General anesthesia in ophthalmology. (73/491)

General or a combination of local and general anesthesia is beneficial in ophthalmic operations. With foreknowledge that they are to be asleep, patients approach operation with less trepidation, and during the procedure the surgeon can be more relaxed. In a series of 300 cases reviewed, no complications that could be attributed to general anesthesia occurred at the operative site. Nasopharyngeal and tracheal irritation sometimes developed. Anesthesia should be conducted by a well-trained, alert anesthetist; and the method and the agent should be determined after thorough examination and appraisal of the patient and consideration of the nature of the operation to be done.  (+info)

Anesthesia for eye operations in the aged. (74/491)

Aged persons appear to fear eye operations. Hence both patient and surgeon are more at ease with the use of a general anesthetic, particularly if the anesthetist has visited the patient before the operation and reassured him. Early ambulation, ordinarily so desirable in the aged, is curtailed in most eye operations because the head and eyes must be completely quiet. Since barbiturates are not well tolerated by aged patients, Dramamine is used instead preoperatively. Dramamine adequately sedates but does not cause depression or hallucinations. Morphine is contraindicated because of its pupillary action; Demerol is the drug of choice for preoperative medication. Xylocaine applied directly to the pyriform fossa and vocal cords prevents laryngospasm, coughing and straining. Then, following induction with Pentothal, a Guedel airway is introduced into the oropharynx and through it a continuous flow of oxygen is maintained throughout the procedure. Relaxation of the eyelids is aided by the use of various muscle relaxants, succinylcholine being the relaxant of choice because it is rapidly eliminated. By administering narcotics intravenously during the course of the operation the amount of Pentothal needed can be held to a minimum. To prevent any slowing of the respiration, Nalline is administered in conjunction with the narcotic. In dealing with debilitated patients, Nalline is usually given in conjunction with the preoperative narcotic. Any latent slowing of the respiration can be promptly relieved by an additional dose of Nalline.  (+info)

Sensory deprivation on an eye service. Its significance and management. (75/491)

In a detailed investigation of 174 patients who wore patches over both eyes after ocular operations, some 35 per cent were observed to have one or more symptoms of mental aberrations. In a smaller group who had repair of retinal detachment and therefore had to wear eye patches for a much longer time, the incidence of mental symptoms was 100 per cent. A common symptom called "noncompliance" was found which has hitherto been regarded simply as lack of cooperation by the patient. The incidence of postoperative complications was considerably higher in patients who had symptoms of mental disturbance than in those who did not. In these circumstances it would appear worth while to prepare the patient mentally for operation, to give him assurances beforehand, and to take measures to reduce his "isolation" while he has to wear patches.  (+info)

Inhibition of intraocular fibrin formation with annexin V. (76/491)

Annexin V is a member of the calcium- and phospholipid-binding proteins, known to have an antithrombotic effect. For the first time, we have tested its ability to prevent intraocular postoperative fibrin formation in a standardised rabbit model and compared its effect with that of heparin. Annexin V, 20 micrograms and 60 micrograms, injected in the anterior chamber post-operatively, significantly reduced the area of the fibrin clot and its time to clearing. Annexin V appeared to be as efficient as heparin. It probably acts by preventing phospholipids from playing their role in the coagulation cascade which leads to fibrin formation. Furthermore, annexin V has an anti-inflammatory effect by protecting phospholipids from phospholipase A2 activity. Therefore, annexin V might be considered as a new therapeutic agent acting both on fibrin formation and inflammatory processes.  (+info)

Dermal cylindroma presenting as mass lesion in superomedial orbit. (77/491)

A superomedial orbital dermal cylindroma in an adult female is described.  (+info)

Age-related macular degeneration: evaluation and treatment. (78/491)

Any patient age 50 or older with distorted vision or vision loss may have age-related macular degeneration and should be immediately referred to an ophthalmologist. Early diagnosis and treatment are essential to preserve the current level of vision. We outline risk factors, clinical signs, what happens to the retina, and what treatments are currently available, as well as recommendations about vitamin and mineral supplementation.  (+info)

The relation of Graves' ophthalmopathy to circulating thyroid hormone status. (79/491)

AIM: The risk factors and epidemiological data for Graves' ophthalmopathy with and without abnormal circulating thyroid levels were examined to determine the relation of thyroid dysfunction to ophthalmopathy. METHODS: The authors retrospectively evaluated 482 patients seen with Graves' ophthalmopathy. Of these, 413 were classified as having abnormal levels of circulating thyroid hormone (ALTH) and 69 as having normal levels of circulating thyroid hormone (NLTH). RESULTS: Patients in the NLTH group, compared to the ALTH group, were older on average (56 (SD 13.5) v 52 (15.4)) and had a higher age adjusted body mass index (26.1 (0.8) v 23.4 (0.3)). In addition, a higher percentage of NLTH patients had hypercholesterolaemia. Those in the ALTH group were more likely to be female (76% v 51%), to have a family history of thyroid problems, and to have had eye surgery. CONCLUSION: NLTH and ALTH appear to differ from each other in terms of risk factors and epidemiological characteristics. Additionally, thyroid dysfunction seems to be associated with a more severe ophthalmopathy compared to the euthyroid state.  (+info)

A simplified approach to the treatment of Duane's syndrome. (80/491)

INTRODUCTION: To report the results of a large series of patients undergoing treatment for Duane's syndrome. METHODS: Patients with Duane's syndrome undergoing strabismus surgery of a horizontal muscle recession procedure, medial rectus recession for an esodeviation or lateral rectus recession for an exodeviation, in order to correct an abnormal head position (AHP) and a significant tropia in primary position were identified. Amount of recession varied with the angle of deviation in forced primary position, versions and ductions, and intraoperative forced ductions. Elimination of AHP was used as a criterion for success. RESULTS: Fifty nine patients were treated with either unilateral or bilateral medial or lateral rectus recession. Mean follow up was 3.1 years. Ninety three percent achieved a postoperative alignment of < or =15 degrees AHP, 66% achieved < or =5 degrees AHP. Only three patients, two from the unilateral Type II group and one from the bilateral combined Types I and II group, went on to have a second procedure for a noticeable residual AHP. CONCLUSIONS: Success (good to excellent results) of horizontal muscle recession was achieved in 93% of patients. Unilateral or bilateral horizontal rectus muscle recession offers a simple and effective surgical option for eliminating AHP and is our treatment of choice in patients with Duane's syndrome.  (+info)