New caliper for small incision cataract surgery

In cataract surgery, incision size determines various factors such as wound stability, corneal curvature changes, postoperative induced astigmatism, and visual rehabilitation. A mechanical caliper has been developed for experimental and clinical studies of incision sizes ranging between 1.0 and 6.0 mm. The caliper has a screw that allows measurements in 0.1 mm steps. The device is produced for two ranges: 2.0 to 4.0 mm and 1.0 to 6.0 mm. The precision of 0.1 mm was confirmed with a vernier caliper in a cadaver eye study. Unlike gauges that determine incision size by trial and error and a combined system of internal and vernier calipers, only one measurement is necessary with this caliper.     

EMLA prevents pain during local anesthesia for cataract surgery

We developed a method to identify maternal deaths (deaths to women within 365 days of delivery) by linking Tennessee vital records. A computerized algorithm compared personal identifiers from the death certificates of reproductive-aged women to maternal identifiers on birth and fetal death certificates. For each decedent record which met the study criteria, the algorithm calculated a "match score" by comparing common elements in both files. The algorithm awarded full credit for data elements that agree exactly, partial credit for elements in partial agreement, and subtracted credit for information that mismatched. Match scores ranged from 0 to 35 for the 9,009 deaths in women 10-55 years of age during the three study years, with the majority of scores (96.3%) being 0 for "no match." Match scores of 1 to 8 were obtained by 153 (1.7%) of decedent records, while scores greater than 9 were obtained by 184 (2.0%) of decedent records. We used nurse-abstracted hospital, autopsy, and coroner records as our standard to verify the linkages. Manual review of personal identifiers showed that scores of 12 or less were not a match while scores of 13 or more indicated "true" matches. Based on this cutoff, the linkage algorithm yielded 130 maternal deaths. Of these, 32 (25%) were classified as truly pregnancy-related upon medical record review by an obstetrician. The remaining 98 deaths were associated only temporally with pregnancy. During the same time period, 16 individuals were identified to the State Health Department on their death certificates as dying from pregnancy-related causes, including one not identified by the linkage process.(ABSTRACT TRUNCATED AT 250 WORDS)     

A preliminary report of small incision cataract surgery by phacoemulsification

The results of 34 cases with cataract extracted by phacoemulsification were preliminarily reported. Postoperatively, they achieved corrected visual acuities > 1.0 in 24 eyes (70.59%) in one week and in 25 eyes (73.53%) after 3 months. The post-operative astigmatism showed a tendency of change from with-the-rule shifting to against-the-rule. The rate of the corneal endothelial cell loss was 13.28%. No severe intra- and post-operative complications were found. It is concluded that the small incision, slight post-operative reaction and fast visual rehabilitation inherent in phacoemulsification procedures are more beneficial to patients than the conventional extracapsular cataract extraction.     

The efficacy of general anesthesia for cataract surgery

This is a report of 259 consecutive cataract extractions performed under general anesthesia over a two-year period. The age of the patients ranged from 6 to 93 with an average of 71. The purpose of this paper is to reiterate the safety of modern general anesthesia for cataract extraction in the elderly, and to demonstrate it can provide a very soft eye in a completely immobilized patient. It offers the most ideal conditions to the surgeon for lens extraction and careful wound closure without the necessity of retrobulbar block, digital massage or osmotic agents.     

Self-closing corneoscleral tunnel incision in cataract surgery]

Each science is identified with the questions it raises with respect to its object of study. This paper discussed the formulation of the basic questions of medical informatics. From a historical point of view, it first dealt with the problems of medical computing. Thereby, three classical questions arose: How can existing computers and information technologies assist in medical activities? Which components of the mathematical apparatus of informatics can be used for solving medical problems, and how and what activities of a physician are subject to algoritmization? The present time raises a new circle of questions centered around the basic one: How is the information system of the human organism structured and how does it function? This question and others form the basis of a new trend in medical informatics.     

Different opening techniques in cataract surgery

A retrospective study on the different opening techniques in cataract surgery at our Department in 1996 was carried out. In our everyday practice fornix based conjunctival flap and sclerocorneal oblique or vertical-oblique approach with a center at 12 o'clock was performed. In the case of hemorrhagic diathesis and secondary ACL implantation the corneal approach was preferred. After glaucomatous filtration surgery the incision was made temporally in some cases.     

Topical versus peribulbar anesthesia in cataract surgery

PURPOSE: To compare the use of topical anesthesia with that of peribulbar anesthesia in cataract surgery. SETTING: Quinze-Vingts Hospital, Paris, France. METHODS: This prospective study comprised 45 patients who had phacoemulsification and intraocular lens implantation in both eyes with 1 to 9 months between surgeries. Each patient had peribulbar anesthesia for one surgery and topical anesthesia for the other. The anesthesia method for the first eye was randomly selected. After surgery, patients were asked to rate their pain and whether they preferred one anesthesia technique over the other. RESULTS: When topical anesthesia was given, 82.2% of patients required no intravenous medications. Overall, 62.2% preferred topical over peribulbar anesthesia, with most patients citing the lack of periocular injection as the reason. CONCLUSION: Despite the increased technical difficulty, topical anesthesia proved an effective alternative to peribulbar anesthesia for cataract surgery that avoids the risks of periocular injection and reduces the need for intravenous medications.     

Clinical results of three types of intraocular lenses for small incision surgery

We implanted three types of intraocular lens (IOL) in 30 eyes each by small-incision surgery. They were: foldable acryl IOL, foldable silicone IOL and polymethylmethacrylate (PMMA) IOL. We evaluated the following items during three years after surgery: visual acuity, astigmatism, glare disability, contrast sensitivity, tilt and decentering of IOL, corneal endothelial population, aqueous flare and aftercataract. Eyes foldable IOLs were more excellent than PMMA IOLs regarding visual acuity, astigmatism and aqueous flare which are indices for the early postoperative period. PMMA and acryl IOLs were more excellent than silicone IOLs regarding decentration of IOL and aftercataract which are indices for the late postoperative period.     

Choice of the site of incision for cataract surgery without suture according to preoperative astigmatism

PURPOSE: To compare surgically induced astigmatism, postoperative astigmatism and uncorrected visual acuity after cataract surgery depending on the site of a 4 mm sutureless incision (superior scleral or corneal temporal) and on the preoperative astigmatism. METHODS: According to preoperative astigmatism and to the site of incision 4 groups have been distinguished. Group I: with-the-rule preoperative astigmatism and superior scleral incision, group II: with-the-rule preoperative astigmatism and corneal temporal incision, group III: against-the-rule preoperative astigmatism and superior scleral incision, group IV: against-the-rule preoperative astigmatism and temporal incision. The patients had a preoperative and postoperative (Day 1, 8, 30, 180, 360) keratometry. Surgically induced astigmatism, preoperative and postoperative astigmatism have been expressed according to Naeser method. The uncorrected visual acuity at Day 30 has been compared in each group. RESULTS: Preoperative astigmatism was similar in the four groups. Surgically induced astigmatism was -0.18 diopter (D) at day 30 and -0.41 D at day 360 for the scleral incisions and +0.60 D at day 30 and +0.33 D at day 360 for the temporal incisions. The postoperative astigmatism was +0.5 D at day 30 and +0.27 at day 360 for the group I and +1.22 D at day 30 and +0.95 D at day 360 for group II. There was no statistical difference in the uncorrected visual acuity. Postoperative astigmatism was -0.8 D at day 30 and -1.03 D at day 360 in group III and -0.04 D at day 30 and -0.31 D at day 360 in group IV. The visual acuity was significantly better in group IV than in group III. CONCLUSION: In cases of preoperative with-the-rule astigmatism < or = 0.75 D the two sites of incisions are possible. In cases of WTR astigmatism over 0.75 D we perform a superior scleral approach. In cases of against-the-rule astigmatism the temporal incision is the only one to consider.     

A prospective randomised study of local versus general anaesthesia for cataract surgery

A new thermodynamic model for calculating the dissociation constants of complexes formed between the aryl hydrocarbon receptor (AhR) and polychlorinated biphenyls (PCBs) is reported. The free energies of binding of PCBs to AhR are controlled by their lipophilicities, electron affinities, and entropies. The corresponding physicochemical properties of polychlorinated dibenzo-p-dioxins and dibenzofurans also control their interactions with AhR. We present evidence supporting the hypothesis that the majority of PCBs are likely to interact with AhR in their nonplanar conformations. In addition, we demonstrate that the affinities of PCBs for AhR relative to 2,3,7,8-tetrachlorodibenzo-p-dioxin correlate with corresponding toxic equivalency factors in animals. The reported methodology is likely to be applicable to other polyhalogenated and mixed polyhalogenated bi- and terphenyls and related xenobiotics; thus, it could minimize the number of in vivo studies in laboratory animals and facilitate the identification of potentially hazardous aromatic xenobiotics.     

Recurrence of inguinal hernia: ambulatory surgery under local anesthesia

In order to assess the feasibility of repair of a recurrent inguinal hernia in unmonitored local anaesthesia in an ambulatory set-up pain scores and data on patient satisfaction were obtained from 76 unselected patients after 79 consecutive operations. Median age was 63 years, and 25%- and 75% quartiles were 49 and 72 years respectively. All operations were conducted in local anesthesia. Three patients stayed in hospital overnight after the operation. Pain: After one, six and 28 days 27, 14 og 7% respectively had severe pain during function (cough and/or rising). Satisfaction: 82% were satisfied with ambulatory surgery in local anaesthesia, 82% were satisfied with the analgesic therapy (tenoxicam and methadone), but one third needed supplementary analgesics during the first week (acetaminophen was recommended). It is concluded, that ambulatory repair of a recurrent inguinal hernia in unmonitored local anaesthesia is a safe and cost effective alternative to operation in general or spinal anaesthesia.     

Evaluation of combined spinal-epidural anesthesia using two different techniques

There is growing evidence, that Borna Disease virus (BDV) or a variant may cause neuropsychiatric disorders in humans. The presence of specific BDV serum antibodies indicates an earlier contact with BDV. Earlier MRI results showing a raised prevalence of white matter lesions in BDV-seropositive psychiatric patients, possibly indicating encephalitic lesions, are not confirmed in this extended study, however in BDV-seropositive psychiatric patients the occurrence of cerebral atrophy seems to be more frequent, a finding compatible with hydrocephalus e vacuo found in animals after BDV-encephalitis. Because encephalitic lesions in BD are predominantly found in the gray matter of the brain, which is hardly visualized by MRI, the failure to detect lesions in BDV-seropositive patients could be due to methodological problems.     

Ophthalmic surgery with local anesthesia or intubation anesthesia at the Leipzig University Ophthalmology Clinic

BACKGROUND: Different opinions about the reliability and serious complications after regional anesthesia have been reported. The paper describes our experiences in deciding about regional or general anesthesia for ophthalmic surgery. PATIENTS AND METHODS: For this report we analyzed retrospectively our protocols of all operations performed in 1995. Eight categories of procedures were developed to give an insight in our way of decision for local or general anesthesia. We imagine the applied technique of peribulbaranesthesia. RESULTS: 3184 patients were operated on in 1995, in the regional anesthesia group the age ranges from 17 to 96 years, in the general anesthesia group from 3 months to 85 years. In 69.9% of all patients we performed a local anesthesia and in 30.1% we chose general anesthesia. The spread of cases and the surgical procedure corresponding to one of these eight classes below are described in this survey. CONCLUSIONS: Almost 70% of our patients who underwent an ophthalmosurgical procedure were operated on under regional anesthesia. No serious complications have occurred and no procedure had do be stopped off due to an insufficient analgesia or akinesia. We demonstrate some observations concerning the duration of pain after the injection and our indications for general anesthesia in ophthalmic surgery.     

Vitreoretinal surgery after inadvertent globe penetration during local ocular anesthesia

BACKGROUND: The efficacy of prophylactic epsilon-aminocaproic acid and tranexamic acid to reduce transfusions after primary myocardial revascularization was evaluated in a teaching hospital context. METHODS: Patients (n = 134) received either epsilon-aminocaproic acid (15-g bolus + infusion of 1 g/h), high-dose tranexamic acid (10-g bolus + placebo infusion), or normal saline solution in a double-blind fashion. Anticoagulation and conduct of cardiopulmonary bypass were standardized. RESULTS: Tranexamic acid and epsilon-aminocaproic acid produced a significant reduction in postoperative blood loss compared with placebo (median loss, 438 mL, 538 mL, and 700 mL, respectively). Transfusion of red cells was similar in all three groups. Nonetheless, the percentage of patients receiving hemostatic blood products was significantly decreased in the epsilon-aminocaproic acid group compared with the placebo group (20% versus 43%; p = 0.03). Both tranexamic acid and epsilon-aminocaproic acid significantly decreased total exposure to allogeneic blood products compared with placebo (p = 0.01 and p = 0.05, respectively), and this reduction was clinically important (median exposure, 2, 2, and 7.5 units, respectively). Fibrinolysis was inhibited significantly in both treatment groups. CONCLUSIONS: We conclude that either high-dose tranexamic acid or epsilon-aminocaproic acid effectively reduces transfusions in patients undergoing primary, elective myocardial revascularization.     

Respiratory arrest following peribulbar anesthesia for cataract surgery: case report and review of the literature

Hypnic headache syndrome is a rare benign disorder which occurs in the elderly. It presents as a holocephalic or, less frequently, hemicranial headache during night sleep, lasting between 20 and 180 min; it is not associated with autonomic signs and responds well to lithium carbonate. We report a new case which responded well to indomethacin, and suggest that indomethacin may be used as an alternative treatment in this rare headache syndrome of the elderly.