Peribulbar anaesthesia: Evaluation and precautions

Purpose: Evaluation of peribulbar anaesthesia and its complications

Methods : 100 eyes were subjected to peribulbar anesthesia using amixture of 3.5 ml. lidocaine 1% and bupivocaine hydrochlorid 0.75%, using 25 gauge needle one inch in length in 50 eyes the injection was transconjunctival and in the other 50 eyes. The injection was transcutaneous in supranasal and infra temperol sites.

Results: in the peribulbar anaesthesia the extra-ocular muscle are not engaged, needle is away from the globe, optic nerve, dural sheaths and optic foramen and easy teclinique

Conclusion: EtTective easy technique free of serious complications.

BACK

---

Topical Anaesthesia for Cataract Surgery

Purpose: To evaluate the efficacy and complications of topical anaesthesia for cataract extraction with or without IOL4mplantation

Methods: 60 patients of different ages, sex, and cataract types were assigned to have ECCE with or without IOL-implantation under topical anaesthesia. The patients received topical 0.5% bupivacaine and intravenous pethidine and dormicum. The level of operative, postoperative pain was assessed. Complications and surgical condition were recorded.

Results: The intruoperative pain was mild in 6% of patients and absent in 47 patients (94%), while the postoperative pain was mild in 88%. Eyelid squeeze was present in 20% of patients, inadvertent movement of the head was present in 10% of cases. However, there was successful implantation of IOL in all cases. Complications included miosis, capsule rupture and vitreous loss. Surgical condition was good in 92% of patients.

Conclusion: Topical Anaesthesia could be used safely for cataract extraction. However, good selection, preparation of the patients and mastering the surgical techniques are mandatory for getting successfiil results.

BACK

---

Three girls suffering from tapetoretinal degeneration are reported. The family pedigree suggested an autosomal recessive disease. The clinical picture is that of progressive cone4od dystrophy as evidenced by poor vision, photophobia, nystagmus, retinal arteriolar attenuation, and pigmentary fundus changes. The association of decreased comeal sensitivity sensorineural deafness, mental retardation, and obesity are, to our knowledge, the first time to be des cribed with progressive cone-rod dystrophy.

Key words: tapetoretinal degeneration, retinal dystrophy, retinitis pigmentosa, corneal sensation, deafness, mental retardation, obesity.

BACK

---

Photorefractive Keratectomy (PRK) in Correction of Myopic Astigmatism

Purpose: To study the efficacy, predictability, stability and safety of excimer laser PRK in correction of simple, compound and mixed myopic astigmatism.

Matenals and Methods: One hundred and thirty five different myopic astigmatic eyes with astigmatism >~1 .0 D were treated by the Aesculap Meditec Mel 60 Excimer laser. Eyes were classified into 4 groups: Group 1(19 eyes) of simple pure myopic astigmatism treated using a single rotating 9x5 mm slit mask. Group 2 (75 eyes) of compound A myopic astigmatism where sphere + cylinder sum < 10 D or cylinder < 4 or sphere > cylinder, and treated using a single 6 mm rotating diaphragm mask. Group 3 (24 eyes) of compound B myopic astigmatism where sphere + cylinder sum> 10 D or cylinder> 4 D, or cylinder > sphere, treated in 2 steps using a rotating slit mask to correct astigmatism, then a circular closing diaphragm mask to correct residual myopia. Group 4 (17 eyes) of mixed myopic astigmatism, treated in 2 steps. The myopic cylinder was treated using the rotating slit mask, then hyperopia was treated using the 9 mm wide rotating hyperopia mask. Follow up ranged from 6 to 12 months and eyes were evaluated for healing, haze, uncorrected visual acuity (UCVA) and comeal stability.

Results: All eyes showed excellent epithelial healing within 3-4 days, and haze varied from clear (grade 0) to trace (1 +) in all the cases. In Group 1, the myopic cylinder range was -1.25 to -9.75 D (mean -3.25 1 2.50), and UCVA was 20/20 or better in 84.2% of cases and eyes were 1 1.00 D of emmetropia after 6 to 12 months. In Group 2, the sphere range was -1.50 to -9.00 D (mean -4.25.11.75), and cylinder range was -1.00 to -4.00 D (mean -2.2510.75), UCVA was 20/20 or better in 89.3% of cases, and eyes were + 1.00 D of emmetropia after 6 to 12 months. In Group 3, the sphere range was -3.25 to -13.50 D (mean -6.00 1 3.75), and the cylinder range was -1.75 to -6.00 D (mean -2.75 1 1.25), UCVA was 20/20 or better in 75%, 20/30 or better in 83.3% and 20/40 or better in 91.6% of cases after 6 to 12 months. In Group 4. the sphere range was +1.00 to +5.00 D (mean +1.75 1 1.25), and cylinder range was 1.00 to -6.00 D (mean -2.50 1 1.50), UCVA was 20/20 or better in 70.6%, 20/30 or better in 82.3%, and 20/40 or better in 88.2% of cases after 6 to 12 months.

Conclusion: These clinical data and stable visual outcome results demonstrate the high efficacy, predictability and safety of excimer laser PPK in correction of different forms of myopic astigmatism.

BACK