI: 10.1016/j.xpro.2022.101801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Laser-induced hypertension in nonhuman primates is used to mimic human glaucoma, the leading cause of irreversible blindness. In this protocol, we detail steps for laser-induced ocular hypertension in nonhuman primates by laser photocoagulation of the trabecular meshwork and subsequent intracameral injection. We further describe recording and evaluation of intraocular pressure changes and peripapillary retinal nerve fiber layer thickness. This protocol can assist researchers improve the success rate and repeatability of the procedure and reduce the number of nonhuman primates needed. For complete details on the use and execution of this protocol, please refer to Sun et al. (2022). Detailed description for general and ophthalmological examination before experiment Protocol to generate laser-induced chronic ocular hypertension in rhesus monkeys Laser photocoagulation of the trabecular meshwork followed by intracameral injection Approach is highly reproducible and offers a tool to test potential treatment strategies
Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.
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Affiliation(s)
- Difang Sun
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao 266071, China,Department of Ophthalmology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China,Corresponding author
| | - Bin Wang
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Zhenlan Yang
- Department of Ophthalmology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
| | - Zongyi Zhan
- Department of Ophthalmology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China,Corresponding author
| | - Jun Li
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao 266071, China,Corresponding author
| | - Yuqing Lan
- Department of Ophthalmology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China,Corresponding author
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McKevitt I, Ward C, Robertson E. Care of the eye during anaesthesia and intensive care. ANAESTHESIA & INTENSIVE CARE MEDICINE 2022. [DOI: 10.1016/j.mpaic.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Sun Y, Wang J, Wang W, Fan G, Wu S, Zhao F, Lu Y, Liu D, Li Y, Hu J, Yang L, Bai Y, Zhao T, Zhao Y. Effect of different surgical positions on intraocular pressure: a cross-sectional study. BMC Ophthalmol 2022; 22:318. [PMID: 35883052 PMCID: PMC9317174 DOI: 10.1186/s12886-022-02547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 07/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intraoperative intraocular pressure (IOP) elevation is a risk factor for postoperative blindness. Surgical position is associated with intraoperative IOP elevation. In China, there are few studies on the effect of various surgical positions on intraoperative IOP. This study was conducted to explore IOP change and its related factors in four common surgical positions in China. Methods This was a cross-sectional observational study. A total of 325 surgical patients who had non-ocular surgery from January 2019 to December 2019 in the hospital, were enrolled in this study. During their surgeries for general anesthesia, these participants were placed in lithotomy position/lateral position/prone position/supine position according to their surgery requirement. IOP was measured by icareTA03 handheld portable tonometer at 9 different time points from admission to exiting the operation room. And general information, postural position, and surgery information were collected through a uniform questionnaire. Multivariate analysis was performed to explore the related factors of IOP change. Results IOP of both eyes on lithotomy position, lateral position, and supine position showed statistical differences by ANOVA test at each time point (p < 0.05). IOP of both eyes in the prone position before exit from the operating room was significantly higher than IOP 10-min after anesthesia (p < 0.01). IOP under different postural angles showed statistical differences (F value = 4.85, P < 0.05), and the larger the head-down angle, the higher the IOP. IOP on the compressed side in the lateral position was higher than that on the non-compressed side (p < 0.01). In the multivariate linear regression analysis adjusted by other factors, postural position and baseline IOP were associated with IOP difference between before and after surgery (p < 0.01). Conclusion IOP in the four surgical positions showed different change patterns with the surgical process and position change. Nurses should assist the surgeon to reduce the head-down angle without interfering with the surgical operation and strengthen the inspection of IOP on patients with long-time surgery, to avoid intraoperative rapid IOP changes.
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Affiliation(s)
- Yuhong Sun
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China.
| | - Juan Wang
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Wei Wang
- Beijng Tongren Hospital, Beijing, 100730, People's Republic of China
| | - Guohui Fan
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Sinan Wu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Fei Zhao
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology,, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Yi Lu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Di Liu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Yan Li
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Jin Hu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Lin Yang
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Yu Bai
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Tong Zhao
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Ying Zhao
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
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18
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Effects of Positive End-Expiratory Pressure on Intraocular Pressure during One-Lung Ventilation in the Lateral Decubitus Position-A Prospective Randomized Trial. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070940. [PMID: 35888659 PMCID: PMC9318682 DOI: 10.3390/medicina58070940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: The effect of positive end-expiratory pressure (PEEP) on intraocular pressure (IOP) is debatable. There have been no studies investigating the effects of PEEP on IOP during one-lung ventilation (OLV). We aimed to investigate the effects of PEEP on IOP in patients undergoing OLV for video-assisted thoracoscopic surgery (VATs). Materials and Methods: Fifty-two patients undergoing VATs were divided into a zero-PEEP (ZEEP) and a 6 cmH2O of PEEP (PEEP) groups. IOP, ocular perfusion pressure (OPP), and respiratory and hemodynamic parameters were measured before induction (T1), immediately following endotracheal intubation (T2), 30 min (T3) and 60 min (T4) after a position change to the lateral decubitus position (LDP) and OLV, and 10 min following two-lung ventilation near the end of the surgery (T5). Results: There was no significant difference in IOP and OPP between the two groups. The IOP of the dependent eye was significantly higher than that of the non-dependent eye during LDP in both groups. Peak inspiratory pressure was significantly higher in the PEEP group than in the ZEEP group at T3-T5. Dynamic compliance was significantly higher in the PEEP group than in the ZEEP group at T2-T5. The ratio of arterial oxygen partial pressure to fractional inspired oxygen was significantly higher in the PEEP group than in the ZEEP group at T4. Conclusions: Applying 6 cmH2O of PEEP did not increase IOP but enhanced dynamic compliance and oxygenation during OLV. These results suggest that 6 cmH2O of PEEP can be safely applied during OLV in LDP.
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19
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Awwad MA, Masoud M, Elhadad MA. Quantitative OCT Angiography Assessment of the Effect of Peribulbar Anesthesia on Retinal Microvasculature in Primary Open-Angle Glaucoma Patients Undergoing Cataract Surgery. Clin Ophthalmol 2022; 16:2011-2024. [PMID: 35757020 PMCID: PMC9231634 DOI: 10.2147/opth.s369969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/10/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To assess the effect of peribulbar anesthesia on retinal microvasculature in primary open-angle glaucoma (POAG) patients undergoing cataract surgery using OCT Angiography. Participants Forty-nine patients undergoing cataract surgery were divided into two groups. Group I included patients with no history of glaucoma, while group II included patients previously diagnosed as POAG with controlled IOP. Each participant received 6 mL of peribulbar anesthetic injection of 4 mL lidocaine 2% containing 150 IU hyaluronidase and 2 mL bupivacaine 0.5%. They were scanned with the OCT-A 10 minutes before and 10 minutes after injection for foveal deep (DCP), superficial (SCP) capillary plexuses density and total vessel density, foveal avascular zone (FAZ) diameter, optic disc total vessel density, and radial peripapillary capillary (RPC) network density. In addition, IOP was checked before and 10 minutes after injection. Results Median percent change in DCP post-injection was significantly greater in group II (−43%) than in group I (−2.5%) (P < 0.001). Also, DCP total density median percent change post-injection was significantly higher in group II (−21%) than in group I (−0.9%) (P < 0.001). Foveal SCP vessel density and total vessel density median percent change post-injection were −62.6% and −16.2%, respectively, in group II and were −2.6% and −1.1%, respectively, in group I, which are statistically significant (P < 0.001). The FAZ diameter median percentage change post-injection was higher in group II (40.6%) than in group I (2.5%) (P < 0.001). Optic disc total vessel density and radial peripapillary capillary (RPC) network density post-injection median percent change were significantly higher in group II (−13.6%) and (−13.1%) respectively than in group I (−1.1%) and (−1.25%) respectively (P < 0.001). Conclusion Peribulbar anesthesia harbors a deleterious ischemic effect on the retinal vascular tree of glaucoma patients, which could harmfully affect the vision and the visual field in those vulnerable patients.
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Affiliation(s)
- Mohamed A Awwad
- Department of Ophthalmology, Benha University Hospital, Benha, Qualubia, Egypt
- Correspondence: Mohamed A Awwad, Department of Ophthalmology, Benha University Hospital, Benha, Qualubia, Egypt, Tel +20 1017014208, Email ;
| | - Mohamed Masoud
- Department of Ophthalmology, Benha University Hospital, Benha, Qualubia, Egypt
| | - Mona Ahmed Elhadad
- Department of Anesthesia and Surgical Intensive Care, Benha University Hospital, Benha, Qualubia, Egypt
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Ripa M, Schipa C, Kopsacheilis N, Nomikarios M, Perrotta G, De Rosa C, Aceto P, Sollazzi L, De Rosa P, Motta L. The Impact of Steep Trendelenburg Position on Intraocular Pressure. J Clin Med 2022; 11:2844. [PMID: 35628970 PMCID: PMC9146028 DOI: 10.3390/jcm11102844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Intraocular pressure occurring during the Trendelenburg position may be a risk for postoperative visual loss and other ocular complications. Intraocular pressure (IOP) higher than 21 mmHg poses a risk for ocular impairment causing several conditions such as glaucoma, detached retina, and postoperative vision loss. Many factors might play a role in IOP increase, like peak expiratory pressure (PIP), mean arterial blood pressure (MAP), end-tidal CO2 (ETCO2) and surgical duration and some others (anaesthetic and neuromuscular blockade depth) contribute by reducing IOP during procedures requiring both pneumoperitoneum and steep Trendelenburg position (25-45° head-down tilt). Despite transient visual field loss after surgery, no signs of ischemia or changes to the retinal nerve fibre layer (RNFL) have been shown after surgery. Over the years, several studies have been conducted to control and prevent IOPs intraoperative increase. Multiple strategies have been proposed by different authors over the years to reduce IOP during laparoscopic procedures, especially those involving steep Trendelenburg positions such as robot-assisted laparoscopic prostatectomy (RALP), and abdominal and pelvic procedures. These strategies included both positional and pharmacological strategies.
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Affiliation(s)
- Matteo Ripa
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Catholic University “Sacro Cuore”, 00135 Rome, Italy; (P.A.); (L.S.)
| | - Chiara Schipa
- Catholic University “Sacro Cuore”, 00135 Rome, Italy; (P.A.); (L.S.)
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Nikolaos Kopsacheilis
- East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital Ethelbert Road, Canterbury CT1 3NG, UK;
- New Hayesbank Ophthalmology Services, Cemetery Lane, Kennington, Ashford TN24 9JZ, UK
| | - Mikes Nomikarios
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK; (M.N.); (L.M.)
| | - Gerardo Perrotta
- GI Surgery Department, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK;
| | - Carlo De Rosa
- Department of Ophthalmology, A. Cardarelli Hospital, 80131 Naples, Italy; (C.D.R.); (P.D.R.)
| | - Paola Aceto
- Catholic University “Sacro Cuore”, 00135 Rome, Italy; (P.A.); (L.S.)
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Liliana Sollazzi
- Catholic University “Sacro Cuore”, 00135 Rome, Italy; (P.A.); (L.S.)
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Pasquale De Rosa
- Department of Ophthalmology, A. Cardarelli Hospital, 80131 Naples, Italy; (C.D.R.); (P.D.R.)
| | - Lorenzo Motta
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK; (M.N.); (L.M.)
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21
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Khan MA, Burden J, Dinsmore J, Lockwood AJ. Making cataract surgery possible in patients with ankylosing spondylitis: A new positioning technique. Am J Ophthalmol Case Rep 2022; 25:101246. [PMID: 35005297 PMCID: PMC8717412 DOI: 10.1016/j.ajoc.2021.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/25/2021] [Accepted: 12/19/2021] [Indexed: 11/15/2022] Open
Abstract
Importance Patients with Ankylosing Spondylitis frequently have fixed kyphosis of their spine together with pain. This makes achieving acceptable head position for ocular surgery difficult. The proposal of new methods that result in successful intraocular surgery will reduce morbidity and sight loss in this group of patients. Objective To describe a novel technique using a vacuum bean bag positioner which enabled cataract surgery to be performed successfully under local anaesthesia. To allow prospects of technique development to standardise cataract surgery positioning in this cohort. Results A 42 year-old male patient underwent phacoemulsification under Sub-Tenon's local anaesthetic with intra-ocular lens implant in the inverted position with no immediate post-operative complications. Conclusions and Relevance Standard operating theatre equipment combined with a vacuum bean bag positioner, soft supports and securing straps can attain a position that is feasible for awake ocular surgery in patients with gross anatomical changes affecting the neck. Describe a novel technique for phacoemulsification and intra-ocular lens implant. Enabling awake cataract surgery in patients with fixed kyphosis. Successfully undertake surgery in the inverted position due to fixed flexion deformity.
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Affiliation(s)
- Muneeb Ahmad Khan
- Portsmouth Hospitals University NHS Trust, Cosham, Portsmouth, PO63LY, United Kingdom
| | - John Burden
- Portsmouth Hospitals University NHS Trust, Cosham, Portsmouth, PO63LY, United Kingdom
| | - James Dinsmore
- Portsmouth Hospitals University NHS Trust, Cosham, Portsmouth, PO63LY, United Kingdom
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22
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Comprehensive perioperative eye protection. Braz J Anesthesiol 2021; 71:595-598. [PMID: 34599969 PMCID: PMC9373210 DOI: 10.1016/j.bjane.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Indexed: 11/23/2022] Open
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23
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Bertens CJF, van Mechelen RJS, Berendschot TTJM, Gijs M, Wolters JEJ, Gorgels TGMF, Nuijts RMMA, Beckers HJM. Repeatability, reproducibility, and agreement of three tonometers for measuring intraocular pressure in rabbits. Sci Rep 2021; 11:19217. [PMID: 34584185 PMCID: PMC8478901 DOI: 10.1038/s41598-021-98762-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/14/2021] [Indexed: 12/04/2022] Open
Abstract
The aim of this study was to evaluate repeatability, reproducibility, and agreement of three commonly used tonometers in animal research (TonoLab, TonoVet, and TonoPEN AVIA) in a cohort of 24 rabbits. Additionally, the impact of sedation on IOP was investigated in 21 New Zealand White rabbits with the TonoVet tonometer. Repeatability was determined using the coefficient of variation (CoV) for two observers. For the TonoLab (6.55%) and TonoVet (6.38%) the CoV was lower than for the TonoPEN AVIA (10.88%). The reproducibility was highest for the TonoVet (0.2 ± 3.3 mmHg), followed by the TonoLab (0 ± 12.89 mmHg) and lowest for the TonoPEN AVIA (− 1.48 ± 10.3 mmHg). The TonoLab and TonoVet showed the highest agreement (r = 0.85, R2 = 0.73). After sedation, a significant IOP reduction (often > 25%) was observed. Our results show that among the three tonometers tested, the TonoVet tonometer is best for use in rabbits while the TonoLab should be avoided. The impact of sedation on IOP was substantial and should be taken into account during experimentation.
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Affiliation(s)
- Christian J F Bertens
- Department of Ophthalmology, University Eye Clinic Maastricht, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, PO Box 5800, 6229 HX, Maastricht, The Netherlands. .,Chemelot Institute for Science and Technology (InSciTe), Gaetano Martinolaan 63-65, 6229 GS, Maastricht, The Netherlands.
| | - Ralph J S van Mechelen
- Department of Ophthalmology, University Eye Clinic Maastricht, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, PO Box 5800, 6229 HX, Maastricht, The Netherlands.,Chemelot Institute for Science and Technology (InSciTe), Gaetano Martinolaan 63-65, 6229 GS, Maastricht, The Netherlands
| | - Tos T J M Berendschot
- Department of Ophthalmology, University Eye Clinic Maastricht, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, PO Box 5800, 6229 HX, Maastricht, The Netherlands
| | - Marlies Gijs
- Department of Ophthalmology, University Eye Clinic Maastricht, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, PO Box 5800, 6229 HX, Maastricht, The Netherlands.,Chemelot Institute for Science and Technology (InSciTe), Gaetano Martinolaan 63-65, 6229 GS, Maastricht, The Netherlands
| | - Jarno E J Wolters
- Department of Ophthalmology, University Eye Clinic Maastricht, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, PO Box 5800, 6229 HX, Maastricht, The Netherlands.,Chemelot Institute for Science and Technology (InSciTe), Gaetano Martinolaan 63-65, 6229 GS, Maastricht, The Netherlands
| | - Theo G M F Gorgels
- Department of Ophthalmology, University Eye Clinic Maastricht, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, PO Box 5800, 6229 HX, Maastricht, The Netherlands.,Chemelot Institute for Science and Technology (InSciTe), Gaetano Martinolaan 63-65, 6229 GS, Maastricht, The Netherlands
| | - Rudy M M A Nuijts
- Department of Ophthalmology, University Eye Clinic Maastricht, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, PO Box 5800, 6229 HX, Maastricht, The Netherlands.,Chemelot Institute for Science and Technology (InSciTe), Gaetano Martinolaan 63-65, 6229 GS, Maastricht, The Netherlands
| | - Henny J M Beckers
- Department of Ophthalmology, University Eye Clinic Maastricht, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, PO Box 5800, 6229 HX, Maastricht, The Netherlands.,Chemelot Institute for Science and Technology (InSciTe), Gaetano Martinolaan 63-65, 6229 GS, Maastricht, The Netherlands
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Cabral SA, Carraretto AR, Sousa AM, Gomez RS. Effect of adding clonidine to lidocaine on ocular hemodynamics during sub-Tenon's anesthesia: randomized double-blind study. Braz J Anesthesiol 2021; 71:628-634. [PMID: 34547340 PMCID: PMC9373552 DOI: 10.1016/j.bjane.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/16/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Different regional anesthesia techniques for ophthalmology can have hemodynamic effects on the eye. We assessed the effects of adding clonidine to lidocaine on Intraocular Pressure (IOP), Ocular Pulse Amplitude (OPA), and Ocular Perfusion Pressure (OPP) after the sub-Tenon's technique for cataract surgery. METHODS The study included 40 patients randomly allocated into two groups: sub-Tenon's blockade with Lidocaine plus Saline Solution (LS) or Lidocaine plus Clonidine (LC). IOP, OPA and OPP were measured before anesthesia, and 1, 5 and 10 minutes after the injection of anesthetic solution. RESULTS There was no difference between the groups in IOP, OPA, and OPP baseline values. After the injection of the anesthetic solution, the IOP increased in both groups at minute one, with a mean difference of +4.67 mmHg (p = 0.001) and +2.15 mmHg (p = 0.013) at 5 minutes. The increase was lower in the LC group when compared to LS (p = 0.027). OPA decreased in both groups, with a baseline difference, after 1 minute, of -0.85 mmHg (p = -0.85 mmHg (p = 0.001), and at 5 and 10 minutes with differences of -1.17 (p = 0.001) and -0.89 mmHg (p = 0.001), respectively. The highest decrease was observed in group LC in relation to group LS (p = 0.03). There was no difference in OPP in relation to baseline measurements. CONCLUSIONS Adding clonidine to lidocaine for sub-Tenon's anesthesia reduced IOP and OPA without significant changes in OPP.
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Affiliation(s)
- Sigmar Aurea Cabral
- Universidade Federal do Espírito Santo, Departamento de Cirurgia, Vitória, ES, Brazil
| | | | - Angela Maria Sousa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Anestesia São Paulo, SP, Brazil
| | - Renato Santiago Gomez
- Universidade Federal de Minas Gerais, Departamento de Cirurgia, Belo Horizonte, MG, Brazil.
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25
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Kondo Y, Echigo N, Mihara T, Koyama Y, Takahashi K, Okamura K, Goto T. Intraocular pressure during robotic-assisted laparoscopic prostatectomy: a prospective observational study. Braz J Anesthesiol 2021; 71:618-622. [PMID: 33823210 PMCID: PMC9373603 DOI: 10.1016/j.bjane.2021.02.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/14/2021] [Accepted: 02/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background and objectives Although previous reports have shown intraocular pressure changes during robotic-assisted laparoscopic prostatectomy, they did not discuss the time course of changes or the timing of the largest change. We conducted this study to quantify pressure changes over time in patients assuming the steep Trendelenburg position during robotic-assisted laparoscopic prostatectomy. Methods Twenty-one men were enrolled. Intraocular pressure was measured before anesthesia induction in the supine position (T0); 30 (T1), 90 (T2), and 150 minutes after assuming the Trendelenburg position (T3); and 30 minutes after reassuming the supine position (T4). End-tidal carbon dioxide and blood pressure were also recorded. To compare intraocular pressure between the time points, we performed repeated-measures analysis of variance. A mixed-effects multivariate regression analysis was conducted to adjust for confounding factors. Results The mean (standard deviation) intraocular pressure was 18.3 (2.4), 23.6 (3.0), 25.1 (3.1), 25.3 (2.2), and 18.1 (5.0) mmHg at T0, T1, T2, T3, and T4, respectively. The mean intraocular pressure was higher at T1, T2, and T3 than at T0 (p < 0.0001 for all). There was no significant difference between T0 and T4, and between T3 and T2 (p > 0.99 for both). Conclusions The Trendelenburg position during robotic-assisted laparoscopic prostatectomy increased intraocular pressure. The increase was moderate at 90 minutes after the position was assumed, with the value being approximately 7 mmHg higher than the baseline value. The baseline intraocular pressure was restored at 30 minutes after the supine position was reassumed. Trial registration UMIN ID 000014973 Date of registration August 27, 2014
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Affiliation(s)
- Yuriko Kondo
- Yokohama Rosai Hospital, Department of Anesthesiology, Yokohama, Japan
| | - Noriyuki Echigo
- Yokohama Rosai Hospital, Department of Anesthesiology, Yokohama, Japan
| | - Takahiro Mihara
- Yokohama City University, Graduate School of Medicine, Department of Anesthesiology and Critical Care Medicine, Yokohama, Japan; YCU Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Education and Training Department, Yokohama, Japan; Yokohama City University, Graduate School of Data Science, Department of Health Data Science, Yokohama, Japan.
| | - Yukihide Koyama
- Nippon Koukan Hospital, Department of Anesthesia, Kawasaki, Japan
| | - Kosuke Takahashi
- Nihon University, School of Dentistry at Matsudo, Department of Maxillofacial Surgery, Tokyo, Japan; Yokohama Rosai Hospital, Department of Maxillofacial Surgery, Yokohama, Japan
| | - Kenta Okamura
- Yokohama City University, Graduate School of Medicine, Department of Anesthesiology and Critical Care Medicine, Yokohama, Japan
| | - Takahisa Goto
- Yokohama City University, Graduate School of Medicine, Department of Anesthesiology and Critical Care Medicine, Yokohama, Japan
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26
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Singh RB, Khera T, Ly V, Saini C, Cho W, Shergill S, Singh KP, Agarwal A. Ocular complications of perioperative anesthesia: a review. Graefes Arch Clin Exp Ophthalmol 2021; 259:2069-2083. [PMID: 33625566 DOI: 10.1007/s00417-021-05119-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/04/2021] [Accepted: 02/12/2021] [Indexed: 12/19/2022] Open
Abstract
Ocular complications associated with anesthesia in ocular and non-ocular surgeries are rare adverse events which may present with clinical presentations vacillating between easily treatable corneal abrasions to more serious complication such as irreversible bilateral vision loss. In this review, we outline the different techniques of anesthetic delivery in ocular surgeries and highlight the incidence and etiologies of associated injuries. The changes in vision in non-ocular surgeries are mistaken for residual sedation or anesthetics, therefore require high clinical suspicion on part of the treating ophthalmologists, to ensure early diagnosis, adequate and swift management especially in surgeries such as cardiac, spine, head and neck, and some orthopedic procedures, that have a comparatively higher incidence of ocular complications. In this article, we review the literature for reports on the clinical incidence of different ocular complications associated with anesthesia in non-ocular surgeries and outline the current understanding of pathophysiological processes associated with these adverse events.
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Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA.,Department of Ophthalmology, Leiden University Medical Center, ZA, 2333, Leiden, The Netherlands
| | - Tanvi Khera
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, MA, 02215, Boston, USA
| | - Victoria Ly
- University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Chhavi Saini
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA
| | - Wonkyung Cho
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA
| | - Sukhman Shergill
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, 06510, USA
| | | | - Aniruddha Agarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
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27
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Chen X, Wu X, Lin X, Wang J, Xu W. Outcome, influence factor and development of CLS measurement in continuous IOP monitoring: A narrative review. Cont Lens Anterior Eye 2020; 44:101376. [PMID: 33092960 DOI: 10.1016/j.clae.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/25/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
A large fluctuation in intraocular pressure (IOP) and a high peak IOP remain the risk factors for progressive visual field loss in patients with glaucoma, which is a leading cause of irreversible blindness. However, IOP measurements during working time cannot provide sufficient information on IOP to guide clinicians in setting IOP target values. Contact lenses are extensively used in ophthalmology to correct the refractive error, and recently, they are serving as platforms for detection and drug delivery. Contact lens sensor (CLS) is a feasible and promising approach to continuously monitor IOP, with superior tolerance, non-invasiveness, and without sleep disturbance. The present work reviewed the associations between progressive course and Triggerfish® CLS outputs as well as the relationship between treatments and Triggerfish® CLS outputs. Moreover, it further summarized state-of-the-art CLS devices of the past decade.
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Affiliation(s)
- Xiang Chen
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Xingdi Wu
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Xueqi Lin
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Jingwen Wang
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Wen Xu
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China.
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28
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Seet E, Zhang J, Macachor J, Kumar CM. Choosing the best supraglottic airway for ophthalmic general anaesthesia: a manikin study. J Clin Monit Comput 2020; 35:443-447. [PMID: 32274646 PMCID: PMC7223643 DOI: 10.1007/s10877-020-00507-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/31/2020] [Indexed: 11/24/2022]
Abstract
General anaesthesia is sometimes favoured over regional anaesthesia in ophthalmic surgery. The use of supraglottic airway (SGA) or laryngeal mask airway (LMA) as the primary airway device is increasing due to numerous advantages over tracheal intubation. Compared with 1st generation SGAs, 2nd generation SGAs have an added benefit of isolating the airway from the alimentary tract. However, the vertical profile of SGAs may encroach into the surgical field and hence interfere with surgery. We investigated the vertical projections of 1st generation SGAs (LMA Classic, Ambu AuraFlex) and commonly used 2nd generation SGAs in our institution (LMA ProSeal, LMA Supreme, LMA Protector, Ambu AuraGain and I-gel) in a manikin model. Each device was connected to a corrugated catheter mount or angled connector following insertion as per usual clinical practice in our institutions. Vertical projections of all devices were measured from the chin using a centimetre ruler. Securing of airway device to the chin with an adhesive tape was possible for the LMA Classic and Ambu AuraFlex with straight corrugated connector, whereas the stiffer 2nd generations SGAs required the addition of an angled connector or straight corrugated tubing to direct the airway tube caudally, away from the surgical field. The LMA ProSeal had the lowest vertical projection amongst the 2nd generation SGAs and may be the suitable choice for ophthalmic surgery. We also describe a novel technique of utilising a 1st generation SGA with placement of an orogastric tube, although with some reservations. This study has several limitations and transferability of our findings into clinical practice is questionable as the use of a manikin may not fully imitate the real condition of the patient. Our study is the first study comparing vertical projected height of different SGAs in manikin, but future studies should investigate the use of SGA in the clinical setting during ophthalmic surgery.
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Affiliation(s)
- Edwin Seet
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore, 768828, Singapore
| | - Jinbin Zhang
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Joselo Macachor
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore, 768828, Singapore
| | - Chandra M Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore, 768828, Singapore.
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29
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Chang CY, Chien YJ, Wu MY. Attenuation of increased intraocular pressure with propofol anesthesia: A systematic review with meta-analysis and trial sequential analysis. J Adv Res 2020; 24:223-238. [PMID: 32373356 PMCID: PMC7191318 DOI: 10.1016/j.jare.2020.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/28/2020] [Accepted: 02/11/2020] [Indexed: 11/26/2022] Open
Abstract
Attenuation of an increase in intraocular pressure (IOP) is crucial to preventing devastating postoperative visual loss following surgery. IOP is affected by several factors, including the physiologic alteration due to pneumoperitoneum and patient positioning and differences in anesthetic regimens. This study aimed to investigate the effects of propofol-based total intravenous anesthesia (TIVA) and volatile anesthesia on IOP. We searched multiple databases for relevant studies published before October 2019. Randomized controlled trials comparing the effects of propofol-based TIVA and volatile anesthesia on IOP during surgery were considered eligible for inclusion. Twenty studies comprising 980 patients were included. The mean IOP was significantly lower in the propofol-based TIVA group after intubation, pneumoperitoneum, Trendelenburg positioning, and lateral decubitus positioning. Moreover, mean arterial pressure and peak inspiratory pressure were also lower after intubation in the propofol-based TIVA group. Trial sequential analyses for these outcomes were conclusive. Propofol-based TIVA is more effective than volatile anesthesia during surgery at attenuating the elevation of IOP and should be considered, especially in at-risk patients.
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Affiliation(s)
- Chun-Yu Chang
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Yung-Jiun Chien
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan.,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
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30
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Najmi H, Mobarki Y, Mania K, Altowairqi B, Basehi M, Mahfouz MS, Elmahdy M. The correlation between keratoconus and eye rubbing: a review. Int J Ophthalmol 2019; 12:1775-1781. [PMID: 31741868 PMCID: PMC6848869 DOI: 10.18240/ijo.2019.11.17] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/22/2019] [Indexed: 12/23/2022] Open
Abstract
Keratoconus is a non-inflammatory disorder which is gradual in development; corneal thinning and ectatic protrusion characterizes it. Keratoconus prevalence varies between different regions depending on several factors that affecting its prevalence. There are risk factors for developing keratoconus such as demographic and environmental factors. It was suggested that eye rubbing was associated with the development of keratoconus. The main aim of this review was to summarize the literature data about keratoconus and to identify the role of eye-rubbing in the aetiology of the disease. A number of 24 articles was reviewed through the PubMed, Google Scholar and Research Gates. There are many keywords used such as keratoconus, aetiology of keratoconus, eye rubbing, keratoconus prevalence, keratoconus and eye rubbing correlation. We concluded that eye rubbing causes the thinning of keratocyte, and the degree of effect of eye rubbing depends on the period and force of performing eye rubbing. It is recommended to avoid eye rubbing to prevent keratoconus, this can be achieved by avoiding itching and treating dryness of the eye and avoiding wearing eye lenses.
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Affiliation(s)
- Hatim Najmi
- Department of Ophthalmology, King Fahad Hospital of the University, Al Khobar 34445, Saudi Arabia
| | - Yara Mobarki
- King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
| | - Khalid Mania
- King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
| | | | - Mohammed Basehi
- Department of Emergency, King Fahad Hospital of the University, Al Khobar 34445, Saudi Arabia
| | - Mohammed Salih Mahfouz
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Mona Elmahdy
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
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31
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Yu L, Yang Z, An M. Lab on the eye: A review of tear-based wearable devices for medical use and health management. Biosci Trends 2019; 13:308-313. [DOI: 10.5582/bst.2019.01178] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lan Yu
- Department of Ophthalmology, Qingdao Municipal Hospital
| | - Zhen Yang
- Department of Ophthalmology, the Second People's Hospital of Jinan City
| | - Ming An
- Department of Ophthalmology, Qingdao Municipal Hospital
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32
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Zeng W, Wang W, Wu S, Zhu X, Zheng T, Chen X, Ren J, Gong Y, Ke M. Mitochondria and Autophagy Dysfunction in Glucocorticoid-Induced Ocular Hypertension/Glaucoma Mice Model. Curr Eye Res 2019; 45:190-198. [PMID: 31425668 DOI: 10.1080/02713683.2019.1657462] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose: This study is aimed to investigate the effects of periocular steroids induction on intraocular pressure (IOP), retinal ganglion cells (RGCs) and trabecular meshwork (TM) ultrastructure in glucocorticoid-induced ocular hypertension mice model.Materials and Methods: Dexamethasone-21-acetate (Dex-Ace) was administered through periocular conjunctival fornix injection every 3 days in C57BL/6J mice. Intraocular pressure was measured weekly by rebound tonometry. RGCs were examined with immunofluorescent staining of BRN3a at week 1, 4, and 8. TM morphology was visualized with electron microscopy. Autophagy was evaluated with immunoblotting in TM tissues.Results: Dex-Ace rapidly and significantly induced IOP, which peaked at week 4. The absolute increase in IOP in the Dex-Ace-treated mice was 8.1 ± 1.4 mmHg, a 60% induction (p < .0001) compared with that in the vehicle-treated mice. The IOP sustained a higher level in the Dex-Ace group from week 4 to week 8. Dex-Ace treatment decreased the number of RGCs in a time-dependent manner, suggesting that high IOP resulted in optic neuropathy. In addition, Dex-Ace thickened trabecular beams and decreased intertrabecular spaces, with marked accumulation of fibrillar and amorphous granular extracellular material. Moreover, Dex-Ace induced swollen and elongated mitochondria in TM cells. The average mitochondria area was 0.090 ± 0.044 µm2 in the vehicle-treated mice, and increased to 0.161 ± 0.094 µm2 (p < .0001), 0.121 ± 0.029 µm2 (p = .0223) and 0.171 ± 0.076 µm2 (p < .0001) in the Dex-Ace-treated mice at weeks 1, 4 and 8, respectively. Autophagy was also increased by Dex-Ace treatment, indicating by the upregulation of LC3-I, LC3-II and beclin-1, and downregulation of p62.Conclusion: Dex-Ace administration decreased RGCs and changed TM ultrastructure, mimicking hallmarks of human glucocorticoid-induced glaucoma (GIG). In addition, mitochondria and autophagy dysfunction suggested abnormal energy metabolism in TM cells, which warranted further study to fully elucidate the pathogenesis of GIG.
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Affiliation(s)
- Wen Zeng
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wenhuan Wang
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shengyu Wu
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaolu Zhu
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tian Zheng
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaomin Chen
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiangbo Ren
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yan Gong
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Min Ke
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
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33
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Czorlich P, Krätzig T, Kluge N, Skevas C, Knospe V, Spitzer MS, Dreimann M, Mende KC, Westphal M, Eicker SO. Intraocular pressure during neurosurgical procedures in context of head position and loss of cerebrospinal fluid. J Neurosurg 2019; 131:271-280. [PMID: 30141760 DOI: 10.3171/2018.3.jns173098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Perioperative visual loss (POVL) is a rare but serious complication in surgical disciplines, especially in spine surgery. The exact pathophysiology of POVL remains unclear, but elevated intraocular pressure (IOP) is known to be part of it. As POVL is rarely described in patients undergoing intracranial or intradural surgery, the aim of this study was to investigate the course of IOP during neurosurgical procedures with opening of the dura mater and loss of CSF. METHODS In this prospective, controlled trial, 64 patients fell into one of 4 groups of 16 patients each. Group A included patients undergoing spine surgery in the prone position, group B patients had intracranial procedures in the prone position, and group C patients were treated for intracranial pathologies in a modified lateral position with the head rotated. In groups A-C, the dura was opened during surgery. Group D patients underwent spine surgeries in the prone position with an intact dura. IOP was measured continuously pre-, peri-, and postoperatively. RESULTS In all groups, IOP decreased after induction of anesthesia and increased time dependently after final positioning for the operation. The maximum IOP in group A prior to opening of the dura was 28.6 ± 6.2 mm Hg and decreased to 23.44 ± 4.9 mm Hg directly after dura opening (p < 0.0007). This effect lasted for 30 minutes (23.5 ± 5.6 mm Hg, p = 0.0028); after 60 minutes IOP slowly increased again (24.5 ± 6.3 mm Hg, p = 0.15). In group B, the last measured IOP before CSF loss was 28.1 ± 5.0 mm Hg and decreased to 23.5 ± 6.1 mm Hg (p = 0.0039) after dura opening. A significant IOP decrease in group B lasted at 30 minutes (23.6 ± 6.0 mm Hg, p = 0.0039) and 60 minutes (23.7 ± 6.0 mm Hg, p = 0.0189). In group C, only the lower eye showed a decrease in IOP up to 60 minutes after loss of CSF (opening of dura, p = 0.0007; 30 minutes, p = 0.0477; 60 minutes, p = 0.0243). In group D (control group), IOP remained stable throughout the operation after the patient was prone. CONCLUSIONS This study is the first to demonstrate that opening of the dura with loss of CSF during neurosurgical procedures results in a decrease in IOP. This might explain why POVL predominantly occurs in spinal but rarely in intracranial procedures, offers new insight to the pathophysiology of POVL, and provides the basis for further research and treatment of POVL.German Clinical Trials Register (DRKS) no.: DRKS00007590 (drks.de).
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Affiliation(s)
| | | | | | | | | | | | - Marc Dreimann
- 3Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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34
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Cok OY, Seet E, Kumar CM, Joshi GP. Perioperative considerations and anesthesia management in patients with obstructive sleep apnea undergoing ophthalmic surgery. J Cataract Refract Surg 2019; 45:1026-1031. [PMID: 31174989 DOI: 10.1016/j.jcrs.2019.02.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/20/2019] [Indexed: 11/26/2022]
Abstract
Obstructive sleep apnea (OSA) is a disorder characterized by breathing cessation caused by obstruction of the upper airway during sleep. It is associated with multiorgan comorbidities such as obesity, hypertension, heart failure, arrhythmias, diabetes mellitus, and stroke. Patients with OSA have an increased prevalence of ophthalmic disorders such as cataract, glaucoma, central serous retinopathy (detachment of retina, macular hole), eyelid laxity, keratoconus, and nonarteritic anterior ischemic optic neuropathy; and some might require surgery. Given that OSA is associated with a high incidence of perioperative complications and more than 80% of surgical patients with OSA are unrecognized, all surgical patients should be screened for OSA (eg, STOP-Bang questionnaire) with comorbidities identified. Patients suspected or diagnosed with OSA scheduled for ophthalmic surgery should have their comorbid conditions optimized. This article includes a review of the literature and highlights best perioperative anesthesia practices in the management of ophthalmic surgical patients with OSA.
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Affiliation(s)
- Oya Y Cok
- Baskent University, School of Medicine, Department of Anesthesiology and Reanimation, Adana Education and Research Centre, Adana, Turkey
| | - Edwin Seet
- Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore
| | - Chandra M Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore.
| | - Girish P Joshi
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
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A computational framework to investigate retinal haemodynamics and tissue stress. Biomech Model Mechanobiol 2019; 18:1745-1757. [PMID: 31140054 DOI: 10.1007/s10237-019-01172-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/12/2019] [Indexed: 10/26/2022]
Abstract
The process of vision begins in the retina, yet the role of biomechanical forces in the retina is relatively unknown and only recently being explored. This contribution describes a computational framework involving 3D fluid-structure interaction simulations derived from fundus images that work towards creating unique data on retinal biomechanics. We developed methods to convert 2D fundus photographs into 3D geometries that follow the curvature of the retina. Retina arterioles are embedded into a six-layer representation of the retinal tissue with varying material properties throughout the retinal tissue. Using three different human retinas (healthy, glaucoma, diabetic retinopathy) and by varying our simulation approaches, we report the effects of transient versus steady flow, viscosity assumptions (Newtonian, non-Newtonian and Fåhræus-Lindqvist effect) and rigid versus compliant retinal tissue, on resulting wall shear stress (WSS) and von Mises stress. In the retinal arterioles, the choice of viscosity model is important and WSS obtained from models with the Fåhræus-Lindqvist effect is markedly different from Newtonian and non-Newtonian models. We found little difference in WSS between steady-state and pulsatile simulations (< 5%) and show that WSS varies by about 7% between rigid and deformable models. Comparing the three geometries, we found notably different WSS in the healthy (3.3 ± 1.3 Pa), glaucoma (5.7 ± 1.6 Pa) and diabetic retinopathy cases (4.3 ± 1.1 Pa). Conversely, von Mises stress was similar in each case. We have reported a novel biomechanical framework to explore the stresses in the retina. Despite current limitations and lack of complete subject-specific physiological inputs, we believe our framework is the first of its kind and with further improvements could be useful to better understand the biomechanics of the retina.
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Kim YS, Han NR, Seo KH. Changes of intraocular pressure and ocular perfusion pressure during controlled hypotension in patients undergoing arthroscopic shoulder surgery: A prospective, randomized, controlled study comparing propofol, and desflurane anesthesia. Medicine (Baltimore) 2019; 98:e15461. [PMID: 31045821 PMCID: PMC6504298 DOI: 10.1097/md.0000000000015461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The aim of the present study is to evaluate the effects of deliberate hypotensive anesthesia on intraocular pressure (IOP) and ocular perfusion pressure (OPP) and compare the effects of propofol total intravenous anesthesia (TIVA) and desflurane anesthesia on IOP and OPP. METHODS A total of 50 patients undergoing arthroscopic shoulder surgery in the lateral decubitus position were randomized to receive desflurane or propofol anesthesia. Mean arterial pressure (MAP) was maintained in the range of 60-75 mm Hg during hypotensive anesthesia. IOP was measured using a handheld tonometer at 7 time points: before induction (T1, baseline); immediately after endotracheal intubation (T2); 10 minutes after position change to lateral decubitus (T3); 10, 30, and 50 minutes after the start of hypotensive anesthesia (T4-T6); and at the end of surgery (T7). RESULTS MAP decreased about 35% to 38% during hypotensive anesthesia. Compared to baseline values, the IOP at T6 in dependent and non-dependent eyes decreased by 0.43 and 2.74 mm Hg, respectively in desflurane group; 3.61 and 6.05 mm Hg, respectively in the propofol group. IOP of both eyes in the propofol group was significantly lower than in the desflurane group from T2 to T7. OPP of both eyes in both groups was significantly lower than at baseline, except at T2 in the desflurane group. OPP of both eyes in the propofol group was significantly higher than that in the desflurane group at T5 and T6. CONCLUSIONS Hypotensive anesthesia reduced IOP and OPP, but propofol TIVA maintained higher OPP than desflurane anesthesia. These findings suggest that propofol TIVA can help mitigate the decrease of OPP during hypotensive anesthesia.
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Affiliation(s)
- Yong-Shin Kim
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Na-Re Han
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Kwon Hui Seo
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
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Ackerman RS, Cohen JB, Getting REG, Patel SY. Are you seeing this: the impact of steep Trendelenburg position during robot-assisted laparoscopic radical prostatectomy on intraocular pressure: a brief review of the literature. J Robot Surg 2018; 13:35-40. [PMID: 30047103 DOI: 10.1007/s11701-018-0857-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
With the increasing popularity, frequency, and acceptance of the robotic-assisted laparoscopic radical prostatectomy procedure, an awareness of unique intra- and postoperative complications is heightened, including that of increases in intraocular pressure. The steep Trendelenburg positioning required for operative exposure has been shown to increase this value. While the literature is infrequent and undeveloped, certain anesthetic parameters including deep neuromuscular blockade, modified positioning, and the use of dexmedetomidine have been shown to have mild-to-modest decreases in intraocular pressure for baseline. In the four randomized control trials and four observational studies that were found via PubMed/Medline search, the aforementioned techniques demonstrate some preliminary evidence of operative considerations in this unique patient population. These modifications may prove to have even greater significance in patients with pre-existing ophthalmologic pathologies, such as glaucoma, which were excluded from the studies' analyses. This review summarizes the early literature obtained in this subject, with the intent of emphasizing the initial hypotheses and identifying areas for future study.
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Affiliation(s)
- Robert S Ackerman
- University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Boulevard, Tampa, FL, 33612, USA.,Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Jonathan B Cohen
- Department of Anesthesiology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | | | - Sephalie Y Patel
- Department of Anesthesiology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
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Gayer S, Prielipp RC. The Eye: What You Don't Know Can Hurt Your Patient. Anesth Analg 2018; 126:1446-1447. [PMID: 29672383 DOI: 10.1213/ane.0000000000002846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Steven Gayer
- From the Department of Anesthesiology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Richard C Prielipp
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota
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Corneal Vibrations during Intraocular Pressure Measurement with an Air-Puff Method. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:5705749. [PMID: 29610655 PMCID: PMC5828335 DOI: 10.1155/2018/5705749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/25/2017] [Accepted: 12/11/2017] [Indexed: 12/19/2022]
Abstract
Introduction The paper presents a commentary on the method of analysis of corneal vibrations occurring during eye pressure measurements with air-puff tonometers, for example, Corvis. The presented definition and measurement method allow for the analysis of image sequences of eye responses—cornea deformation. In particular, the outer corneal contour and sclera fragments are analysed, and 3D reconstruction is performed. Methods On this basis, well-known parameters such as eyeball reaction or corneal response are determined. The next steps of analysis allow for automatic and reproducible separation of four different corneal vibrations. These vibrations are associated with (1) the location of the maximum of cornea deformation; (2) the cutoff area measured in relation to the cornea in a steady state; (3) the maximum of peaks occurring between applanations; and (4) the other characteristic points of the corneal contour. Results The results obtained enable (1) automatic determination of the amplitude of vibrations; (2) determination of the frequency of vibrations; and (3) determination of the correlation between the selected types of vibrations. Conclusions These are diagnostic features that can be directly applied clinically for new and archived data.
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