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Outcome Values of Adding Sodium Bicarbonate, Dexamethasone and Fentanyl to Local Anesthetic in Peribulbar Block during vitreoretinal Surgeries. A Randomized Prospective Study

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Open Journal of Anesthesiology 2018年第1期8卷 1-13页

作者： Sherif Kamal Arafa Amir Abouzkry El-Sayed Department of Anesthesia Faculty of Medicine Aswan University Aswan Egypt

Background and aims: we aimed to detect the outcome values of adding fentanyl, dexamethasone and sodium bicarbonate to mixture of local anesthetic in peribulbar block for vitreoretinal surgery. Methods: 120 adult ASA I & II patients, admitted for vitreoretinal surgery under peribulbar block were included in this comparative study. This study included 4 groups: Group I: (30) patients using a mixture of 1 ml normal saline, 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group II: (30) patients using a mixture of 1 ml of sodium bicarbonate (from 1 ml sodium bicarbonate 8.4% diluted in 10 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group III: (30) patients using a mixture of 1 ml fentanyl 20 μg (from a mixture of fentanyl 100 μg diluted in 5 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group IV: (30) patients using a mixture of 1 ml of 4 mg dexamethasone (1 ampoule = 8 mg/2 ml), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. We measured the onset and duration of anesthesia, IOP, eyelid and global akinesia, postoperative pain by numerical pain rating scale, first analgesic requirement and postoperative side effects. Results: No significant differences were detected among the four groups as respect to age, sex and the intraocular pressure (IOP) before the anesthesia block. While the intraocular pressure (IOP) after the anesthesia block there was a significant difference, as IOP was markedly decreased postoperatively in group II compared with other groups. As regard to the onset & duration of anesthesia there was significant difference among all groups, there was rapid onset and prolonged duration of anesthesia in group III compared with other groups (1.77 ± 0.63 & 5.03 ± 0.89) respectively. As regard the onset of lid akinesia there was signif

关键词： Fentanyl Dexamethasone Sodium Bicarbonate Local Anesthesia Peribulbar Block vitreoretinal Surgeries

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Presenting clinical features of patients with vitreoretinal lymphoma

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World Journal of Ophthalmology 2014年第2期4卷 21-24页

作者： Katie M Keck David J Wilson Eric B Suhler Alison Skalet Christina J Flaxel Eric B Suhler Department of Ophthalmology Casey Eye Institute Oregon Health and Science University Portland OR 97239 United States Ophthalmology Service Portland VA Medical Center Portland OR 97239 United States

AIM: To assess the presenting clinical features, time from presentation to diagnosis and association with central nervous system(CNS) lymphoma in patients with vitreoretinal ***: Retrospective case series of patients diagnosed with vitreoretinal lymphoma between 2009 and 2011 at a single ***: Fifteen eyes in 9 patients were included. Common presenting ocular symptoms included blurred vision(78%) and worsening floaters(44%) with an average symptom duration prior to presentation of 88.4 d(range 7-365 d). Common ophthalmic exam findings were vitreous haze(89%) and subretinal lesions(56%). The average time from presentation to diagnosis was 56.3 d(range 16-180 d). All patients were diagnosedwith large B-cell lymphoma according to pathology results. Lymphoma was restricted to the eye in 33%, while 67% of patients had CNS involvement. Of the patients with secondary vitreoretinal lymphoma, 67% initially presented with CNS lymphoma while 33% initially presented with vitreoretinal lymphoma. Of the patients with CNS involvement, memory loss(67%) was the most common presenting ***: vitreoretinal lymphoma most commonly presents with symptoms of blurred vision and/or worsening floaters and vitreous haze on exam. The average time from presentation to diagnosis may be decreasing with increased awareness among clinicians.

关键词： Primary vitreoretinal lymphoma Secondary vitreoretinal lymphoma Primary central nervous sys-tem lymphoma Primary intraocular lymphoma

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Perfluorocarbon in vitreoretinal surgery and preoperative bevacizumab in diabetic tractional retinal detachment

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World Journal of Diabetes 2014年第5期5卷 724-729页

作者： J Fernando Arevalo Martin A Serrano Juan D Arias From the Retina Division Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore MD 21287 United States the vitreoretinal Division King Khaled Eye Specialist Hospital Riyadh 11462 Saudi Arabia Division of Ophthalmology Faculty of Medicine and Health Sciences University of Stellenbosch Stellenbosch 7600 South Africa the Retina and Vitreous Service Clinica Oftalmologica Centro Caracas Caracas 1010 Venezuela

AIM: To describe the en bloc perfluorodissection(EBPD) technique and to demonstrate the applicabilityof using preoperative intravitreal bevacizumab duringsmall-gauge vitreoretinal surgery(23-gauge transconjunctival sutureless vitrectomy) in eyes with advancedproliferative diabetic retinopathy(PDR) with tractionalretinal detachment(TRD).METHODS: This is a prospective, interventional caseseries. Participants included 114(eyes) with advancedproliferative diabetic retinopathy and TRD. EBPD wasperformed in 114 eyes(consecutive patients) during23-gauge vitrectomy with the utilization of preoperativebevacizumab(1.25 mg/-0.05 mL). Patients mean age was 45 years(range, 21-85 years). Surgical time had a mean of 55 min(Range, 25-85 min). Mean follow up of this group of patients was 24 mo(range, 12-32 mo). Main outcome measures included best-corrected visual acuity(BCVA), retinal reattachment, and ***: Anatomic success occurred in 100%(114/-114) of eyes. Significant visual improvement [≥ 2 Early Treatment Diabetic Retinopathy Study(ETDRS) lines] was obtained in 69.2%(79/-114), in 26 eyes(22.8%) BCVA remained stable, and in 8 eyes(7%) BCVA decreased(≥ 2 ETDRS lines). Final BCVA was 20/-50 or better in 24% of eyes, between 20/-60 and 20/-400 in 46% of eyes, and worse than 20/-400 in 30% of eyes. Complications included cataract in 32(28%) eyes, iatrogenic retinal breaks in 9(7.8%) eyes, vitreous hemorrhage requiring another procedure in 7(6.1%) eyes, and phthisis bulbi in 1(0.9%) ***: This study demonstrates the usefulne-ss of using preoperative intravitreal bevacizumab and EBPD during smallgauge vitreoretinal surgery in eyes with TRD in PDR.

关键词： Avastin Intravitreal bevacizumab Intravitreal injections Proliferative diabetic retinopathy Tractional retinal detachment Perfluorodissection Minimally invasive vitreoretinal surgery Vitrectomy

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Posterior vitreous detachment rate following intravitreal dexamethasone injection

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International Journal of Ophthalmology(English edition) 2019年第8期12卷 1298-1303页

作者： Atilla Alpay Department of Ophthalmology the School of MedicineZonguldak Bülent Ecevit University

AIM: To determine whether intravitreal dexamethasone(DEX) implant induces posterior vitreous detachment or not. METHODS: We retrospectively reviewed 810 eyes of 405 patients who underwent intravitreal DEX implantation due to macular edema caused by diabetic and retinal venous occlusion in our clinic. The eyes having no injection were determined as the control group. The examination findings of the patients before the injection and 3 mo after the injection and optical coherence tomography(OCT) images were scanned. The pre-injection OCT findings and OCT findings of the patients having no posterior vitreous detachment(PVD) and determined to have partial PVD were compared. RESULTS: The separation in vitreoretinal adhesion and total PVD development of DEX-injected 56/208(26.9%) eyes were statistically greater in comparison with the 12/129(9.3%) eyes that had not been injected(P=0.001). PVD development was observed more in the patients that were younger, had larger macula thickness and lower visual acuity. CONCLUSION: It can be stated that intravitreal DEX implant induces PVD development. Prospective, controlled studies are required in order to determine prognosis of vitreoretinal disease in PVD-developed patients and in non-PVD-developed patients.

关键词： dexamethasone implant intravitreal injection vitreoretinal adhesion diabetic macular edema retinal vein occlusion posterior vitreous detchment

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Treatment of Coats' disease: an analysis of pooled results

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International Journal of Ophthalmology(English edition) 2019年第4期12卷 668-674页

作者： Janelle Fassbender Adeniran Sarah M Duff Michael Mimouni Nathan Lambert Aparna Ramasubramanian Department of Ophthalmology & Visual Sciences University of Louisville School of Medicine Rambam Hospital University of Utah

AIM: To elucidate the association of treatment modality to vitreoretinal fibrosis and traction retinal detachment(TRD) in Coats' ***: A PubMed search for Coats' disease with included studies describing eyes with clinical features and treatment course of Coats' disease. Binary logistic regression with fibrosis at presentation and treatment type as independent variables was performed to determine predictors of TRD historically(since 1921) and in the antivascular endothelial growth factor(VEGF) era(since2007). Odds ratios(OR) with 95% confidence intervals(CI)***: Of 175 articles described 1183 eyes. vitreoretinal fibrosis increased from presentation(5.4%) to follow-up(15.5%) and TRD increased from 0.44% to 3.9% at follow up. Laser was protective against vitreoretinal fibrosis(OR0.6, 95%CI 0.4-0.9) but TRD was borderline(OR 0.6, 95%CI0.3-1.1). Cryotherapy showed a higher association with TRD(OR 1.9, 95%CI 1.0-3.7) than with vitreoretinal fibrosis(OR 0.8, 95%CI 0.5-1.2). Similarly, intravitreal anti-VEGF alone was not associated with fibrosis(OR 1.1, 95%CI 0.6-1.8) nor TRD(OR 1.1, 95%CI 0.5-2.6) but the combination of laser and anti-VEGF therapy was protective [Fibrosis: 0.1(0.03, 0.35); TRD: 0.05(0.01, 0.23)] compared to anti-VEGF plus cryotherapy(Pvitreoretinal fibrosis and TRD increase after treatment in Coats' disease. The combination of antiVEGF agents and cryotherapy may lead to higher risk for TRD. Presence of pre-treatment fibrosis is the highest risk factor for post-treatment worsening of vitreoretinal fibrosis and TRD.

关键词： Coats’ disease cryotherapy anti-vascular endothelial growth factor traction retinal detachment vitreoretinal fibrosis

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Free autologous internal limiting membrane transplantation in the treatment of large macular hole

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International Journal of Ophthalmology(English edition) 2019年第5期12卷 848-851页

作者： Fei-Yan Ma Rui-Jie Xi Peng-Fei Chen Yu-Hua Hao Department of Ophthalmology Second Hospital of Hebei Medical University NIMO Ophthalmology Research Institute

We evaluated the clinical efficacy of free internal limiting membrane(ILM) flap transplantation for the treatment of large macular hole over 500 μm in 42 consecutive patients. Quantified evaluation of the post-operative macular anatomy restoration was performed by spectral-domain optical coherence tomography in the 12 mo follow-up. The results showed 41 eyes achieved successful closure(97.6%). Postoperative best corrected visual acuity, ellipsoid layer, and external limiting membrane disruption were significantly improved at all follow-up time points. The central foveal thickness was significantly higher at 1 mo. We concluded that free ILM flap transplantation proves to be effective to achieve anatomical and functional improvement for the treatment of large macular hole.

关键词： vitreoretinal disease macular hole internal limiting membrane vitrectomy

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Macrophages in Human Epiretinal and Vitreal Membranes in Patients with Proliferative Intraocular Disorders

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Eye Science 1996年第1期16卷 28-32页

作者： Shibo Tang, Rulong Gao, De-zheng WuZhongshan Ophthalmic Center, Sun Yat-sen University of Medical Sciences, Guangzhou 510060, China Zhongshan Ophthalmic Center Sun Yat-sen University of Medical Sciences Guangzhou China.

Purpose: Macrophages are versatile cells and have been known as a cellular component of epiretinal membranes of proliferative intraocular disorders (PID). However, the origin and functions of these cells in the membranes are not yet clear. In the present study we investigated the characterization of macrophages/monocytes in various types of human epiretinal membranes from patients with proliferative vitreortinopathy (PVR) , proliferative diabetic retinopathy (PDR) and ocular perforating injury by means of immunohistochemical techniques. Methods: A total of 49 epiretinal membranes of PID in which 24 were PDR specimens, 17 were PVR and 8 were proliferations after perforating eye injury were studied. Monoclonal antibodies against human macrophages, monocytes, HLA-DR antigen and interleukin-1 (IL-1) were used. The alkaline phosphatase anti-alkaline phosphatase (APAAP) technique was ***: The results showed that 19 out of 24 PDR specimens (79%), 15 out of 17 PVR specimens (88%) and 7 out of 8

关键词： vitreoretinal diseases macrophages cytokine

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