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AIM: To observe the outcome of intravitreal balanced salt solution(BSS)injection to increase intraocular pressure(IOP)after extrascleral subretinal fluid drainage, then scleral buckling(SB)to treat superior bullous retinal detachment(SBRD), and compare it with the effect of conventional surgery(without any intravitreal filling)and postoperative air filling.METHODS: Retrospective case-control study. A total of 72 patients(73 eyes)who underwent SB for SBRD from January 2018 to December 2022 in ophthalmology department of Xijing Hospital were included. The extrascleral subretinal fluid drainage was performed in all eyes. According to whether intravitreal injection was performed and different injections, patients were divided into three groups: with 24 cases(24 eyes)in the conventional group(no intravitreal injection), 23 cases(23 eyes)in the air group(sterile air was injected after surgery), and 25 cases(26 eyes)in the BSS group(BSS was injected during extrascleral subretinal fluid drainage). All patients were followed up until subretinal fluid was absorbed completely. The average surgery time, postoperative IOP, retinal reattachment rate, subretinal fluid absorption, visual acuity(LogMAR)and major complications were compared.RESULTS: All surgeries were completed successfully. The average surgery time of the conventional group, air group and BSS group were 63.17±13.22, 61.65±15.55 and 57.30±11.70 min, respectively. There had no significant difference among these groups(F=0.825, P=0.443). On the first post-operative day, the average IOP of the conventional group, air group and BSS group were 13.69±2.69, 16.40±2.86 and 18.35±2.88 mmHg, respectively. The average IOP of the air group and the BSS group were significant higher than that of the conventional group(F=17.18, P<0.001). Primary reattachment rates were 88%, 96%, and 100%, respectively. The postoperative BCVA was 0.71±0.42, 0.59±0.44, and 0.91±0.50, respectively, which were significantly higher than those before operation(all P<0.05), but there was no significant difference among groups(F=3.046, P>0.05). The main complications included subretinal hemorrhage in 1 eye from the conventional group and 1 eye from the air group, and a new retinal tear in 1 eye from the air group, resulting in localized retinal detachment.CONCLUSIONS: For SBRD patients with hypotony during SB surgery, intravitreal injection of BSS to properly increase the IOP and then complete the surgery can improve the reattachment rate and reduce postoperative complications. This method is safe and effective for selected SBRD patients.
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To compare the viability of periodontal ligament (PDL) cells stored in Hanks Balanced Salt Solution (HBSS) with those in readily available transport media over a variable period of time. Methods: Periodontal ligament cells harvested from premolars freshly extracted for orthodontic reasons were cultured for exponential growth. The cells were exposed to egg white, evaporated milk, water and Hanks Balanced Salt Solution (HBSS) at room temperature. Their viability was evaluated after 30 minutes, 1 hour and 3 hours with the tetrazolium salt-based colorimetric assay (MTT assay). Statistical analysis was done using the IBM® SPSS version 23.0 software. Comparison between the Mean Optical Densities (MODs) of the cells stored in HBSS and other media at each time interval was done using the independent t test. Repeated measure ANOVA and Tukey post-hoc test were also carried out to compare the MOD of cells within each medium over time. The level of significance was set at p <0.05. Result: The PDL cells stored in egg white had higher MODs than those in HBSS at 30 minutes and 1 hour. Conversely, the MODs of the cells stored in milk and water were lower than those in HBSS at all the studied points. There was a significant difference in the viability of the cells stored in HBSS and water at all the time points (p<0.05). Conclusion: For up to an hour, egg white was found to perform better than HBSS in supporting the viability of PDL cell
Subject(s)
Periodontal Ligament , Tooth Avulsion , Milk , Egg White , Saline SolutionABSTRACT
Purpose: The purpose of this study was to compare and analyze the endothelial cell loss during manual small-incision cataract surgery (MSICS) using the viscoelastic-assisted nucleus removal versus basal salt solution plus technique. Methods: This was a prospective randomized trial of 204 patients who underwent MSICS using viscoelastic-assisted nucleus removal (Group 1- OVD) versus basal salt solution plus technique (Group 2- BSS) at a tertiary eye care hospital in North India from January 2018 to 2021. Of these 204 patients, 103 (50.5%) and 101 (49.5%) were allocated to Group 1 and 2, respectively. The parameters assessed were detailed history, demographics, and anterior and posterior segment details. Visual acuity, intraocular pressure (IOP), keratometry, pachymetry, and endothelial cell density were evaluated preoperatively and postoperatively on day 1 and 30. Results: The mean age of the patients was 64.5 � 8.2 years (range 48� years). There were 129 (63.2%) males and 75 (36.8%) females. The mean LogMAR visual acuity for both groups on day 1 (Group 1- 0.3 � 0.1, Group 2- 0.5 � 0.2) and day 30 (Group 1- 0.1 � 0.2, Group 2- 0.1 � 0.1) was statistically significant (P < 0.001), and the mean IOP value showed a statistically significant value (P < 0.009) on day 1 in Group 2 (15.0 � 2.4 mmHg) and on day 30 (P < 0.001) in both the groups (Group 1- 13.6 � 1.8 mmHg, Group 2- 13.5 � 2 mmHg). The horizontal and vertical k values also showed a statistically significant difference on day 1 and day 30 (P < 0.001). The mean percentage change of central corneal thickness (CCT) in Group 1 was 17.7% and in Group 2 was 17.4% on day 1, and it was 1.1% on day 30 in both the groups, which was statistically significant (P < 0.001) compared to preoperative values. The percentage change in endothelial cell density on day 1 was 9% in Group 1 and 4.6% in Group 2, which was statistically significant (P < 0.001). On day 30, it was 9.7% and 4.8%, respectively, which was statistically significant (P < 0.001). Conclusion: Our study highlights statistically significant endothelial cell loss with viscoelastic-assisted nuclear delivery compared to BSS-assisted nuclear delivery during MSICS in a short follow-up of 1 month. The CCT values showed a slight increase, and the keratometry and IOP were unaffected compared to the preoperative parameters in both the groups
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@#AIM: To investigate the effect of application of corneal protective agent(2% hydroxyl propyl methyl cellulose, 2% HPMC)on the stability of ocular surface tear film after phacoemulsification in age-related cataract(ARC)patients with type 2 diabetes.<p>METHODS: Prospective parallel controlled trial. Totally 107 cases(107 eyes)of the patients with ARC and type 2 diabetes who underwent phacoemulsification in our hospital from March 2017 to May 2018 were included in this study. According to the random number table, the patients were divided into HPMC group and BSS group. All 57 eyes were enrolled in HPMC group and 2% HPMC was evenly covered on the corneal surface during operation; 50 eyes were enrolled in BSS group and BSS was continuously dripped on the cornea during operation. Break up time(BUT), Schimer Ⅰ test(SⅠt)and corneal fluorescein staining(CFS)were performed 1d before operation and 7d, 30d, 60d and 90d after operation, and observed their changes.<p>RESULTS: At 7d, 30d and 60d after cataract surgery, compared with BSS group, BUT was significantly prolonged and CFS staining spots were significantly reduced in HPMC group; At 7d after surgery, SⅠt in HPMC group was significantly lower than that in BSS group; At 30d and 60d after surgery, SⅠt in HPMC group was significantly higher than that in BSS group(<i>P</i><0.05). At 60d after operation, there was no difference in BUT, SⅠt and CFS between HPMC group and preoperative group(<i>P</i>>0.05), while there was difference in BUT, SⅠt and CFS between BSS group and preoperative group(<i>P</i><0.05).<p>CONCLUSION:2% HPMC in phacoemulsification can protect the stability of tear film on the ocular surface of ARC patients with type 2 diabetes. The tear film stability indexes can be restored to the preoperative level 60d after operation.
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OBJECTIVES: To compare the amount of ultrasound energy and irrigation volume in conventional phacoemulsification cataract surgery versus femtosecond laser-assisted phacoemulsification at different nuclear-cortical cataract grades. METHOD: This was a prospective, consecutive, investigator-masked nonrandomized parallel cohort study. Patients were divided into 4 groups (Phaco1, Phaco2, Femto1 and Femto2) according to the surgical technique (conventional phacoemulsification [Group Phaco] or femtosecond laser-assisted cataract surgery [Group Femto]) and the Lens Opacity Classification System III (LOCS) grade (LOCS<11 [group 1] or LOCS≥11 [group 2]). The measured outcomes were effective phacoemulsification time (EPT), indicating the ultrasound energy, and balanced salt solution (BSS) use, indicating the irrigation volume, to indirectly estimate the damage to the corneal endothelium caused by the cataract surgery. RESULTS: A total of 160 eyes from 109 patients were included: 87 eyes in Group Phaco, 73 eyes in Group Femto, 76 eyes in group 1 and 84 eyes in group 2. The EPT mean in Femto1 was 53% less (2.73±1.88, 0.1 to 8.65) than that in Phaco1 (5.80±2.86) (p=0.00) and in Femto2 (8.38±9.32) was 33% less than that in Phaco2 (12.55±8.38) (p=0.00). No significant differences in mean LOCS grades between the Phaco1 (8.21±1.44) and Femto1 (7.90±1.90) groups (p=0.73) or between the Phaco2 (13.15±2.55) and Femto2 (12.72±2.18) groups (p=0.95) were found. There were no significant differences in the mean BSS use between the Phaco1 (55.73±12.45) and Femto1 (59.37±10.93) groups (p=0.48) or between the Phaco2 (64.34±21.00) and Femto2 (65.71±17.60) groups (p=0.47). CONCLUSIONS: Compared to conventional phacoemulsification at different nuclear-cortical cataract grades, femtosecond laser-assisted cataract surgery provides an EPT reduction but does not influence the BSS use.
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Humans , Male , Female , Middle Aged , Aged , Cataract Extraction/methods , Phacoemulsification/methods , Visual Acuity , Prospective Studies , Cohort Studies , Treatment OutcomeABSTRACT
AIM: To compare the difference in corneal endothelial cell density and morphology after phacoemulsification using Ringer lactate ( RL ) and balanced salt solution ( BSS) irrigating solutions.?METHODS: The prospective randomized controlled trial study was conducted between February 2017 and April 2017 in Dr. YAP Eye Hospital, Yogyakarta, Indonesia. There were a total of 52 subjects ( 52 eyes ) who were senile cataract patients further grouped into two, 26 patients undergoing the phacoemulsification procedure using RL irrigating solution and the other 26 patients with BSS irrigating solution, both conducted by one operator. On the 1, 7, and 28d post operative, an evaluation was done to measure the density and corneal endothelial cell morphology, as well as the variable of inflammation in the two groups.? RESULTS: Fifty - two eyes had undergone phacoemulsification with posterior intraocular lens implantation. Both groups were evaluated for the endothelial cell reduction and corneal endothelial cell morphology change, along with post - operative inflammation. On the 28d post-operative, endothelial cell reduction in the BSS group ( 173. 96 cell/mm2 , 8. 12％) was lower than the RL group (253.20 cell/mm2, 10.25％), percentage of corneal endothelial cell variation coefficient increase in the BSS group ( 2. 92％, 8. 36％) was lower compared to the RL group (3. 42％, 9. 96％), decrease of hexagonal cells of corneal endothelium cells presentation percentage in the BSS group (4. 30％, 8. 17％) was lower compared to the RL group (4. 84％, 8. 97％), and the percentage increase of central corneal thickness in the BSS group (4. 69 μm, 0. 89％) was almost equal to the RL group (4. 53 μm, 0. 90％). All of the results regarding difference in density and corneal cell endothelium morphology between the two groups did not reveal any statistically significant difference (P>0. 05). Inflammatory variable in the two groups were even.? CONCLUSION: BSS and RL were equal in their capability of maintaining endothelial cell loss and endothelial cell morphologic change in senile cataract patients after phacoemulsification.
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To explore the present status of fluid therapy and clinical outcome in critically ill patients in intensive care units (ICU).ICU patients consecutively admitted to our ICU were prospectively enrolled.Patients' demographics,laboratory data,fluid record and clinical outcome were collected.Fluid intake quantity of all patients was at peak on the fifth day which was 2 806 (1 997,3 582)ml.From the fourth day in ICU,fluid balance started to benegative as-84 (-1 127,612)ml and gradually increased.Crystalloid solution was the main components.For treatment purposes,medication injections and nutrients were major fluids.Positive correlations were found between total fluid intake quantity,total crystalloid volume,total colloidal volume and hospital stay,ICU stay,duration of intubation (r values as 0.211,0.686,0.282,0.155,0.506,0.174,0.209,0.072,0.292,respectively P＜0.05).Moreover,positive correlations were also demonstrated between total colloidal volume and total bilirubin,direct bilirubin,alanine transaminase,aspartate transaminase,blood urea nitrogen,serum creatinine (r values as 0.196,0.242,0.190,0.335,0.284,0.223,respectively P＜0.05).
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Fluid overload is frequently found in patients with intravenous fluid resuscitation,and recent studies showed the potential risks of fluid overload for organ failure and mortality.To avoid volume overload and its associated complications,strategies to identify fluid responsiveness are necessary.Apart from the amount of fluid utilized for resuscitation,the type of fluid used also impacts patient outcome.In recent years,there has also been an increasing focus on comparing various resuscitation fluids with respect to both benefits and risks.In this article,through analyzing the impact of fluid overload on patient outcome,we describe the differences in static and dynamic estimates of fluid responsiveness,and review the current literature regarding choice of intravenous fluids for resuscitation in critically ill patients to help clinicians to make appropriative decision on intravenous fluids prescription and to optimize patient outcome.
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Objective To study the influence of intraoperative use of saline and balanced salt solution on postoperative nerve function recovery in patients with brain trauma.Methods Totally 120 patients were randomly divided into the saline group and the balanced salt solu-tion group,and the postoperative nerve function recovery of the two groups were observed.Results The level of pH and HCO3 -24 hours af-ter operation in the saline group were lower than those in the balanced salt solution group (P <0.05),while the level of Cl - in the saline group was higer than that in the balanced salt solution group (P <0.05).The intracranial pressure and preoperative Glasgow coma score (GCS)of the two groups had no statistical significance (P =0.94).And the Glasgow coma score at 336 hours and 672 hours after opreation of the two groups were of statistical significance (P =0.00,P =0.03).The mortality of the saline group and the balanced solution group 28days after surgery were 15% and 10% respectively,and there was no significant difference between the two groups (P =0.58).Conclusion Saline resuscitation during surgery would lead to hyperchloremic acidosis as well as worse nerve function.However,the perfusion of balanced salt solution during the operation is more favorable to the recovery of neurological function.
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PURPOSE: To compare the corneal wetting properties of balanced salt solution (BSS) and ophthalmic viscosurgical device (OVD) during cataract surgery. METHODS: The patients with senile cataract were randomly assigned to receive either BSS or viscous dispersive OVD for maintaining optical clarity during phacoemulsification. Intraoperative factors (VAS pain score, occurrence of corneal punctate epithelial erosions (PEE)) and postoperative factors (visual acuity, Oxford staining score, changes in endothelial cell counts, corneal thickness and volume) were compared. RESULTS: Twenty-two eyes were assigned to the BSS group and; 33 eyes were assigned to the OVD group. There were no significant differences in demographic variable between the 2 groups. Intraoperative PEE was observed in 6 eyes in the BSS group and in 2 eyes in the OVD group. The incidence of PEE in the OVD group was significantly lower than in the BSS group (p = 0.045). There were no significant differences in other parameters (VAS pain score, postoperative factors). CONCLUSIONS: Corneal wetting with OVD (Discovisc(R)) provides better surgical view and reduces mechanical damage to the corneal surface without additional material or cost than BSS.
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Humans , Cataract , Endothelial Cells , Eye , Incidence , PhacoemulsificationABSTRACT
PURPOSE: To compare surgical results between conventional intraocular lens (IOL) implantation using an ophthalmic viscosurgical device (OVD) and IOL implantation using a balanced salt solution (BSS) after irrigation/aspiration (I/A) of the lens cortex. METHODS: A randomized prospective study was conducted on 62 patients who underwent cataract surgery. Following completion of conventional I/A of the lens cortex, we divided patients into two groups according to whether or not BSS was used. In group A (n = 31), the anterior chamber and the capsular bag were completely filled with an OVD before IOL implantation. On the other hand, in group B (n = 31), BSS was irrigated into the anterior chamber through a previous side port during IOL implantation. Surgical results were compared between the two groups. RESULTS: In both groups, IOP peaked six hours after surgery. The occurrence of an IOP spike by postoperative day one was observed in six cases (6 / 31) in group A and in no cases (0 / 31) in group B, a difference that was statistically significant (p = 0.024). The values of endothelial cell density, central corneal thickness, anterior chamber inflammation, myopic shift, and posterior capsule opacification were not significantly different between the two groups. CONCLUSIONS: Compared with the use of OVD for IOL implantation, use of BSS during IOL implantation resulted in reductions in postoperative IOP spike and OVD removal time.
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Aged , Humans , Middle Aged , Anterior Chamber/surgery , Cataract Extraction , Device Removal , Intraocular Pressure , Lens Implantation, Intraocular/methods , Phacoemulsification/instrumentation , Prospective Studies , Therapeutic Irrigation/methodsABSTRACT
PURPOSE: To compare the intraoperative performances and postoperative outcomes of cataract surgery performed with longitudinal phacoemulsification and torsional phacoemulsification in moderate and hard cataracts. METHODS: Of 85 patients who had senile cataracts, 102 eyes were operated on using the Infiniti Vision System. Preoperative examinations (slit lamp examination, mean central corneal thickness, and central endothelial cell counts) were performed for each patient. Cataracts were subdivided into moderate and hard, according to the Lens Opacities Classification System III grading of nucleus opalescence (NO). Eyes in each cataract group were randomly assigned to conventional and torsional phaco-mode. Intraoperative parameters, including ultrasound time (UST), cumulative dissipated energy (CDE), and the balanced salt solution plus (BSSP) volume utilized were evaluated. Best corrected visual acuity (BCVA) was checked on postoperative day 30; mean central corneal thickness and central endothelial cell counts were investigated on postoperative days 7 and 30. RESULTS: Preoperative BCVA and mean grading of NO showed no difference in both groups. Preoperative endothelial cell count and central corneal thickness also showed no significant difference in both groups. In the moderate cataract group, the CDE, UST, and BSSP volume were significantly lower in the torsional mode than the longitudinal mode, but they did not show any difference in the hard cataract group. Torsional group showed less endothelial cell loss and central corneal thickening at postoperative day seven in moderate cataracts but showed no significant differences, as compared with the longitudinal group, by postoperative day 30. CONCLUSIONS: Torsional phacoemulsification showed superior efficiency for moderate cataracts, as compared with longitudinal phacoemulsification, in the early postoperative stage.
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Aged , Female , Humans , Male , Middle Aged , Cataract/classification , Cataract Extraction/methods , Cell Count , Cornea/diagnostic imaging , Endothelium, Corneal/pathology , Eyeglasses , Phacoemulsification/methods , Postoperative Period , Time Factors , Treatment Outcome , Visual AcuityABSTRACT
PURPOSE: To report a case of inadvertent anterior chamber and cornea stromal injection with high dose antibiotics and steroids during cataract operation. METHODS: During cataract operation on a 78 year-old female patient, high dose gentamicin (20 mg/0.5 ml) and dexamethasone (2 mg/0.5 ml) were inadvertently injected into the anterior chamber and cornea stroma when making cornea edema for sealing of the incision sites. Anterior chamber irrigation with balanced salt solution (BSS) was immediately administered. On postoperative day one, extensive cornea edema was noted, and best-corrected visual acuity was 0.2. Descemet's membrane folds were observed around the corneal incision sites. Topical 5% NaCl and 1% prednisolone were started. RESULTS: Four weeks postoperatively, corneal edema began to reduce significantly. At four months postoperatively, corneal edema fully resolved, and best-corrected visual acuity was 0.8. However, some Descemet's membrane folds still remained, and a decrease in the number of endothelial cells was noted by specular microscope. CONCLUSIONS: In this case involving anterior chamber and cornea stromal injection with high dose antibiotics and steroids, immediate anterior chamber irrigation with balanced salt solution seemed an appropriate management, and the patient's long-term visual acuity appears good. To prevent such mistakes, precise labeling of all solutions and use of different syringe needles should be considered.
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Humans , Female , Aged , Visual Acuity , Postoperative Complications/prevention & control , Intraoperative Care/methods , Injections , Follow-Up Studies , Endophthalmitis/prevention & control , Corneal Stroma , Cataract Extraction/methods , Anti-Bacterial Agents/administration & dosage , Anterior ChamberABSTRACT
PURPOSE: To report a case of anterior chamber irrigation with distilled water during cataract operation. METHODS: During the cataract operation of 56 year-old male patient, corneal edema and anterior chamber hazziness were noted after anterior chamber irrigation with distilled water for a minute. Distilled water was replaced rapidly balanced salt solution (BSS) as irrigation solution and operation was completed. At postoperative one day, corneal edema and anterior chamber exudative membrane were formed. After topical 5% NaCl, 1% prednisolone treatment, corneal edema and exudative membrane disappeared at postoperative sixth week. BCVA was 0.6. At postoperative ninth week, the patient complained of decreased visual acuity. On fundus exmination and flourescein angiography, cystoid macular edema (CME) was detected. RESULTS: After prednisolone oral administration and diclofenac eyedrop instillation, CME improved. At postoperative 24th month, BCVA was 0.8 and CME disappeared. CONCLUSIONS: From our experience of a case of anterior chamber irrigation with distilled water during cataract operation, if balanced salt solution replaces hypotonic solution rapidly as irrigation solution, corneal and other complications are managed properly, long term visual acuity appears good.
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Humans , Male , Middle Aged , Administration, Oral , Angiography , Anterior Chamber , Cataract , Corneal Edema , Diclofenac , Macular Edema , Membranes , Prednisolone , Visual Acuity , WaterABSTRACT
During intraocular surgery including cataract, air bubbles occasionally enter the anterior chamber during irrigation. The influences of these air bubbles on the cornea endothelium, however, have yet to be known. The purpose of this study is to investigate the effects of bubbles on the rabbit corneal endothelium during irrigation and aspiration mode in experimental phacoemulsification. After anesthesia, the anterior chamber was irrigated and aspirated for 1 minute with balanced salt solution. The rabbits were then randomly divided into 4 groups. In group 1, corneal endothelial irrigation and aspiration were performed without air bubbles for 1 minute. In group 2, corneal endothelial irrigation was performed in the presence of air bubbles in the anterior chamber for 1 minute. In group 3, corneal endothelial irrigation and aspiration were performed in the presence of air bubbles in the anterior chamber for 1minute. In group 4, corneal endothelial irrigation was performed with silicone oil at 50 mmHg pressure in the presence of air bubbles in the anterior chamber for 1 minute. In group 1, the cornea endothelial cells showed normal F-actin without cell damage. In group 2, a ring shaped endothelial cell destruction area adjacent to the border was found along the margin of the air bubble. In group 3, similar ring-shaped lesion found in group 2 were observed but with more extensive cell destruction. In group 4, a partial number of cell to cell separation was found without endothelial cell destruction. In conclusion, air bubbles in the anterior chamber during irrigation with balanced salt solution showed destructive changes in rabbit corneal endothelial cell.
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Rabbits , Actins , Anesthesia , Anterior Chamber , Cataract , Cell Separation , Cornea , Endothelial Cells , Endothelium , Endothelium, Corneal , Phacoemulsification , Silicone OilsABSTRACT
OBJECTIVE:To study the method to control the quality stability of balanced salt solution.METHODS:The detecting results of the contents of electrolyte ions in semi-finished product and end product were analysed to find out their changing regulation.RESULTS:After sterilization,the contents of Cl-,Ca2+and HCO-3 in end product decreased by