Haemorrhage and risk factors associated with retrobulbar/peribulbar block: a prospective study in 1383 patients.
Patients undergoing intraocular surgery are elderly and may have disease or be receiving medication which increases the risk of haemorrhage. We interviewed 1383 consecutive patients scheduled for eye surgery requiring retrobulbar/peribulbar block about their use of non-steroidal anti-inflammatory drugs, oral steroids and warfarin. A history of diabetes mellitus and globe axial length was noted. Medial peribulbar and inferolateral retrobulbar blocks were performed by three specialists and six doctors in training. The ensuing haemorrhages were graded as follows: 1 = spot ecchymosis; 2 = lid ecchymosis involving half of the lid surface area or less; 3 = lid ecchymosis all around the eye, no increase in intraocular pressure; 4 = retrobulbar haemorrhage with increased intraocular pressure. Acetylsalicylic acid was taken by 482 (35%) patients, non-steroidal anti-inflammatory drugs by 260 (19%) and warfarin by 76 (5.5%). Lid haemorrhages (grades 1-3) were observed in 55 patients (4.0%); in 33 of these patients the haemorrhages were spotlike (grade 1). No grade 4 haemorrhages occurred. The preoperative use of acetylsalicylic acid, non-steroidal anti-inflammatory drugs or warfarin, whether or not they had been discontinued, did not predispose to haemorrhage associated with retrobulbar/peribulbar block. (+info)
Characteristics and functional outcome of traumatic hyphema without routine administration of epsilon-aminocaproic acid.
BACKGROUND: The prevalence of traumatic hyphema as well as the distribution of its severity varies among different patient populations. Treatment recommendations in the literature differ significantly among various published reports. This lack of a uniformly accepted treatment probably reflects the different characteristics of this pathology among the populations investigated and cells for a population-adjusted treatment recommendation. OBJECTIVES: To report the characteristics and functional outcome of patients with traumatic hyphema and to discuss possible recommendations regarding the use of epsilon-aminocaproic acid. METHODS: A prospective, non-randomized study was conducted in 154 consecutive patients with traumatic hyphema, including data collection of ophthalmic status at various time points, the presence or absence of secondary hemorrhage, and final visual acuity. RESULTS: Of the 154 eyes studied over 3 years, nearly 90% had hyphema of grade 1 or less, 5 (3.25%) experienced rebleeding, and 2 (1.3%)--neither of which rebled--needed surgical intervention. None of the four patients who experienced final visual acuity of 6/40 or less suffered rebleeding. CONCLUSION: The use of epsilon-aminocaproic acid in the studied population was unjustified and routine use of epsilon-aminocaproic acid in our patient population is probably not indicated. A treatment policy regarding epsilon-aminocaproic acid use should be adjusted to the population being treated. (+info)
Sub-Tenon anesthesia: a prospective study of 6,000 blocks.
BACKGROUND: An initial pilot study of 300 sub-Tenon local anesthetic blocks (STBs) for intraocular surgery established the effectiveness and patient acceptability of the technique. Following this, a decision was made in 1995 to change from sharp needle techniques to STB for all eye surgeries performed during local anesthesia at Auckland Hospital (Auckland, New Zealand) by reeducation of anesthetists and surgeons. At this point, sufficient data were not available to confirm that STB would avoid the complications associated with the passage of sharp needles into the orbit or would cause a different set of serious complications. METHODS: A prospective study of the next 6,000 consecutive STBs performed at Auckland Hospital was carried out over a period of 6 yr (from 1995 to 2000). RESULTS: Sub-Tenon block is very effective, with a surgeon and patient acceptability rate of 98.8%. Insertion of the sub-Tenon cannula and administration of the anesthetic produces minimal discomfort, being completely painless in 68.8% of cases. There were no serious block-related complications in this series, supporting the safety of the sub-Tenon technique. CONCLUSION: The experience at Auckland Hospital provides further support for the avoidance of passing sharp needles into the orbit. (+info)
Visual performance after interface haemorrhage during laser in situ keratomileusis.
AIM: To study the visual performance in eyes with interface haemorrhage during laser assisted in situ keratomileusis (LASIK). METHODS: Case records of 20 patients, who had bleeding from the limbal vessels in one eye during LASIK (group 1) and uncomplicated surgery in the fellow eye (group 2) were studied. The parameters evaluated were uncorrected visual acuity (UCVA) best corrected visual acuity (BCVA), spherical equivalent of refraction (SEQ), contrast sensitivity, and glare acuity preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: The mean preoperative SEQ in group 1 and 2 eyes was -5.79 (2.3) D and -5.27 (1.68) D, respectively. The mean decimal UCVA at 6 months after LASIK in group 1 and 2 eyes were 0.6 (0.2) and 1.0 respectively (p<0.001). The mean decimal BCVA at 1 week after LASIK in group 1 and 2 eyes were 0.89 (0.04) and 1.0 respectively (p<0.05). However, all eyes had a BCVA of 6/6 at 1, 3, and 6 months after LASIK. The mean contrast sensitivity values preoperatively in group 1 and 2 eyes were 161.3 (8.7) and 172 (68.2) respectively. There was a significant decrease in group 1 at 6 months (102 (60.5) (p<0.01)) compared to group 2. The decimal glare acuity preoperatively in group 1 and 2 eyes was 0.95 (0.11) and 0.89 (0.12), respectively. It decreased significantly in group 1 (0.7) (0.1 (p<0.01)) compared to group 2 at the 6 month follow up. CONCLUSION: Occurrence of intraoperative interface haemorrhage may affect the visual performance following LASIK surgery. (+info)
Spontaneous subconjunctival haemorrhage--a sign of hypertension?
The relationship between the condition of spontaneous subconjunctival haemorrhage (SCH) and hypertension was investigated. Seventy eight patients with SCH and 78 controls with unrelated ophthalmic conditions were compared. Blood pressure (BP) was significantly higher at presentation in the group with SCH at 149 (SD 27)/89 (SD 15) versus 142 (SD 25)/81 (SD 12). The proportion of hypertensives by WHO criteria (systolic blood pressure > 160 and/or diastolic blood pressure >95) was 46% on presentation compared with 23% of the control group. The morphology of the lesion did not influence the association with hypertension although there was a suggestion that the group with raised haemorrhages had a tendency to higher systolic blood pressure. It is recommended that all patients with SCH have their BP checked; this will result in the diagnosis of a significant number of new hypertensives. (+info)
An uncommonly serious case of an uncommon sport injury.
BACKGROUND: A 55 year old man sustained a severe ocular injury when hit by a cricket ball even though he was wearing a helmet. METHODS: A suprachoroidal haemorrhage was drained and dense intravitreal blood was removed. An inferior buckle was applied with the use of intraocular gas. A macular haemorrhage resolved slowly. RESULTS: Despite several surgical procedures over 1.5 years, the final visual acuity of the patient was only 6/60 because of a dense macular scar. CONCLUSIONS: Helmets worn as protection when playing cricket need to be designed better and be of better material. Eye protection should be worn at all levels of play. (+info)
Management of traumatic optic neuropathy--a study of 23 patients.
Twenty three patients with traumatic optic neuropathy were managed by medical and surgical treatment as follows. High dose intravenous steroids were initiated in all patients. If visions did not improve significantly after 24 to 48 hours decompression of an optic nerve sheath haematoma by medial orbitotomy and neurosurgical decompression of the optic canal were considered based on computed tomographic scan findings. Nine of 16 patients who received steroids only showed significant improvement. One of three showed improvement on optic nerve decompression after steroid failure; three or four showed improvement on optic nerve decompression after steroid failure; three or four showed improvement with combined optic nerve sheath decompression by the medial orbitotomy and decompression of the optic canal by frontal craniotomy. A lucid interval of vision after injury and an enlarged optic nerve sheath were associated with an improved prognosis. Five of the 23 patients had a lucid interval and all five had a final improved vision, while only five of 18 patients without a lucid interval improved. Similarly seven of the nine with an enlarged optic nerve sheath showed improvement while only three of 10 patients (three bilateral cases) who presented with no light perception improved with medical and surgical treatment. While a prospective controlled study of the management of traumatic optic neuropathy is necessary this preliminary study suggests that treatment of traumatic optic nerve sheath haematoma by optic nerve sheath decompression should be considered in selected patients. (+info)
Neonatal haemorrhagic conjunctivitis: a specific sign of chlamydial infection.
OBJECTIVE: To review the bacteriological causes and clinical features of acute neonatal conjunctivitis in a local paediatric centre. DESIGN: Retrospective review. SETTING: Paediatric unit of a regional hospital, Hong Kong. PATIENTS: All neonates who presented to Tuen Mun Hospital from 1 January 1996 to 31 December 2002 with persistent eye discharge and a positive eye swab culture. MAIN OUTCOME MEASURES: Clinical features of neonates with chlamydial and non-chlamydial conjunctivitis. RESULTS: Of 90 neonates with positive eye swab or conjunctival scraping cultures, Chlamydia trachomatis was the second most common (n=19, 21%) cause of acute neonatal conjunctivitis after Staphylococcus aureus (n=32, 36%). All of the neonates with chlamydial conjunctivitis were delivered vaginally: two of them had concomitant chlamydial pneumonia. Neisseria gonorrhoeae conjunctivitis was rare (n=1, 1%). None of the mothers of neonates with Chlamydia had any history of sexually transmitted disease. The timing of presentation, gestational age, birth weight, and sex of the neonates did not suggest a risk of chlamydial infection. Nonetheless haemorrhagic eye discharge had a specificity of 100% and positive predictive value of 100% for chlamydial infection. There were no adverse ophthalmological consequences or complications of pyloric stenosis in any neonate following treatment with oral erythromycin. CONCLUSIONS: Haemorrhagic eye discharge is a highly specific sign of neonatal chlamydial conjunctivitis. Early and prompt treatment with oral erythromycin is safe and effective. (+info)