Effectiveness of oxygenation under the drape in phacoemulsification with intraocular lens implantation: a randomized clinical trial.

OBJECTIVE: To compare the oxygen saturation and comfort of the patients undergoing phacoemulsification with intraocular lens implantation (PE/IOL) between the patients with and without oxygenation under the linen drape. SETTING: Institutional practice. MATERIAL AND METHOD: A randomized, triple-blind, clinical equivalence trial was conducted. Eighty consecutive patients, scheduled for PE/IOL under topical or subconjunctival anesthesia, were randomized The patients in group 1 received 5 liters/minute flow of 100% oxygen via tubes attached to the upper chest walls. Sham oxygenation was given to the patients in group 2. Patients, surgeons and investigators were masked. The oxygen saturation was recorded every 10 minutes. The patients rated the comfort score within 15 minutes after operation. RESULTS: In group 1 (n = 37), mean age was 68.2 +/- 10.5 years and mean operative time was 29.4 +/- 7.2 minutes. In group 2 (n = 43), mean age was 66.9 +/- 10.6 years and mean operative time was 27.2 +/- 6.3 minutes. In both groups, the oxygen saturation ranged from the mean of 97.3 to 100% throughout the present study. The 99% confidence intervals of the mean differences of the oxygen saturation at 10, 20, and 30 minutes after draping were -1.60 to 0. 17%, -1.63 to 0.05%, and -2.37 to 0.74%, respectively. The comfort score was 84.9% in group 1 and 89.8% in group 2 (p = 0.61). CONCLUSION: With or without oxygen flow under the drape with the tip of the oxygen tube 1.5 cm away from the chin during PE/IOL, the patients' oxygen saturation is equivalent. The patients' comfort is not statistically different. Oxygenation under the linen drape seems to be unnecessary in uncomplicated cases.

Solitary keratoacanthoma of the conjunctiva: report of a case.

Keratoacanthoma characteristically occurs on the skin and is rarely found in the conjunctiva. We, herein, report a case of a healthy 41-year-old Thai woman presenting with a rapidly growing conjunctival mass. The tumor was excised to exclude squamous cell carcinoma. Histopathology revealed a cup shaped well-circumscribed proliferation of squamous cells, with a central keratin crater, consistent with a keratoacanthoma. On the literature review, only 12 cases have previously been reported in the English language. The mean age of presentation was 40.75 years, with a male preponderance. Presentation of a mass was mostly within 4 weeks after onset. History of foreign material getting into the eye was positive in 5 cases. All cases were successfully treated by excision, except for one case in which malignancy transformation was found, and enucleation was required eventually. Conjunctival keratoacanthoma is a rare disease. However, this lesion should be well recognized and not misinterpreted as malignancy. As far as we are aware, this is the first report of conjunctival keratoacanthoma from this region.

Primary conjunctival tuberculoma: a case report.

Conjunctival tuberculoma is very rare in modern medicine. We report a case of a 34-year-old Thai female patient presenting with multiple peculiar conjunctival nodules. Two small nodules were excised and submitted for histopathological study, which showed discrete granulomatous inflammation with caseating necrosis. The acid-fast bacilli's staining for tuberculous bacteria was positive. There was no other organ involvement of active tuberculosis. The patient was then treated with systemic anti-tuberculous regimen for 6 months. The remaining lesions disappeared within the first few months of treatment. Conjunctival tuberculoma should always be considered in cases of conjunctival nodules.