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Journal of Hip Preservation Surgery Jul 2023Appropriate post-operative (post-op) pain control has been shown to reduce length of stay and facilitate day case surgery. Periacetabular injection of bupivacaine is...
Appropriate post-operative (post-op) pain control has been shown to reduce length of stay and facilitate day case surgery. Periacetabular injection of bupivacaine is effective in pain reduction after hip arthroscopy. This study aims to evaluate the anterior superior iliac spine (ASIS) as an anatomical landmark to facilitate needle insertion prior to fluoroscopy. The meeting point derived from a vertical line one fingerbreadth distal to the ASIS and a longitudinal line from the greater trochanter (GT) was used as a landmark in 30 consecutive hip arthroscopy patients for periacetabular analgesia. The distance between the tip of the needle and the acetabular roof was measured via fluoroscopy. Needle location was corrected if needed, followed by periacetabular bupivacaine injection (at anterior, lateral and posterior joint aspects). Post-op pain was measured using the Visual Analog Scale (VAS) 4-6 h post-op and at discharge. The ASIS and GT were identified and used for periacetabular analgesia landmarks in all cases. Results revealed that 93.3% of needle entries fell within 10 mm of the lateral acetabular rim and only one case had fallen distal to it. The post-op mean VAS score was 1.03 (range 0-6, standard error - 0.30, median = 0). At hospital discharge, 90% (27/30 of patients) reported VAS score ≤ 5. Twenty-six of the 30 patients were discharged on the same day as the operation (remaining four patients stayed due to accommodation/traveling issues). The ASIS and GT can be used as an anatomical landmark for periacetabular analgesia in hip arthroscopy with reproducible needle location, significant analgesic effect and minimal radiation.
PubMed: 37900892
DOI: 10.1093/jhps/hnad011 -
Arquivos Brasileiros de Oftalmologia 2023
Topics: Humans; Presbyopia; Accommodation, Ocular
PubMed: 37878949
DOI: 10.5935/0004-2749.2023-0196 -
Indian Journal of Ophthalmology Nov 2023Microspherophakia is a rare developmental lens anomaly with increased anteroposterior and reduced equatorial diameter. It presents with refractive myopia, shallow...
BACKGROUND
Microspherophakia is a rare developmental lens anomaly with increased anteroposterior and reduced equatorial diameter. It presents with refractive myopia, shallow anterior chamber, and angle closure glaucoma. It is associated with subluxated or dislocated lens, progressive myopia, defective accommodation, and glaucoma. Glaucoma is the most common vision-threatening complication and mostly requires surgical management that includes trabeculectomy, lensectomy, and drainage implant. A staged or combined procedure can be performed. The purpose of this video is to highlight the advantages of combining parsplana vitrectomy (PPV) with parsplana lensectomy (PPL), scleral fixated intraocular lens (SFIOL), and Aurolab aqueous drainage implant (AADI) in a young patient with advanced glaucoma and gross subluxation. Drainage implants are preferred over filtering surgeries in eyes undergoing vitreoretinal procedures due to the risk of bleb fibrosis and hypotony seen in the latter. The combined procedures should be tailored according to the lens status and severity of glaucoma in each patient.
PURPOSE
The purpose of this video is to illustrate a combined quadruple procedure (PPL, PPV, SFIOL, and AADI) in microspherophakic patients with unstable glaucoma and video-based skill transfer to a novice surgeon.
SYNOPSIS
This video illustrates quadruple surgery in a microspherophakic patient with secondary angle closure glaucoma. The authors also emphasize the advantages of a combined quadruple procedure over staged procedure or combined PPL with filtering procedure.
HIGHLIGHTS
Quadruple procedure can be performed in young microspherophakic patients with advanced glaucoma or at risk of progression and losing central vision along with gross subluxation of lens. It eliminates the need for multiple procedures, the risk of hypotony, and bleb-related complications.
VIDEO LINK
https://youtu.be/KdFjb7acXCI.
Topics: Humans; Glaucoma, Angle-Closure; Intraocular Pressure; Visual Acuity; Glaucoma; Retrospective Studies
PubMed: 37870033
DOI: 10.4103/IJO.IJO_733_23 -
Indian Journal of Ophthalmology Nov 2023To compare bilateral lateral rectus recession (BLR) with unilateral recession and resection (RR) for divergence excess intermittent exotropia (IXT).
PURPOSE
To compare bilateral lateral rectus recession (BLR) with unilateral recession and resection (RR) for divergence excess intermittent exotropia (IXT).
METHODS
Retrospective analysis of 66 patients with divergence excess IXT who underwent either BLR or RR from January 2013 to December 2020 was conducted. Data on demographics, pre- and postoperative deviations, fusion, stereopsis, control, and accommodative convergence/accommodation ratio were collected. Success was defined as esodeviation ≤5 PD (prism diopter) to exodeviation ≤10 PD with a follow-up time of at least 8.0 ± 2.0 weeks.
RESULTS
BLR (42 cases) and RR (24 cases) groups had the same success rate (83.3%, P = 0.688) and similar reduced postoperative deviations both in distance and at near (P > 0.05). Near-distance disparity decreased significantly in both groups (P = 0.000) with no intergroup difference (P = 0.193).
CONCLUSION
BLR and RR were equally effective for divergence excess IXT with comparable outcomes of both distance and near deviations.
Topics: Humans; Exotropia; Follow-Up Studies; Treatment Outcome; Retrospective Studies; Ophthalmologic Surgical Procedures; Vision, Binocular; Visual Acuity; Oculomotor Muscles; Strabismus; Chronic Disease
PubMed: 37870024
DOI: 10.4103/IJO.IJO_2977_22 -
Ophthalmology Science 2024Anterior iris-claw phakic intraocular lens (pIOL) implantation is a treatment option for refractive, ametropic patients. However, the postoperative accommodative ability...
PURPOSE
Anterior iris-claw phakic intraocular lens (pIOL) implantation is a treatment option for refractive, ametropic patients. However, the postoperative accommodative ability has not been systematically researched. Dynamic stimulation aberrometry allows the objective and dynamical measurement of accommodation by observing ocular aberrations during the accommodation process. We investigated the dynamic accommodative ability after pIOL implantation compared with a healthy age- and gender-matched control group.
DESIGN
Clinical, comparative case-control study.
SUBJECTS
We included patients aged 18-50 years that either underwent pIOL implantation > 1 month ago or served as a healthy, phakic control group.
METHODS
The accommodative ability and pupil dynamics of both groups were investigated using dynamic stimulation aberrometry. The method allows the analysis of dynamic parameters during accommodation, such as the accommodation speed. A 1:1 propensity score matching was conducted based on the patients' age and gender.
MAIN OUTCOME MEASURES
Parameters of objective accommodation, such as accommodative amplitude and pupil dynamic during accommodation.
RESULTS
Fifty-eight healthy, phakic eyes < 50 years of age and 21 eyes after pIOL implantation to correct myopia (pIOL, Verisyse, AMO, Inc) were enrolled. Patients that underwent anterior pIOL implantation were examined on average 24 ± 18 months after surgery. After matching, the mean age of both groups was not significantly different (35 ± 8 vs. 34 ± 8 years). No significant difference in dynamic parameters of accommodation or the accommodative amplitude (2.8 ± 1.4 and 2.9 ± 1.4 diopters [D] for pIOL and control group, = 0.82) were seen. Maximum and minimum pupil sizes were not significantly different. The change in pupil size during deaccommodation was significantly faster in patients after pIOL implantation ( < 0.001).
CONCLUSIONS
Dynamic stimulation aberrometry allowed the objective, dynamic, measurement of wavefronts in subjects with accommodative amplitudes up to 7 D. Phakic intraocular lens implantation does not impair the accommodative ability. It alters pupil dynamics during deaccommodation.
FINANCIAL DISCLOSURES
Proprietary or commercial disclosure may be found after the references.
PubMed: 37868795
DOI: 10.1016/j.xops.2023.100374 -
The British and Irish Orthoptic Journal 2023To investigate the changes in near accommodative facility and response time in young adults following computer work of 30 minutes and 1 hour in duration.
AIM
To investigate the changes in near accommodative facility and response time in young adults following computer work of 30 minutes and 1 hour in duration.
METHODS
A total of 50 young adults (37 females, 13 males) with mean age of 20.68 ± 1.33 years were included in this experimental study. Monocular near accommodative facility was measured using ±2.00 Dioptre Sphere (DS) flipper at 40 cm using the N6 (the smallest print size that can be read by an individual with normal visual acuity) target before and after two reading tasks. Both pre- and post-task measurements were video recorded using a smart phone and the number of cycles per minute, positive response time (time taken to stimulate accommodation), and negative response time (time taken to relax accommodation) were calculated from the video recording. Data were analysed using SPSS Version 22.0.
RESULTS
Out of the 50 participants, 29 were emmetropes (Mean SER: 0.16 ± 0.29 D), and 21 were myopes (Mean SER: -1.89 ± 1.16 D). The mean pre-task accommodative facility was 6.79 ± 3.52 cycles per minute, and the post-task accommodative facility was 6.25 ± 3.65 cycles per minute (p = 0.10) for the 30-minutes task and 5.76 ± 3.89 cycles per minute (p = 0.01) for 1-hour task. The mean pre-task positive response time was 2.87 ± 1.55 seconds, and the post-task positive response times for 30 minutes and 1 hour were 2.86 ± 1.67 seconds (p = 0.88) and 2.98 ± 2.33 seconds (p = 0.42), respectively. The mean pre-task negative response time was 8.77 ± 8.83 seconds, and the post-task negative response times for 30 minutes and 1 hour task were 11.83 ± 14.28 seconds (p = 0.16) and 14.72 ± 17.32 seconds (p = 0.03), respectively.
CONCLUSION
Monocular near accommodative facility was significantly reduced, and negative response time was delayed following 1 hour of computer work.
PubMed: 37868656
DOI: 10.22599/bioj.295 -
Heliyon Sep 2023This study aims to evaluate the safety, biocompatibility, and functionality of a new accommodative intraocular lens (IOL) (LUZ, patent PCT/ES2016/070,813) after...
This study aims to evaluate the safety, biocompatibility, and functionality of a new accommodative intraocular lens (IOL) (LUZ, patent PCT/ES2016/070,813) after implantation in rabbit eyes. LUZ (Study) and EyeCee® plus a capsular ring (Control) were implanted in rabbits ( = 8 each) after phacoemulsification. Intraoperative follow-up, long-term clinical follow-up, and functional IOL studies were carried out periodically for up to 180 days. A macroscopic examination of the eyeballs to reveal abnormalities and determine the implant centering and a microscopic examination to semi-quantify cell and tissue response were performed. Statistical analysis of the collected data was finally achieved. During follow-up, no significant changes in the general condition nor the clinical evaluation were observed between both groups. However, Study IOL remained centered throughout the study and did not present severe complications as observed in the Control group. Functional studies did not reveal significant differences between both materials. Study showed better centering, fewer adhesions, and maintenance of an opening capsular bag compared to the Control. Local biological effects caused by Study implantation are minimal and comparable to the Control. Therefore, LUZ showed no clinical signs or histological response of adverse reaction to the implanted material, according to UNE-EN ISO 11979-5 and 10993-6. Functionality must be confirmed in another animal species with greater lens accommodation capacity than the rabbit. LUZ keeps the capsular bag open, favoring its centering and avoiding fibrosis and adherence to the bag; this allows potential accommodation of this IOL and theoretically enables the patient to focus dynamically.
PubMed: 37810139
DOI: 10.1016/j.heliyon.2023.e19604 -
Biomedical Optics Express Aug 2023Quantifying human crystalline lens geometry as a function of age and accommodation is important for improved cataract and presbyopia treatments. In previous works we...
Quantifying human crystalline lens geometry as a function of age and accommodation is important for improved cataract and presbyopia treatments. In previous works we presented as a basis of 3-D functions to represent the full shape of the crystalline lens . Also, we presented the application of to estimate the full shape of the lens from 3-D optical coherence tomography (OCT) images, where only the central part of the lens -visible through the pupil- is available. The current work presents a validation of the use of to estimate the full shape of dis-accommodated lenses. We used 14 crystalline lenses from donor eyes (11-54 y/o) mounted in a lens stretcher, and measured the geometry and the power of the lenses using a combined OCT and ray tracing aberrometry system. , the full extent of the lens is accessible from OCT because the incident light is not blocked by the iris. We measured in non-stretched (fully accommodated) and stretched (mimicking dis-accommodated lenses) conditions. Then, we simulated computationally conditions on the obtained lenses geometry (assuming that just the portion of the lens within a given pupil is available), and estimated the full shape using The mean absolute error (MAE) between estimated and measured lens' diameters and volumes were MAE = 0.26 ± 0.18 mm and MAE = 7.0 ± 4.5 mm, respectively. Furthermore, we concluded that the estimation error between measured and estimated lenses did not depend on the accommodative state (change in power due to stretching), and thus are also useful for the full shape estimation of dis-accommodated lenses.
PubMed: 37799671
DOI: 10.1364/BOE.493795 -
American Journal of Ophthalmology Jan 2024To compare the final cycloplegic refraction of tropicamide 1% and cyclopentolate 1% in children 3-16 years of age with brown irides. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To compare the final cycloplegic refraction of tropicamide 1% and cyclopentolate 1% in children 3-16 years of age with brown irides.
DESIGN
Randomized, controlled, multicenter prospective clinical trial.
METHODS
Included patients were randomized to either cyclopentolate 1% or tropicamide 1% in the first visit with autorefraction measurements. Each subject underwent a second cycloplegic refraction using the other agent on a separate visit with a minimum of 1-week interval and a maximum of 12 weeks. We measured the change in SE (ΔSE) for each eye by deducting the SE before cycloplegia from the SE after cycloplegia.
RESULTS
A total of 185 eyes from 94 children aged 3-16 years (average= 8.79 ±3.11 years) were included. The average SE of both eyes before cycloplegia was -0.082 ± 4.8 diopters. The SE after instillation of cyclopentolate and tropicamide in both eyes was 1.07±5.2 and 0.96±5.1, respectively (P value < .001). The average ΔSE after cycloplegia was 1.15±1.2 for cyclopentolate and 1.04±1.2 for tropicamide (P value < .001). The difference between ΔSE of cyclopentolate and tropicamide was found statistically significant at 0.11±1.2 (P < .001), although clinically insignificant. The ΔSE between the 2 drops before and after cycloplegia in both eyes for all refractive error groups was clinically insignificant. The greatest effect of cyclopentolate and tropicamide was in hyperopic eyes with ΔSE of 1.54±1.4 and 1.39±1.4, respectively.
CONCLUSIONS
Tropicamide might be an effective and safe replacement for cyclopentolate in the refracting nonstrabismic pediatric population 3-16 years of age regardless of their refractive error status.
Topics: Humans; Child; Child, Preschool; Adolescent; Tropicamide; Cyclopentolate; Mydriatics; Prospective Studies; Refraction, Ocular; Accommodation, Ocular; Ophthalmic Solutions; Refractive Errors; Pupil; Presbyopia
PubMed: 37797867
DOI: 10.1016/j.ajo.2023.09.022