Clinical study of acupuncture combined with surface anesthesia using proparacaine in geriatric cataract phacoemulsification

BACKGROUND

During anesthesia administration for cataract surgery, low pH of proparacaine may induce pain or complications such as corneal damage and poor wound healing, with the use of additional drops intraoperatively increasing the risk of complications. Accordingly, there is a clinical need for adjuncts to local anesthesia needs to improve the efficiency of anesthesia and reduce the required amount of intraoperative proparacaine.

AIM

To identify a method of anesthesia for geriatric cataract phacoemulsification that provides more efficient analgesia and improves clinical efficacy.

METHODS

A total of 130 geriatric patients with cataracts who attended Hebei Eye Hospital from December 2020 to December 2022 were included in the present study. Patients were divided into the proparacaine surface anesthesia (SA) group (65 cases) and the compound acupuncture-medicine anesthesia group (CAMA group, 65 cases). Patients in the CAMA group were provided acupuncture analgesia in addition to SA. Preoperative anxiety [Self-Rating Anxiety Scale (SAS) score and state anxiety inventory (SAI) score], intraoperative stress, vital signs, analgesia, and cooperation, as well as postoperative adverse events, were compared between groups.

RESULTS

More marked reductions in anxiety were observed among patients in the CAMA group, with corresponding reductions in SAS and SAI scores. During the operation, no change in the secretion of E, NE, or Cor group compared to the preoperative period was observed in the CAMA, which was markedly lower than that in the SA group. Heart rate, blood pressure, and respiratory rate were more stable intraoperatively in the CAMA group. In addition, the incidence of intraoperative pain and the number of additional doses of anesthesia required in the CAMA group were markedly lower than in the SA group. Accordingly, patients in the CAMA group were able to avoid eye movements and eyelid closing leading to greater cooperation with surgeons during surgery. Furthermore, marked reductions in intraoperative adverse effects were observed in the CAMA group, indicating greater overall safety.

CONCLUSION

Proparacaine SA combined with acupuncture as an analgesic provides improved analgesia with greater safety compared to surface anesthesia with proparacaine during geriatric cataract phacoemulsification.

[Observation of cosmetic effect of corneal interlamellar staining in patients with corneal leucoma]

Objective: To observe the clinical effect of corneal staining in patients with corneal leucoma. Methods: Restrospective case series study.Thirty eyes of 30 patients (17 males, 13 females) with corneal leucoma who underwent corneal interlamellar staining at Beijing Aier-Intech Eye Hospital from October 2014 to July 2018 were included. The mean age was 31.50±15.66 years. Postoperative follow-up was more than 1 year. All the patients underwent appearance examination, anterior segment examination with a slit lamp, B-scan examination and anterior segment OCT examination preoperatively and postoperatively. The effect of corneal staining, patient satisfaction and the incidence of complications were investigated. Results: The corneal epithelium of all the patients healed completely within 1-3 days after operation. The mean follow-up period was 30.68±18.02 months (range, 12.37-58.10 months). During the postoperative follow-up period, no staining permeation or inflammatory reaction in the anterior chamber occurred. The corneal color and appearance were well maintained in 18 patients (72.0%). Seven patients (28.0%) showed mild corneal color-fading. One patient was treated with enucleation and orbital hydroxyapatite implantation because of eye atrophy and corneal banding degeneration caused by the primary disease at 4 years after operation. The surgeon was satisfied with the improvement of the appearance of all cases; 22 patients (88.0%) were satisfied with the postoperative appearance. No significant complications were observed in all the cases. Conclusions: Corneal interlamellar staining is one of best choices for the treatment of corneal leucoma. It has advantages of quick postoperative recovery, long-standing color staining and good cosmetic effect. The operation is simple and easy to carry out and there is no obvious damage to eye tissues. (Chin J Ophthalmol, 2020, 56:465-472).

[Research progress on the role of NLRP3 inflammasome in ocular diseases]

Nucleotide-binding oligomerization domain-like receptor pyrin domain containing-3 (NLRP3) inflammasome is a type of multi-protein complex within the cell, the activation of which promotes the release of bioactive interleukin(IL)-1β and IL-18 and contributes to inflammatory progress. In recent years, the research on the role of NLRP3 inflammasome in the pathogenesis and development of ocular surface and fundus diseases has made considerable progress. This review summarizes current understanding in the structure, ocular expression, and mechanisms of activation of NLRP3 inflammasome, as well as the contribution of this protein complex to eye diseases, thereby revealing the theoretical possibility that NLRP3 inflammasome might serve as a novel therapeutic target for the related ocular diseases.(Chin J Ophthalmol, 2018, 54: 396-400).

Changes in the soil environment from excessive application of fertilizers and manures to two contrasting intensive cropping systems on the North China Plain

Effects of excessive fertilizer and manure applications on the soil environment were compared in greenhouse vegetable systems shifted from wheat-maize rotations 5-15years previously and in wheat-maize rotations. N, P and K surpluses to the greenhouses were 4328, 1337 and 1466kgha(-1)year(-1), respectively compared to 346, 65 and -163kgha(-1)year(-1) to wheat-maize fields. Subsequently, substantial mineral N and available P and K accumulated in the soil and leaching occurred down the soil profile in the greenhouses. Soil pH under vegetables was significantly lower than in the wheat-maize fields, while the EC was significantly higher in the vegetable soils. The mean Cd concentration in the vegetable soils was 2.8 times that in the wheat-maize rotations. Due to excessive fertilizer application in greenhouse vegetable production in northeast China, excessive salt and nitrate concentrations may accumulate and soil quality may deteriorate faster than in conventional wheat-maize rotations.