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American Journal of Ophthalmology Case... Mar 2024This case report presents an event of retrobulbar hemorrhage (RH) occurring during the initial stage of strabismus surgery after incision of the conjunctiva and Tenon's...
PURPOSE
This case report presents an event of retrobulbar hemorrhage (RH) occurring during the initial stage of strabismus surgery after incision of the conjunctiva and Tenon's capsule.
OBSERVATION
Significant bleeding with subsequent proptosis was observed intraoperatively after the incision of conjunctiva and Tenon's capsule during routine strabismus surgery on the medial rectus muscle in a 5-year-old boy. Intravenous mannitol was administered intraoperatively and surgery was completed as planned. The RH receded within 24 hours without the necessity of orbital decompression. Tenon's capsule prolapse was noted on the first postoperative day and managed with surgical excision under shallow intravenous anesthesia. No damage to the optic nerve or ganglion cells was detected a week after and three months post-surgery.
CONCLUSIONS AND IMPORTANCE
Strabismus surgery bears a risk of RH at every stage of the operation. Careful hemostasis should be provided at each step of the procedure to decrease the risk of such an event. Patients after events of serious intraoperative bleeding should undergo careful post-operative investigation towards coagulation insufficiencies, though no such deficits were identified in the present case.
PubMed: 38292880
DOI: 10.1016/j.ajoc.2024.101991 -
Plastic and Reconstructive Surgery.... Jun 2023This study describes a novel three-point tangent technique for tear trough filler and the results from the largest series to date.
UNLABELLED
This study describes a novel three-point tangent technique for tear trough filler and the results from the largest series to date.
METHODS
A retrospective case review was performed for all patients treated between 2016 and 2020. Patient demographics, filler details and complications were recorded. The injection technique involves using a blunt cannula to deliver filler along three linear tangents bespoke to each patient.
RESULTS
A total of 1452 applications of filler to the orbits of 583 patients were recorded. The median patient age was 41 years (range 19-77), and 84% were women. The mean volume of applied filler at the first appointment was 0.34 mL to each orbit (range 0.1--1.5); 82% reported no complication, 10% reported swelling with a median duration of 4 weeks (range 1-52), 4.3% experienced bruising, 4.6% reported contour irregularities, and 3.3% experienced a Tyndall effect. Retrobulbar hemorrhage occurred in one patient (0.17%), which was managed immediately with no lasting visual compromise. Volume of filler injected was significantly associated with a risk of edema ( < 0.00001) and contour irregularities ( = 0.012). In total, 50% of cases of edema resolved spontaneously after 4 weeks. Filler was dissolved in 1.9% of orbits. Patients with a history of dissolving were significantly more likely to require dissolving after subsequent reinjection ( = 0.043).
CONCLUSIONS
The three-point tangent technique is a safe and effective method. Increasing volume of filler administered is associated with complications of edema and contour irregularities. Edema is the most common complication and resolves spontaneously in half of patients by 4 weeks.
PubMed: 37305194
DOI: 10.1097/GOX.0000000000005060 -
Cureus Apr 2024To describe the clinical profile, complications and trends of ocular anaesthesia in a multi-tier ophthalmology network in India.
INTRODUCTION
To describe the clinical profile, complications and trends of ocular anaesthesia in a multi-tier ophthalmology network in India.
METHODS
This retrospective hospital-based study included 417,622 patients presenting between January 2013 and December 2020. Patients who were administered either topical, local or general anaesthesia for ocular surgery in at least one eye were included as cases. The data were collected using an electronic medical record system.
RESULTS
Among the 417,622 patients, local anaesthesia was administered to 280,638, (67.2%) patients and was the most commonly administered type followed by topical anaesthesia in 84,117 (20.14%) patients. The most common complication encountered in administering local anaesthesia was retrobulbar haemorrhage in 103 (0.037%) patients followed by lid haematoma in 49 (0.017%) patients. Tooth damage occurred in 40 (0.076%) patients followed by delayed recovery in 30 (0.057%) patients during general anaesthesia. The trend of local anaesthesia decreased (83.48% vs 53.36%), whereas the trend of topical anaesthesia increased (8.61% vs 32.42%) over the study period.
CONCLUSION
There is a notable trend towards the adoption of less invasive anaesthetic methods, particularly in common surgeries such as cataract, intravitreal injection, and vitreoretinal surgery. However, despite this trend, a significant proportion of oculoplastic/orbital surgeries, trauma, and strabismus surgeries continue to be performed under general anaesthesia. These observations underscore the ongoing evolution of ocular anaesthesia practices, reflecting advancements in surgical techniques and patient preferences.
PubMed: 38707167
DOI: 10.7759/cureus.57564 -
Journal of Feline Medicine and Surgery May 2024A total of 13 cases of cats with a caudal mandibular fracture treated with a novel surgical technique using the Ramus Anatomical Plate system were reviewed....
CASE SERIES SUMMARY
A total of 13 cases of cats with a caudal mandibular fracture treated with a novel surgical technique using the Ramus Anatomical Plate system were reviewed. Preoperative, immediate postoperative and a minimum of 8 weeks postoperative CT images were required as inclusion criteria. The outcome and complications were determined from clinical data and radiographic follow-up examinations. All cases achieved adequate anatomical reduction, resulting in a functional and atraumatic occlusion postoperatively. No intraoperative complications were reported. Time to voluntary food intake was in the range of 1-25 days. No evidence of disruptions to the implants or screw loosening was observed in the 8-week postoperative CT imaging, with radiographic evidence of complete osseous union in all fractures. The most common postoperative complication was swelling at the surgical site. Two cats had postoperative exophthalmos due to retrobulbar haemorrhage, and one cat exhibited partial wound dehiscence 5 days postoperatively, which resolved with medical management. Longer-term complications included intraoral plate exposure in one cat, which required plate removal 10 months postoperatively.
RELEVANCE AND NOVEL INFORMATION
In this case series, rigid internal fixation of caudal mandibular fractures using the Ramus Anatomical Plate osteosynthesis system was associated with a minimal complication rate, and satisfactory radiographic and clinical outcomes. The reported outcomes of this novel technique are favourable when compared with previous techniques described for the management of these fracture types.
Topics: Cats; Animals; Bone Plates; Fracture Fixation, Internal; Mandibular Fractures; Male; Female; Treatment Outcome; Postoperative Complications; Tomography, X-Ray Computed; Cat Diseases
PubMed: 38717791
DOI: 10.1177/1098612X241243134