ANESTHESIA FOR OPHTHALMIC SURGERY: PERIOPERATIVE CONSIDERATIONS

The use of anesthesia during ophthalmic surgery is crucial for ensuring patient comfort and safety. Different types of ophthalmic surgeries require different types of anesthesia techniques. Cataract surgery is the most performed ophthalmic surgery and is typically performed under local anesthesia with sedation, while glaucoma surgery can be performed using local or general anesthesia depending on the complexity of the procedure. The use of local anesthesia can reduce intraocular pressure (IOP) and is associated with fewer postoperative complications compared to general anesthesia. Three ophthalmic reexes, the oculocardiac, oculorespiratory, and oculoemetic reexes, should be recognized by the anesthesiologist. Appropriate prophylaxis and treatment of postoperative nausea and vomiting are essential for patients undergoing ophthalmic surgery.

Advances in the study of the pathogenesis of ophthalmic surgery-related dry eye / 国际眼科杂志(Guoji Yanke Zazhi)

With the rapid development and widespread implementation of all types of ophthalmic surgery, more attention is being paid to the quality of post-operative vision. Dry eye is a common complication after ophthalmic surgery, often causing eye discomfort, blurred vision and other dry eye symptoms. Ophthalmic surgery-related dry eye is a common type of dry eye and is usually caused by a combination of surgical injury to the conjunctival tissue and nerves, destabilisation of the tear film, postoperative inflammatory reaction and perioperative topical medication. This article reviews the risk factors for ophthalmic surgery-related dry eye, the pathogenesis of dry eye due to different ophthalmic surgeries and the prevention of this type of dry eye, with the aim of reducing the occurrence and development of ophthalmic surgery-related dry eye and improving the quality of vision and life after ophthalmic surgery in the clinical setting.

Ophthalmology practice in COVID-19 pandemic: Performance of rapid antigen test versus real time-reverse transcription polymerase chain reaction in a tertiary eye care institute in South India

Purpose: To assess the rapid antigen test (RAT) against the gold standard reverse transcription?polymerase chain reaction (RT?PCR) to screen COVID?19 infection in asymptomatic patients undergoing ophthalmic procedures. Methods: This was a retrospective hospital?based study. Point?of?care (PoC) RAT was performed using nasopharyngeal swab, while RT?PCR for SARS?CoV?2 viral RNA was performed using both nasopharyngeal and throat swabs. Results: A total of 629 patients were tested for SARS?CoV?2 by using both RAT and RT?PCR. Only one patient had tested positive for SARS?CoV?2 with both RAT and RT?PCR, while two patients had tested positive with RT?PCR after an initial negative RAT. The positivity rate for RAT was 0.15% (1/629), and that for RT?PCR was 0.47%. Percent agreement or proportion of agreement observed between the two tests was 99.68%, while Cohen’s kappa coefficient value was 0.49. The sensitivity of RAT in comparison to RT?PCR was 33.33%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 99.68%. Conclusion: The sensitivity and Cohen’s kappa coefficient in our study were low but that can be attributed to the overall low positivity rates with both RAT and RT?PCR. However, percent agreement observed between the two tests was very high. Therefore, we recommend initial screening of all the patients for COVID?19 symptoms followed by RAT before performing any ophthalmic surgical procedure to ensure the safety of the health care professionals as well as the patients.

Optimization of surgeon ergonomics with three-dimensional heads-up display for ophthalmic surgeries

Purpose: To describe the variables that may be utilized in the optimization of three?dimensional heads?up surgeries (3D?HUS) for achieving better ergonomics among ophthalmic surgeons. Methods: A cross?sectional study was conducted at the operating room of a tertiary eye care center, equipped with an ARTEVO 800 3D surgical microscope and display monitor. The parameters noted were monitor height (MH), surgeon eye?to?floor distance (ETFD), surgeon eye?to?monitor distance (ETMD) and viewing tilt (VT) angle. The neck and eye strain of the surgeon and assistant were scored as per Borg’s CR?10 scale, before and after surgeries. Results: Thirty (13 right, 17 left) eye surgeries were analyzed. The minimum ETMD was 51 inches (in) and the eye strain reduced with shorter ETMD (within the range 51 inches to 83 inches). The VT and ETFD were higher for right eye surgeries. The optimum MH was between 50 and 55 in. Overall, the neck strain and eye strain were in the range of 0–3 and 0–1, respectively. Conclusion: The various parameters affecting the 3D image quality, neck and eye strain are chair height, VT angle, eye centration, monitor distance, laterality of the eye, and room illumination.

COVID-19 testing recommendations prior to elective ophthalmic surgeries

@#With the resumption of elective surgeries during this COVID-19 pandemic, surgeons and facilities should implement infection prevention and control measures to ensure the safety of patients and health care workers. This advisory highlights the key principles, risk stratification considerations, and recommended approach regarding Covid-19 testing prior to elective ophthalmic surgeries.

COVID-19 guidance on the resumption of eye surgery

@#This document offers guidance to help the ophthalmologist plan for the safe resumption of elective surgical care. There are 4 sections: (I) COVID-19 Awareness, (II) Preparedness, (III) Patient Issues, and (IV) Delivery of Safe and High-Quality Care. Each section contains key issues to be addressed before elective surgery may be safely reinstituted. Understanding the capabilities of health facilities (e.g., testing, operating rooms) as well as the potential limitations in manpower and supplies will remain important, while keeping an eye out on subsequent waves of COVID-19.

Clinical observation on the treatment of ocular alkali burn by stages / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effect of comprehensive treatment of ocular alkali burn in different periods.<p>METHOD: A retrospective analysis was performed on 124 cases(166 eyes)of ocular alkali burns admitted to our hospital from January 2019 to December 12. According to the severity of the disease, a number of comprehensive measures were taken to treat the ocular alkali burn with drugs and surgery respectively. The patients were followed up for 6-12mo to observe the healing of ocular alkali burn and the final outcome of disease.<p>RESULTS: After treatment, the symptoms of all patients were relieved, the corneal conjunctiva healed, and no infection occurred. The average hospitalization time was 13d, totally 118 eyes were cured(71.1%), 43 eyes were improved(25.9%), 5 eyes were ineffective(3.0%). There was no complication in degree I and degree II of ocular alkali burn patients, degree III was better than degree IV, and the complication rate in degree III was lower than that in degree IV.<p>CONCLUSION: According to the corneal conjunctiva and eyelid injury evaluation of ocular alkali burn degree, choose appropriate time to take corresponding treatment measures, and give systemic and local drug treatment. Combined with ocular surface irrigation, anterior chamber puncture, amniotic membrane transplantation, conjunctival flap covering, corneal transplantation, limbal stem cell transplantation and other comprehensive treatment methods can obtain good clinical effect.

Clinical study on 14 cases of intraorbital organic foreign bodies / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the clinical imaging characteristics and surgical methods of intraorbitalorganic foreign bodies.<p>METHODS: The materials of 14 patients(14 eyes)with orbital organic foreign bodies from January 2010 to April 2019 in our hospital were retrospectively analyzed, then to summarize their clinical features and imaging characteristics and surgical methods. <p>RESULTS: It had been proved that all of foreign bodies removed from 14 patients's(14 eyes)were organisms. There were 9 patients's(9 eyes)foreign bodies were found with low density and inflammatory response in soft tissue around of 14 patients by orbital three-dimensional reconstruction computed tomography(CT). CT images showed different manifestations due to different properties of foreign bodies, and soft foreign bodies had no characteristic images. Drainage strips were placed after removed foreign bodies. After the operation, the incision healed in the first stage and scar formed. <p>CONCLUSION: Due to the complexity of orbital organic foreign bodies, it is important to make presurgical preparation sufficient and surgical plan individualized for remove the foreign body completely and reduce the difficulty of the surgery.

The evolutional and developing mindset in management of ocular trauma in recent ten years / 中华实验眼科杂志

The main developments and progresses of the mindset for the management of ocular trauma in China were summarized into the following 6 aspects:the emphasis on management of wound has been transferred from outside to inner site of the wound;emergence of the idea of continuous treatment;wound involving both anterior and posterior segments should be considered integratedly as an inseparable part in terms of surgical management;the zone of ciliary body receives more attention;assessment prior to the surgeries is insufficient for decision of enucleation;between vitreous body and retina,the stress of surgical management should be focoused on retina.We should pay attention to the evolutional and developing mindset in management of ocular trauma in recent ten years,it will help us to sort out the treatment ideas and summarize the treatment experience.

Use and validation of mirrorless digital single light reflex camera for recording of vitreoretinal surgeries in high definition

Purpose: The purpose of this study is to describe the use of commercial digital single light reflex (DSLR) for vitreoretinal surgery recording and compare it to standard 3-chip charged coupling device (CCD) camera. Methods: Simultaneous recording was done using Sony A7s2 camera and Sony high-definition 3-chip camera attached to each side of the microscope. The videos recorded from both the camera systems were edited and sequences of similar time frames were selected. Three sequences that selected for evaluation were (a) anterior segment surgery, (b) surgery under direct viewing system, and (c) surgery under indirect wide-angle viewing system. The videos of each sequence were evaluated and rated on a scale of 0-10 for color, contrast, and overall quality Results: Most results were rated either 8/10 or 9/10 for both the cameras. A noninferiority analysis by comparing mean scores of DSLR camera versus CCD camera was performed and P values were obtained. The mean scores of the two cameras were comparable for each other on all parameters assessed in the different videos except of color and contrast in posterior pole view and color on wide-angle view, which were rated significantly higher (better) in DSLR camera. Conclusion: Commercial DSLRs are an affordable low-cost alternative for vitreoretinal surgery recording and may be used for documentation and teaching.

Qualitative research about the influence of communication disabilities caused by dialects on the safety of ophthalmic surgery and its solution / 中国实用护理杂志

Objective To explore the influence of dialect-based communication obstacle on the safety of ophthalmic operation room and to provide the basis for improving the safety of ophthalmic operation room. Methods An in-depth interview was taken on 10 medical staff by qualitative research. The information was arranged and analyzed by phenomenology method. Results The interview with the surgical doctors on the communication barriers were extracted to three themes, including lower surgical efficiency, decreased patient satisfaction, increased risk of surgical complications, the interview with the surgical nurses on the dialects leading to communication barriers were extracted three themes, including surgical verification difficult to carry out, affect the perioperative care, hinder the postoperative mission to carry out, the extracted themes about the impact on patients include increased stress and anxiety affect the surgical outcome, poor intraoperative experience reduced satisfaction, the extracted themes about solution include the organization of medical staff to learn the dialect of the common language, recruit staff diversification, to provide professional translation, standardized body language to instruct the patient. Conclusions In this study, the experience of communication disorder caused by doctors and nurses in the ophthalmic operating room reflects the shortcomings of the safety management of the ophthalmic operating room. These deficiencies can be reduced by the independent study of the medical staff.

Perioperative management of ophthalmic patients on antithrombotic therapy / 国际眼科杂志(Guoji Yanke Zazhi)

The large majority of elderly patients undergoing ophthalmic surgery take antiplatelet and anticoagulant drugs on a regular basis. Antithrombotic treatments predisposes to bleeding complications that may lead to retrobulbar haemorrhage, suprachoroidal haemorrhage and ultimately, to loss of vision. However, discontinuation of antithrombotic medication in such patients may lead to thromboembolic events with serious consequences. There are no guidelines on perioperative management of ophthalmic patients who are on antiplatelet and anticoagulant drugs. We reviewed traditional and newer agents in the context of cataract, vitreoretinal, glaucoma and oculoplastic surgery. Recommendations are given for continuation, cessation and recommencement of these agents in order to minimise the risk of bleeding and thrombotic complications.

Anesthesia Recovery Quality Observation of Treated with Dexmedetomidine Used in Eye Surgery Anesthe-sia / 中国药师

Objective:To observe the effect of dexmedetomidine used in ophthalmic surgery anesthesia on the recovery quality in children. Methods:Totally 126 children with ophthalmic surgery were randomly divided into the control group and the observation group with the same induction program. The control group was given propofol with target controlled infusion during the operation, while the observation group was given dexmedetomidine 0. 6μg·kg-1 before the induction, and infused up in 10min, propofol with target controlled infusion was used during the operation, and stopped infusion 10min before the end of the operation. The cough number and degree, the occurrence of agitation and extubation time of the two groups were observed and compared during the anesthesia recovery period. Results:The cough incidence and agitation incidence was 36. 51% and 4. 76% in the observation group, respectively, which were significantly lower than those in the control group (74. 60% and 33. 33%, P0. 05). Conclusion:Dexmedetomidine used in ophthalmic surgery anesthesia of children can effectively control cough frequency and degree during the recovery period and reduce the agitation to improve the quality of clinical anesthesia recovery.

A new surgical technique to treat corneal perforations using amniotic membrane and surgical adhesive / Nova técnica cirúrgica para tratamento de perfuração de córnea utilizando membrana amniótica e adesivo cirúrgico

The objectives of this study were to compare surgical techniques and the effects of using n-butyl 2-cyanoacrylate and bovine amniotic membrane to repair perforated lesions in corneas. Penetrating keratoplasty was performed in sixty New Zealand White rabbits under general anesthesia. Group 1 (G1) was treated with n-butyl 2-cyanoacrylate, group 2 (G2) received a fragment of amniotic membrane through the anterior chamber and application of n-butyl 2-cyanoacrylate over the lesion, group 3 (G3) was treated with the same technique as G2 with the addition of an amniotic membrane bandage covering the cornea and sutured in the limbus region, and group 4 (G4) was treated with an amniotic membrane sutured to the lesion and an amniotic membrane bandage sutured in the limbus region. Clinical, histological and histomorphometric examinations of the corneas were performed. The membrane acted as a barrier for aqueous humor in G2 and G3, thereby keeping the surface dry for adhesive application; it also prevented the adhesive from contacting intraocular structures. The groups treated with amniotic membrane and surgical adhesive showed better results than the groups treated with either material alone. Thus, the combination of the membrane with the adhesive is recommended for this type of lesion...

Os objetivos deste estudo foram comparar técnicas cirúrgicas e efeitos do n-butil 2-cianoacrilato e da membrana amniótica bovina na reparação de lesões perfuradas em córneas. Sessenta coelhos da raça Nova Zelândia Branca foram submetidos à ceratoplastia penetrante sob anestesia geral. O grupo 1 (G1) foi tratado com n-butil 2-cianoacrilato; o grupo 2 (G2) recebeu um fragmento de membrana amniótica pela câmara anterior e aplicação de n-butil 2-cianoacrilato sobre a lesão; o grupo 3 (G3) foi tratado com a mesma técnica aplicada ao G2, adicionando-se uma bandagem de membrana amniótica cobrindo a córnea e suturada à região do limbo; e o grupo 4 (G4) foi tratado com membrana amniótica suturada nas bordas da lesão e bandagem de membrana amniótica suturada na região do limbo. Foram realizados exames clínico, histológico e histomorfométrico. A membrana atuou como barreira contra o extravasamento do humor aquoso nos grupos 2 e 3, manteve a superfície seca para posterior aplicação do adesivo e impediu o contato do adesivo com as estruturas intraoculares. Os grupos tratados com o adesivo associado à membrana amniótica demonstraram melhores resultados do que aqueles tratados com cada material isoladamente. Assim, a combinação da membrana com o adesivo é indicada neste tipo de lesão...

Etiological analysis of infection after eye surgery and the investigation of drug sensitivity / 中华实验眼科杂志

Background Clinical researches showed that antimicrobial-resistance of bacterium is gradually serious.It is very important to master pathogen distribution and antimicrobial susceptibility after eye surgery.Objective This study was to investigate the distribution and drug sensitivity of pathogenic bacteria from ocular operative infection in 3-year duration to provide a reference for reasonable selection of antibiotics.Methods Sixtyfive positive specimens were obtained from 65 patients due to postoperative infection in Department of Ophthalmology of Shenzhou Hospital and Shengjing Hospital from 2009 January through 2011 December.The pathogenic bacteria were isolated and then the drug sensitivity test of conventional antibiotics was performed.Results Among the 65 ophthalmic specimens,35 strains of Gram-positive bacteria were isolated with the constituent ratio 53.8％,and 15 strains of Gram-negative bacteria accounted for 23.1％.Fungus was found in 15 cases with the constituent ratio 23.1％.Staphylococcus epidermidis accounted for 42.9％ in Gram-positive bacteria,and Pseudomonas aeruginosa accounted for 33.3％ in Gram-negative bacteria.Aspergillus was the main component of fungus,which accounted for 60.0％ of the proportion 3 strains of methicillin-resistant Staphylococcus aureus (MRSA) in 8 strains of Staphylococcus aureus,but no vancomycin-resistant Enterococcus (VRE) and vancomycin-resistant Staphylococcus (VRS) were seen.The in vitro drug sensitivity test showed that the main Gram-positive bacteria,Staphylococcus epidermidis and Staphylococcus aureus,were sensitive to linezolid,vancomycin,levofloxacin and ciprofloxacin with the sensitive rates ＞50.0％,and these bacteria were lowly sensitive to penicillin and erythromycin with the sensitive rates ≤30.0％.Pseudomonas aeruginosa appeared to be the main Gram-negative bacteria,showing a sensitive rate ≥ 80.0％ to tobramycin,amikacin,ceftazidime,cefepime,cefoperazone/sulbactam,piperacillin/tazobactam,imipenem and meropenem.Conclusions Staphylococcus epidermidis,Staphylococcus aureus,Pseudomonas aeruginosa and Aspergillus are primary pathogens in ocular infection after operation.Antibiotics such as penicillin,erythromycin,levofloxacin,cefotaxime seem to be relatively high resistant to eye infection.To choose sensitive antibiotics timely and reasonably is a key to the prevention and control of ocular infection after operation.

Bacterial and fungal endophthalmitis in Upper Egypt：related species and risk factors

Objective: To study risk factors, contributing factors of bacterial and fungal endophthalmitis in Upper Egypt, test the isolated species sensitive to some therapeutic agents, and to investigate the air-borne bacteria and fungi in opthalmology operating rooms. Methods: Thirty one cases of endophthalmitis were clinically diagnosed and microbiologically studied. Indoor air-borne bacteria and fungi inside four air-conditioned operating rooms in the Ophthalmology Department at Assiut University Hospitals were also investigated. The isolated microbes from endophthalmitis cases were tested for their ability to produce some extracellular enzymes including protease, lipase, urease, phosphatase and catalase. Also the ability of 5 fungal isolates from endophthalmitis origin to produce mycotoxins and their sensitivity to some therapeutic agents were studied. Results: Results showed that bacteria and fungi were responsihle for infection in 10 and 6 cases of endophthalmitis, respectively and only 2 cases produced a mixture of bacteria and fungi. Trauma was the most prevalent risk factor of endophthalmitis where 58.1% of the 31 cases were due to trauma. In ophthalmology operating rooms, different bacterial and fungal species were isolated. 8 bacterial and 5 fungal isolates showed their ability to produce enzymes while only 3 fungal isolates were able to produce mycotoxins. Terbinafine showed the highest effect against most isolates in vitro. Conclusions: The ability of bacterial and fungal isolates to produce extracellular enzymes and mycotoxins may be aid in the invasion and destruction of eye tissues. Microbial contamination of operating rooms with air-borne bacteria and fungi in the present work may be a source of postoperative endophthalmitis.

Investigation of the effect of nursing intervention on psychological state of patients with ophthalmic surgery / 中国实用护理杂志

Objective To observe the psychological state of patients with ophthalmic surgery, and investigated the effect of nursing intervention on the psychological state of them. Methods 120 patients with ophthalmic surgery were selected randomly, including 40 youth, 40 middle-aged and 40 elderly, they were subsequently divided randomly into the control group and the nursing intervention group with 20 of youth, middle- aged and elderly separately. The control group received preoperative health education ae-cording to nursing process, the nursing intervention group was given nursing intervention based upon routine nursing. Anxiety standard score was evaluated by the self-rating anxiety scale (SAS) when upon admission,one day before surgery, and upon discharge. Results The anxiety standard score of the patients admitted into hospital was above the critical standard score (50), the anxiety standard score of patients when the day before surgery was significantly above that upon admission, but was less than the critical standard score when they left hospital, and it was significantly less than that upon admission. There was no statistical sig-nificance of anxiety standard score between the control group and the nursing intervention group when they were admitted into hospital, it was significantly less than that of the control group when the day before surgery and when they left hospital. The anxiety standard scores of the elderly and the middle- aged of the control group were more and significantly more than the youth's when the day before surgery separately, and both of theirs were more than the youth's when they left hospital. After nursing intervention, the anxiety standard score of the elderly and the middle- aged were significantly more and more than the youth when the day before surgery separately, and the elderly was more than the youth when they left hospital, there was no statistical significance between the youth and the middle- aged. The anxiety standard score of the youth and the middle- aged were significantly less than that of the control group separately when the day before surgery and when they left hospital, that elderly was less than that of the control group. Conclusions Anxiety existed in almost all patients with ophthalmic surgery, and it reached high degree the day before surgery. It appeared more in the middle-aged than among the youth and the elderly. Nursing intervention shows positive effect on the psychological state of patients with ophthalmic surgery, and it influences more on the youth and the middle-aged than on the elderly. Therefore, it is necessary to give different periopera-tire nursing intervention to the patients with ophthalmic surgery.

Anesthetic management of ophthalmic surgery / 대한마취과학회지

Ophthalmic surgery presents challenges for the anesthesiologists, including control of intraocular pressure, prevention and management of the oculocardiac reflex. In addition to understanding ocular anatomy and physiology, the anesthesiologists must have possess technical expertise and knowledge of ophthalmic drug's systemic effects. Patients undergoing ophthalmic surgery have extremes of age and several medical diseases, like as hypertension, diabetes mellitus, coronary heart disease, chronic renal failure, and chronic obstructive lung disease. Anesthesiologist should be knowledgeable about the content as stated above to perform safe and desirable anesthesia for ophthalmic surgery.

Comparison of Propofol and Thiopental / Halothane for Short Duration Ophthalmic Surgical Procedures in Children / 대한마취과학회지

Experiences with propofol in pediatric anesthesia are limited. We undertook a study to evaluate the quantity of induction and recovery from anesthesia with propofol compared to thiopental/halothane. Fifty children received 2mg/kg of propofol as a loading dose followed by a maintenance dose of 9mg/kg/hr for first 30minutes and followed by 6mg/kg/hr there- after. Fifty children received 5mg/kg of thiopental, and maintensnce was provided with halothane (0.5%-1.5%). The interval between the end of the administration of propofol or thiopental/halothane and extubation, as well as discharge to the ward,was significantly shorter with propofol (5.43 versua 10.72 min and 10.30 versus 18.20 min, respectively). Pain on injection site were seen more frequently with propofol, whereas nausea and hiccup were only observed with thiopental. During the first 6 hour after the surgical procedure, an- algesics were needed significantly more often in the thiopental group. In conclusion, propofol used as a single anesthetic for total intravenous anesthesia is a satisfactory agent for oph- thalmic surgery of short duration in children.