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Journal of Refractive Surgery... Jun 2023To estimate the accommodative changes of the anterior segment and its impact on the central and peripheral vaults after Visian Implantable Collamer Lens (ICL) (STAAR...
PURPOSE
To estimate the accommodative changes of the anterior segment and its impact on the central and peripheral vaults after Visian Implantable Collamer Lens (ICL) (STAAR Surgical) implantation.
METHODS
Eighty eyes of 40 consecutive patients (mean age: 28.05 years; range: 19 to 42 years) were examined 3 months after ICL implantation. Eyes were randomly divided into a mydriasis group and a miosis group. Anterior chamber depth (ACD) to crystalline lens (ACD-L), anterior chamber depth to ICL (ACD-ICL), central distance from endothelium to sulcus to sulcus (ASL), central distance from sulcus to sulcus to crystalline lens (STS-L), central distance from ICL to sulcus to sulcus (STS-ICL), and central (cICL-L), midperipheral (mICL-L), and peripheral (pICL-L) vaults were measured by ultrasound biomicroscopy at baseline and after induction with tropicamide or pilocarpine.
RESULTS
After tropicamide treatment, cICL-L, mICL-L, and pICL-L decreased from 0.531 ± 0.200, 0.419 ± 0.173, and 0.362 ± 0.150 mm to 0.488 ± 0.171, 0.373 ± 0.153, and 0.311 ± 0.131 mm, respectively. The values decreased from 0.540 ± 0.185, 0.445 ± 0.172, and 0.388 ± 0.149 mm to 0.464 ± 0.199, 0.378 ± 0.156, and 0.324 ± 0.137 mm after pilocarpine administration, respectively. The ASL and STS showed a significant increase in the mydriasis group (all ≤ .038), but a decrease in the miosis group (all < .001). The ACD-L increased and STS-L decreased in the mydriasis group (all < .001), indicating the backward shift of the crystalline lens, whereas crystalline lens forward shift was observed in the miosis group. Additionally, the STS-ICL decreased in both groups (all ≤ .021), suggesting the ICL backward shift.
CONCLUSIONS
Both central and peripheral vaults decreased during the pharmacological accommodation process, and the ciliaris-iris-lens complex contributed to the changes. .
Topics: Humans; Adult; Mydriasis; Pilocarpine; Tropicamide; Lenses, Intraocular; Miosis
PubMed: 37306203
DOI: 10.3928/1081597X-20230512-01 -
BMC Ophthalmology May 2023To compare the intraoperative challenges, complications, and operation time of illuminated chopper-assisted cataract surgery between cataract surgery only and...
Intraoperative challenges and complications of cataract surgery between cataract surgery alone and phacovitrectomy in eyes with diabetic retinopathy: efficacy of illuminated chopper-assisted cataract surgery.
BACKGROUND
To compare the intraoperative challenges, complications, and operation time of illuminated chopper-assisted cataract surgery between cataract surgery only and phacovitrectomy in eyes with diabetic retinopathy.
METHODS
One university hospital, retrospective case series. Two hundred ninety-five eyes of 295 consecutive patients with diabetic retinopathy who underwent cataract surgery only or phacovitrectomy were retrospectively reviewed. Intraoperative challenges and complications of cataract surgery were thoroughly analyzed by 3D viewing of digitally recorded videos. The pupil diameter, operation time, and improved efficacy (100/operation time × pupil diameter) were compared between the cataract surgery only and phacovitrectomy groups.
RESULTS
Of the 295 eyes, 211 underwent cataract surgery only, and 84 underwent phacovitrectomy. Intraoperative challenges such as small pupil, miosis, or poor red reflex occurred more frequently (46 [21.8%] vs. 28 [33.3%], p = 0.029); pupil diameter was smaller (7.34 ± 0.94 vs. 6.89 ± 0.88 mm, p < 0.001) in the phacovitrectomy group than in the cataract surgery only group; however, rates of posterior capsule rupture and operation time were not different between the two groups (0 [0%] vs. 1 [1.2%], p = 0.285; 16.54 ± 2.65 vs. 16.31 ± 4.30 min, p = 0.434). Improved efficacy was higher in the phacovitrectomy group (0.85 ± 0.18 vs. 0.97 ± 0.28, p = 0.002).
CONCLUSIONS
The use of an illuminated chopper is a potential solution for diabetic cataract surgery, particularly in phacovitrectomy, by decreasing the use of supplemental devices, operation time, and posterior capsule rupture.
TRIAL REGISTRATION
Retrospectively registered.
Topics: Humans; Diabetic Retinopathy; Retrospective Studies; Postoperative Complications; Cataract Extraction; Cataract; Phacoemulsification; Intraoperative Complications; Diabetes Mellitus
PubMed: 37237351
DOI: 10.1186/s12886-023-02982-6 -
Cureus Apr 2023Post-thyroidectomy Horner's syndrome (HS) is a rare occurrence, and its probability increases when a modified radical neck dissection is performed. We present a case of...
Post-thyroidectomy Horner's syndrome (HS) is a rare occurrence, and its probability increases when a modified radical neck dissection is performed. We present a case of a patient with papillary thyroid carcinoma who presented with Horner's syndrome one week after the right lateral dissection of the cervical lymph nodes. She underwent a complete thyroidectomy four months prior to this surgery. Both surgeries were uneventful intraoperatively. On examination, the right eye (RE) had partial ptosis with miosis and the absence of anhidrosis. A pharmacological test with phenylephrine 1% was used to localize the interruption of the oculosympathetic pathway with postganglionic third-order neuron involvement. She was treated conservatively, and her symptoms improved over time. Horner's syndrome is a rare and benign complication of post-thyroidectomy surgery with radical neck dissection surgery. Since it does not compromise visual acuity, the disease is constantly overlooked. However, in view of the facial disfigurement and the possibility of incomplete recovery, the patient needs to be forewarned regarding this complication.
PubMed: 37228545
DOI: 10.7759/cureus.38046 -
Indian Journal of Ophthalmology May 2023Insufficient pupillary dilatation is a significant challenge during cataract surgery, as it increases the risk of various intraoperative complications. Implantation of...
Insufficient pupillary dilatation is a significant challenge during cataract surgery, as it increases the risk of various intraoperative complications. Implantation of toric intraocular lenses (TIOL) is particularly difficult in eyes with small pupils, as the toric marks are provided in the periphery of the IOL optic, making the visualization of the same difficult for proper alignment. Attempts at visualizing these marks using a second instrument such as a dialler or iris retractor lead to additional manipulations in the anterior chamber resulting in increased chances of postoperative inflammation and intraocular pressure rise. A new intraocular lens (IOL) marker to guide the implantation of TIOLs in eyes with small pupils is described, which can potentially be beneficial in achieving accurate alignment of toric IOLs in small pupils, without the need for additional manipulations, thus improving safety, efficacy, and success rates of TIOL implantation in these eyes.
Topics: Humans; Lens Implantation, Intraocular; Visual Acuity; Astigmatism; Lenses, Intraocular; Miosis; Phacoemulsification; Refraction, Ocular
PubMed: 37202962
DOI: 10.4103/ijo.IJO_1979_22 -
Ophthalmology Science Sep 2023To assess the safety and efficacy of a ciliary neurotrophic factor (CNTF) intraocular implant on neuroprotection and neuroenhancement in glaucoma.
PURPOSE
To assess the safety and efficacy of a ciliary neurotrophic factor (CNTF) intraocular implant on neuroprotection and neuroenhancement in glaucoma.
DESIGN
Open-label, prospective, phase I clinical trial.
PARTICIPANTS
A total of 11 participants were diagnosed with primary open-angle glaucoma (POAG). One eye of each patient was assigned as the study (implant) eye.
METHODS
The study eye was implanted with a high-dose CNTF-secreting NT-501 implant, whereas the other eye served as a control. All patients were followed up for 18 months. Analysis was limited to descriptive statistics.
MAIN OUTCOME MEASURES
Primary outcome was safety through 18 months after implantation assessed by serial eye examinations, structural and functional testing, and adverse events (AEs) recording. Parameters measured included visual acuity (VA), Humphrey visual field (HVF), pattern electroretinogram, scanning laser polarimetry with variable corneal compensation (GDx VCC), and OCT. These parameters were also used for secondary analysis of efficacy outcome.
RESULTS
All NT-501 implants were well tolerated with no serious AEs associated with the implant. The majority of AEs were related to the implant placement procedure and were resolved by 12 weeks after surgery. Foreign-body sensation was the most commonly reported AE and was self-limited to the postoperative period. The most common implant-related AE was pupil miosis; no patients underwent explant. Visual acuity and contrast sensitivity decreased more in fellow eyes than in study eyes (VA, -5.82 vs. -0.82 letters; and contrast sensitivity, -1.82 vs. -0.37 letters, for fellow vs. study eyes, respectively). The median HVF visual field index and mean deviation measurements worsened (decreased) in fellow eyes (-13.0%, -3.9 dB) and improved (increased) in study eyes (2.7%, 1.2 dB). Implanted eyes showed an increase in retinal nerve fiber layer thickness measured by OCT and by GDx VCC (OCT, 2.66 μm vs. 10.16 μm; and GDx VCC, 1.58 μm vs. 8.36 μm in fellow vs. study eyes, respectively).
CONCLUSIONS
The NT-501 CNTF implant was safe and well tolerated in eyes with POAG. Eyes with the implant demonstrated both structural and functional improvements suggesting biological activity, supporting the premise for a randomized phase II clinical trial of single and dual NT-501 CNTF implants in patients with POAG, which is now underway.
FINANCIAL DISCLOSURES
Proprietary or commercial disclosure may be found after the references.
PubMed: 37197702
DOI: 10.1016/j.xops.2023.100298 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Mar 2023Obstructive sleep apnea syndrome (OSAS) is associated with increased risk of postoperative complications, which is possibly related to increased sensitivity to opioid....
OBJECTIVES
Obstructive sleep apnea syndrome (OSAS) is associated with increased risk of postoperative complications, which is possibly related to increased sensitivity to opioid. However, the effect of increased sensitivity to opioids in patients with OSAS remains controversial. This study aims to investigate whether male patients with moderate to severe OSAS have increased sensitivity to opioid remifentanil and its related predictive factors, so as to provide a reference for the rational use of opioids in patients with OSAS.
METHODS
This study was a prospective study. From December 28, 2021 to October 15, 2022, a total of 61 male patients aged 22 to 60 years old, American Society of Anesthesiologists (ASA) status I and II, who underwent nasopharyngeal surgery under general anesthesia, were selected. According to STOP-BANG questionnaire score and apnea-hypopnea index (AHI), the patients were divided into an OSAS group (=39) and a control group (=22). The pupil diameter (PD) of the patients was measured by hand-held monocular pupillometer, and the perception threshold (PT) and pain tolerance threshold (PTT) of the patients were measured by somatosensory evoked potential stimulator. The initial PD, PT, and PTT were measured in a quiet environment and recorded as PD0, PT0, and PTT0. Changes in PD, PT, PTT, respiration, and consciousness were recorded after remifentanil infusion. Age, body mass index (BMI), smoking, AHI, minimal oxygen saturation, and percentage of sleep time spent with oxygen saturation <90% (T90) were included as independent variables in multiple linear regression equations to analyze the possible predictors of increased opioid sensitivity in patients with moderate to severe OSAS.
RESULTS
There were no significant differences in PD0, PT0 and PTT0 between the OSAS group and the control group (all >0.05). After remifentanil infusion, there was no significant difference in the rate of PT change between the 2 groups (>0.05). The change rate of PTT and PD in the OSAS group was significantly higher than that in the control group (<0.05 and <0.001, respectively), PD in the OSAS group was significantly lower than that in the control group (<0.001). During remifentanil infusion, there were no significant differences in the incidence of respiratory depression and the distribution of observer's assessment of alertness/sedation (OAA/S) scores between the 2 groups (both >0.05), and there were no changes in mental status and airway support in the patients of the 2 groups. Multiple linear regression showed that T90 was positively correlated with miosis rate (=0.597, 95% 0.269 to 0.924, <0.05) and the rate of PTT change (=0.458, 95% 0.116 to 0.800, <0.05). However, minimal oxygen saturation, age, BMI, smoking, and AHI were not correlated with PD change rate and PTT change rate in the OSAS patients (all >0.05).
CONCLUSIONS
Male patients with moderate to severe OSAS have increased sensitivity to remifentanil, the duration of nocturnal desaturation may be its predictive factor. Male patients with moderate to severe OSAS with a longer duration of nocturnal hypoxia are more sensitive to remifentanil, and the use of opioids in these patients should be more cautious in clinical.
Topics: Humans; Male; Young Adult; Adult; Middle Aged; Remifentanil; Analgesics, Opioid; Prospective Studies; Sleep Apnea, Obstructive; Sleep; Syndrome
PubMed: 37164918
DOI: 10.11817/j.issn.1672-7347.2023.220579 -
Cureus Mar 2023Altered mental status is a common emergency department presentation. It has a broad differential and can be particularly challenging when the patient is unable to give a...
Altered mental status is a common emergency department presentation. It has a broad differential and can be particularly challenging when the patient is unable to give a history and collateral information is not immediately available. The authors present a case of altered mental status initially brought in as a stroke alert but later discovered to be intentional organophosphate ingestion. Although organophosphate poisoning is relatively rare in the United States, it should be considered in patients with altered mental status with miosis who are unresponsive to naloxone, especially in the setting of bradycardia or copious secretions.
PubMed: 37128516
DOI: 10.7759/cureus.36882 -
Radiology Case Reports Jun 2023Raeder's syndrome is characterized by pain, ipsilateral oculosympathetic defect (ptosis and miosis), and ipsilateral trigeminal dysfunction. We report the first case of...
Raeder's syndrome is characterized by pain, ipsilateral oculosympathetic defect (ptosis and miosis), and ipsilateral trigeminal dysfunction. We report the first case of agenesis of the right internal carotid artery, which presented with a third-order postganglionic oculosympathetic paralysis and a dysfunction of the ophthalmic division of the trigeminal cranial nerve. An MRI angiography was performed and revealed a total absence of flow in the right internal carotid artery with a permeable right Sylvian artery through a well-developed right posterior communicating artery. A CT of the skull base revealed a total absence of the right carotid channel, which was consistent with a congenital absence of the right internal carotid artery.
PubMed: 37128254
DOI: 10.1016/j.radcr.2023.03.030