To Compare the Effectiveness of Sub-Tenon’s Anesthesia with Peribulbar Anesthesia in Patients Undergoing Manual Small-incision Cataract Surgery

Background: Blindness due to cataract presents an enormous problem in terms of human morbidity, economical loss, andsocial burden. Retrobulbar anesthesia was commonly used for cataract surgery. Rare but serious complications led manyophthalmologists to replace retrobulbar with peribulbar anesthesia. However, even peribulbar anesthesia does not eliminatethe serious complications totally. These concerns have led to increased use of blunt needle sub-Tenon’s block over the sharpneedle blocks.Materials and Methods: 200 cases were selected, of which 100 were in the sub-Tenon’s group and the remaining 100 werein the peribulbar group. The efficacy of anesthesia between the two groups was compared in terms of analgesia at variousintervals, akinesia of the globe and eyelids attained after the block. They were graded on a subjective scale and recorded.Minor complications such as chemosis, sub-conjunctival hemorrhage, and rise in increased intraocular pressure (IOP) werealso compared and analyzed.Results: Sub-Tenon’s anesthesia provided better analgesia than peribulbar anesthesia although the akinesia was poorer thanthe latter. Minor complications such as sub-conjunctival hemorrhage were more in sub-Tenon’s group while instantaneous risein IOP was more in peribulbar group. The incidence of chemosis was almost comparable in both the groups.Interpretation and Conclusion: Sub-Tenon’s anesthesia is recommended as a safe and effective alternative to peribulbaranesthesia for small-incision cataract surgery as it provides good analgesia, adequate akinesia, and rare minor complications.

Successful treatment of conjunctival lymphangiectasia accompanied by corneal dellen using a high-frequency radiowave electrosurgical device

A 62-year-old man presented with a 1-month history of right eye pain unresponsive to artificial tears and topical steroids. At presentation, bullous yellowish fluid collection was noted in the nasal conjunctiva. Corneal thinning and opacity were observed at the 3 o'clock position of the cornea. High-frequency radiowave ablation and biopsy were performed at the affected area. Conjunctival lymphangiectasia was confirmed by excisional biopsy. An improvement in the degree of corneal dellen and chemosis was evident 1 week after ablation. Use of a high-frequency radiowave electrosurgical device may be a simple and effective treatment option for symptomatic conjunctival lymphangiectasia.

Orbital Cellulitis from Untreated Conjunctival Wound

Orbital cellulitis is a potential blinding condition resulting from infection of the orbital contents, including the optic nerve. It may be fatal in cases with extension into the optic canal and subsequently the brain. Common aetiologies include extension of infection from paranasal sinusitis or preseptal cellulitis. This case report depicts the unusual occurrence of orbital cellulitis following a trivial superficial conjunctiva laceration wound from a motor-vehicle accident. Aggressive treatment with systemic antibiotics resulted in good visual outcome. All wound on or around the globe must be diligently treated to prevent such detrimental complication.

Short-term Analysis of the Residual Volume of an Eye Drop Following 23-Gauge Microincision Vitrectomy Surgery

PURPOSE: To evaluate the change of residual volume of eye drop after instillation in patients with 23-gauge microincision vitrectomy surgery (MIVS). METHODS: Patient who were treated 23-gauge MIVS from November 2014 to July 2015 were included. The residual volume was defined as the amount of remnant eye drop in patient's eyes after instillation, calculated as the difference between instillation volume and spilled volume of eye drop. Calculation of residual volume of eye drop was performed one day before surgery, and daily from postoperative day 1 to day 5. RESULTS: Forty consecutive patients were included. The residual volume of eye drop decreased from 30.3 ± 1.4 µL at baseline to 13.0 ± 1.5 µL at day 1, 18.3 ± 1.6 µL at day 2, 24.7 ± 1.5 µL at day 3, and 27.9 ± 1.4 µL in day 4, postoperatively (p < 0.001, respectively). The volume at postoperative day 5 was 29.4 ± 1.3 µL, but it was not different from the volume at baseline (p = 0.105). The change of residual volume was significantly correlated with postoperative chemosis (r = 0.672, p < 0.001) and effected by the number of quadrant with postoperative chemosis (p < 0.05). CONCLUSIONS: This study shows that postoperative residual volume of eye drop after instillation decreased until postoperative day 4, and postoperative chemosis affects the change of residual volume. Thus, checking proper use of eye drops and teaching about instillation technique by physician is necessary for patients with 23-gauge MIVS.

Cavernous sinus thrombosis following dental extraction: a rare case report and forgotten entity

Prior to the advent of efficacious antimicrobial agents, the mortality rate from cavernous sinus thrombosis (CST) was effectively 100%. There have been very few reports of CST associated with tooth extraction. A 40-year-old female presented to the emergency room with swelling over the right side of the face and history of extraction in the upper right region by an unregistered dental practitioner. The patient presented with diplopia, periorbital ecchymosis, and chemosis of the right eye. A computed tomography scan revealed venous dilatation of the right superior ophthalmic vein. The patient was immediately treated with incision and drainage, intravenous antibiotics, and heparin (low molecular weight). Unfortunately, the patient died two days after surgery due to complications from the disease. CST is a rare disease with a high mortality rate. Therefore, dental health education in rural areas, legal action against unregistered dental practitioners, early diagnosis, and aggressive antibiotic treatment can prevent future mortality resulting from CST.

Cavernous sinus thrombosis following dental extraction: a rare case report and forgotten entity

Prior to the advent of efficacious antimicrobial agents, the mortality rate from cavernous sinus thrombosis (CST) was effectively 100%. There have been very few reports of CST associated with tooth extraction. A 40-year-old female presented to the emergency room with swelling over the right side of the face and history of extraction in the upper right region by an unregistered dental practitioner. The patient presented with diplopia, periorbital ecchymosis, and chemosis of the right eye. A computed tomography scan revealed venous dilatation of the right superior ophthalmic vein. The patient was immediately treated with incision and drainage, intravenous antibiotics, and heparin (low molecular weight). Unfortunately, the patient died two days after surgery due to complications from the disease. CST is a rare disease with a high mortality rate. Therefore, dental health education in rural areas, legal action against unregistered dental practitioners, early diagnosis, and aggressive antibiotic treatment can prevent future mortality resulting from CST.

Treatment modalities of thyroid related orbitopathy.

Aims: The aim was to highlight recent advances in the treatment of thyroid eye disease. Settings and Design: Review article. Materials and Methods: Existing literature and the authors’ experience was reviewed. Results: Thyroid ophthalmopathy is a disfiguring and vision‑threatening complication of autoimmune thyroid disease that may develop or persist even in the setting of well‑controlled systemic thyroid status. Treatment response can be difficult to predict, and optimized algorithms for disease management do not exist. Thyroid ophthalmopathy should be graded for both severity and disease activity before choosing a treatment modality for each patient. The severity of the disease may not correlate directly with the activity; medical treatment is most effective in active disease, and surgery is usually reserved for quiescent disease with persistent proptosis and/or eyelid changes. Conclusions: Intravenous pulsed corticosteroids, orbital radiotherapy, and orbital surgical techniques form the mainstay of current management of thyroid ophthalmopathy. Immunosuppressive and biologic agents may have a role in treating active disease although additional safety and efficacy studies are needed.

Transient Myopia with Severe Chemosis Associated with Systemic Lupus Erythematosus

PURPOSE: To report a transient myopia with severe chemosis associated with systemic lupus erythematosus. METHODS: A 31-year-old woman was referred for decreased visual acuity of both eyes for 1 week. The patient came to the emergency medical center for facial edema and fever. She was examined and treated for systemic lupus erythematosus. Three years previously the patient underwent LASIK in both eyes, and maintained emmetropia postoperatively. RESULTS: At admission, spherical equivalent was -0.75D in the right eye and -6.5D in the left eye. On the 3rd day, the spherical equivalent was -11.0D in the right eye and -10.0D in the left eye and progressively decreased to -2.0D both eyes by the 12th hospital day. The mean corneal power was 39.8D in the right eye and 39.9D in the left eye on the 2nd hospital day and decreased to 38.8D in the right eye and 38.9D in the left eye by the 12th hospital day. The axial length change was not parallel with myopic changes. The anterior chamber depth was 2.14 mm in the right eye and 1.94 mm in the left eye on the 3rd hospital day and increased to 2.96 mm in the right eye and 2.84 mm in the left eye by the 12th hospital day. Under cycloplegic refraction, ciliary spasm was not evident. The bulbar conjunctivas were markedly chemotic on the 3rd hospital day, but after systemic steroid therapy the chemosis subsided and the conjunctivas became normal by the 12th hospital day. The patient was diagnosed with systemic lupus erythematosus and after medical treatment, was discharged from the hospital.

Chemosis and papillitis-presenting signs in systemic lupus erythematosus: Report of a case.

The authors report a case with chemosis of conjunctiva and papillitis in a young female patient. Physical examination revealed no malar rash, skin lesion, photophobia, oral ulcer or joint symptom. Laboratory examination revealed anemia, leucopenia, albuminuria. Urine examined every 24 hours 3 days amounted to 1.26, 1.77, 1.47 gm./day respectively. Immunologic examination revealed L.E. cell-positive, antinuclear factor-posititve (reticular type). Renal biopsy: mesangial proliferative glomerulonephritis. Final diagnosis for this patient was systemic lupus erythematosus. Prednisolone 60 mg. orally/day improved both chemosis and papillitis. These presenting ocular signs are seen rarely in systemic lupus erythematosus.