Assessment of non-invasive tear break-up time and tear meniscus height after instillation of three different formulations of anesthetic eye drops by Oculus Keratograph 5M / Avaliação do tempo de ruptura lacrimal não invasivo e da altura do menisco lacrimal após a instilação de três diferentes formulações de colírio anestésico por Oculus Keratograph 5M

Abstract Purpose: To assess the non-invasive tear break-up time (NITBUT) and tear meniscus height (TMH) after instilling the three different types of anesthetic eye drops by Oculus Keratograph 5M. Methods: In this prospective study, 85 healthy subjects (85 eyes) were randomly divided into three groups. The groups were randomly received lidocaine hydrochloride 2%, proparacaine hydrochloride 0.5%, and tetracaine hydrochloride 0.5%. The qualitative and quantitative parameters of tear film were assessed using NITBUT and TMH, respectively. In all groups, the quantity of tear film using TMH was measured in the right eye of subjects, while the quality of tear film using NITBUT was assessed in the left eye. The analysis of variance (ANOVA) was used to compare the difference between before and after the intervention. A P-value < 0.05 was considered significant. Results: Differences for TMH and NITBUT between before and after applying lidocaine hydrochloride 2% were not statistically significant (P > 0.05). The mean values of NITBUT and TMH after the instillation of proparacaine hydrochloride 0.5% showed a significant decrease than before the intervention (P < 0.05). Also, after the use of tetracaine hydrochloride 0.5%, the mean value of NITBUT was significantly increased (P < 0.05), but the mean value of TMH was significantly decreased than before the intervention (P < 0.05). Conclusion: Our study showed that lidocaine hydrochloride 2% as an anesthetic eye drops can be an appropriate choice for eye examinations due to a lack of significant effect on the quantity and quality of tear film.

Resumo Objetivo: Avaliar o tempo de ruptura lacrimal não invasivo (NITBUT) e a altura do menisco lacrimal (TMH) após instilar os três tipos diferentes de colírio anestésico pelo Oculus Keratograph 5M. Métodos: Neste estudo prospectivo, 85 indivíduos saudáveis (85 olhos) foram divididos aleatoriamente em três grupos. Os grupos receberam aleatoriamente cloridrato de lidocaína a 2%, cloridrato de proparacaína a 0.5% e cloridrato de tetracaína a 0.5%. Os parâmetros qualitativos e quantitativos do filme lacrimal foram avaliados utilizando NITBUT e TMH, respectivamente. Em todos os grupos, a quantidade de filme lacrimal utilizando TMH foi medida no olho direito dos sujeitos, enquanto a qualidade do filme lacrimal usando NITBUT foi avaliada no olho esquerdo. A análise de variância (ANOVA) foi utilizada para comparar a diferença entre antes e depois da intervenção. Um valor de P < 0.05 foi considerado significativo. Resultados: Diferenças para TMH e NITBUT entre antes e depois da aplicação de cloridrato de lidocaína a 2% não foram estatisticamente significantes (P > 0.05). Os valores médios de NITBUT e TMH após a instilação de cloridrato de proparacaína a 0.5% mostraram uma diminuição significativa do que antes da intervenção (P < 0.05). Além disso, após o uso de cloridrato de tetracaína a 0.5%, o valor médio de NITBUT foi significativamente aumentado (P < 0.05), mas o valor médio de TMH foi significativamente menor do que antes da intervenção (P < 0.05). Conclusão: Nosso estudo mostrou que o cloridrato de lidocaína a 2% como colírio anestésico pode ser uma escolha apropriada para exames oftalmológicos devido à falta de efeito significativo sobre a quantidade e a qualidade do filme lacrimal.

Comparison of 3 different anesthetic approaches for intravitreal injections: a prospective randomized trial / Comparação de três abordagens anestésicas diferentes para injeções intravítreas: um estudo prospectivo e randomizado

Purpose: To compare the anesthetic effectiveness of topical proparacaine drops, subconjunctival lidocaine, and 2% lidocaine gel. Methods: Ninety-two patients undergoing intravitreal injections were randomized to 1 of 3 groups: proparacaine 0.5% drops (Group Drops), proparacaine 0.5% drops plus subconjunctival lidocaine (Group SC), or 2% lidocaine gel (Group Gel). Patients were asked to score their pain experience using a visual analog scale of 0 to 10 immediately following the injections and 10 min, 1 h, 6 h, and 24 h after the injections. Patients also graded the overall injection experience as Excellent, Very Good, Fair, Poor, or Awful. The physician evaluated the patients’ eye movement during intravitreal injection on 3 levels: (0) none or minimal, (1) not compromising the injection, and (2) compromising the injection. Results: The patients in Group Drops had the worst mean pain scores during the injection and 10 min after, with the highest occurrence of movements compromising the procedure (Grade 2; 38.7%). The patients in Group SC had a higher percentage of good experiences (37.9%) but a higher incidence of chemosis (16.7%). The patients in Group Gel had similar overall pain scores to Group Drops patients but a higher incidence of keratitis (19.4%). There was no statistically significant correlation between the use of aspirin or anticoagulants and the occurrence of hyperemia or hyposphagma. Conclusion: Subconjunctival lidocaine was most effective in preventing pain and eye movements during intravitreal injections. Although 2% lidocaine gel produced a good overall experience for the patients, the incidence of keratitis was very high (19.4%). Therefore, we do not recommend 2% lidocaine gel as the first anesthetic choice for intravitreal injections. There is no evidence to suspend the use of aspirin or other anticoagulants drugs prior to intravitreal injections. .

Objetivo: Comparar a eficácia anestésica entre proparacaína tópica, lidocaína subconjuntival e lidocaína gel a 2%. Métodos: Noventa e dois pacientes em tratamento com injeções intravítreas foram randomizados para um de três grupos: proparacaína 0,5% gotas (Grupo gotas), proparacaína 0,5% gotas seguida de lidocaína subconjuntival (Grupo SC), ou lidocaína gel a 2%. (Grupo Gel). Os pacientes foram orientados a graduar a sua experiência de dor por uma escala visual analógica, numa escala de 0 a 10, imediatamente após as injeções, bem como 10 minutos, 1 hora, 6 horas e 24 horas após. Os pacientes também classificaram a experiência global de injeção como excelente, muito boa, regular, ruim ou horrível. O médico avaliou o movimento do olho do paciente durante a injeção intravítrea em três níveis: nenhuma ou mínima (0), não comprometendo a injeção (1), comprometendo a injeção (2). Resultados: Os pacientes do grupo gotas apresentaram uma graduação média de dor pior durante a injeção e 10 minutos após, com maior ocorrência de movimentos comprometendo a injeção (grau 2) (38,7%). Os pacientes do grupo SC, apresentaram maior percentual de boa experiência durante o procedimento (37,9%) e maior ocorrência de quemose (16,7%). Os pacientes do grupo Gel apresentaram escore de dor geral semelhante ao grupo Gotas e maior incidência de ceratite (19,4%). Não houve correlação estatisticamente significativa com o uso de aspirina ou anticoagulantes e a ocorrência de hiperemia ou hiposfagma. Conclusão: Lidocaína subconjuntival foi mais eficaz na prevenção da dor durante injeção intravítrea com movimentação ocular mínima. Embora os pacientes do grupo lidocaína gel a 2% tenham apresentado uma boa experiência, consideramos a incidência ceratite muito elevada (19,4%) e não recomendamos lidocaína gel a 2% como a primeira escolha como anestésico para injeções intravítreas. Não há evidência para a suspensão do uso de aspirina ou drogas anti-coagulantes em pacientes ...

Anesthetic effectiveness of topical levobupivacaine 0.75% versus topical proparacaine 0.5% for intravitreal injections

Today no method of topical anesthesia for intravitreal injection administration has been proven to make the patient comfortable yet. We compared the efficacy of topical levobupivacaine 0.75% and proparacaine 0.5% in patients undergoing intravitreal injections. A prospective, randomized study comparing two agents for topical anesthesia in intravitreal injections. Ninety-six consecutive patients were enrolled into two groups to receive either topical levobupivacaine 0.75% [n=48] or proparacaine 0.5% [n=48]. Patients were asked to score their pain using a visual analog scale [VAS] immediately following the injection. The average of these scores was used as the primary outcome. The surgeon performing the procedure scored his perception of the patients' pain using the Wong-Baker FACES scale. Mean VAS pain scores for two groups were found to be 44.77 +/- 16.42 and 34.18 +/- 14.83, respectively. Mean VAS pain score in the proparacaine group was significantly lower than that in the levobupivacaine group [P= 0.003]. Mean Wong-Baker FACES scores for the two groups were 1.08 +/- 0.49 and 1.10 +/- 0.30, respectively. There was no statistically significant difference between levobupivacaine and proparacaine groups [P=0.824]. Topical proparacaine 0.5% was more effective in preventing pain during intravitreal injections.

single drop of 0.5% proparacaine hydrochloride for uncomplicated clear corneal phacoemulsification

The purpose of this study was to compare the efficacy of a single drop of 0.5% proparacaine hydrochloride in uncomplicated cataract surgery with phacoemulsification. Two hundred and ninety five patients scheduled for the phacoemulsification were divided into 2 groups based on the anesthetic agents they were to receive: 146 patients who received a single drop of 0.5% proparacaine 2 min before the start of the surgery [proparacaine group] and; 149 patients who received supplementation of 0.5% intracameral preservative free xylocaine [xylocaine group]. A single surgeon performed all surgeries. Intraoperative and post-operative pain scores were evaluated on a visual analog scale. The surgeon noted his subjective impression of corneal clarity, discomfort while performing the surgery any supplemental anesthesia required and intraoperative complications. An anesthetist noted vital parameters and the need for intravenous sedation. Total surgical time was noted. Comparison of parameters was performed with the Chi-square test, and A P value less than 0.05 was considered as statistically significant. No statistically significant difference was seen in the intraoperative [P = 0.24] and post-operative [P = 0.164] pain scores between groups. There was no pain [0 score] in 41.8% of patients in the proparacaine group and 46.3% of patients in the xylocaine group. The average surgical time [P = 0.279] and surgeon discomfort [P = 0.07] were not statistically significantly different between groups. No patients required supplemental anesthesia. There were no surgical complications that could compromise the visual outcome. An equal number of patients in both groups preferred same type of anesthetic technique for the fellow eye cataract surgery [89.11% for the proparacaine group and 90.18% for the xylocaine group]. No patients in either group had changes in vital parameters or required intravenous sedation. A single drop pre-operatively, of proparacaine hydrochloride was comparable to the intracameral supplementation of preservative free xylocaine for phacoemulsification in uncomplicated cataract surgery without compromising the visual outcome. However, we recommend individualizing the anesthetic technique according to the requirements of the surgeon

No-patch 23-gauge vitrectomy under topical anesthesia: A pilot study.

A pilot study was designed to evaluate the safety and efficacy of 23-gauge vitrectomy under topical anesthesia. Five eyes of five patients underwent 23-gauge sutureless vitrectomy under topical anesthesia with a pledget soaked in 0.5% proparacaine hydrochloride anesthetic, for vitreous hemorrhage (four eyes), epiretinal membrane (one eye). Subjective pain and discomfort were graded using a visual analogue chart from 0 (no pain or discomfort) to 4 (severe pain and discomfort). At the end of surgery no patch was applied and patients were given dark glasses. Patients underwent an immediate postoperative assessment, followed by next day and one week postoperative evaluation. Four patients had Grade 0 pain during the surgery. One patient had Grade 1 pain during the placement and withdrawal of the micro cannulas. The surgical outcomes were favorable. 23-gauge vitrectomy under topical anesthesia is safe and effective in selected cases. Further study is recommended to validate the outcome of this study.

Two Cases of Conjunctival Mucosa-associated Lymphoid Tissue (MALT) Lymphomas Treated by Cryotherapy

PURPOSE: To report two cases of conjunctival mucosa-associated lymphoid tissue (MALT) lymphomas treated with cryotherapy. CASE SUMMARY: Two patients with MALT lymphoma of the conjunctiva were treated by carbon dioxide cryotherapy under topical anesthesia using 0.5% proparacaine hydrochloride (Alcaine(R), Alcon). Cryotherapy was repeated in recurrent lesions up to three times. One patient was free of the tumor for 18 months of follow-up after the third cryotherapy was performed. The second patient had complete disease arrest for 9 months after the third cryotherapy. Neither patient experienced complications during the follow-up period. CONCLUSIONS: Cryotherapy is a comparatively easy treatment tool with fewer complications for patients, making it preferable from a patient's perspective as well. Cryotherapy may be a useful treatment modality in patients with MALT lymphomas localized to the conjunctiva.

Utilidad de la anestesia tópica en cirugía de estrabismo paralítico / Utility of topical anesthesia in paralytic strabismus surgery

Objetivo: demostrar el uso de anestesia tópica en cirugía de estrabismo paralítico. Método: Es un estudio retrospectivo, comparativo con dos grupos de pacientes mayores de 12 años de edad con estrabismos de diferentes etiologías. Grupo A: pacientes con estrabismo para corregirse bajo anestesia tópica. Grupo B: pacientes con estrabismo para corregirse bajo anestesia general. Para el uso de anestesia tópica se empleó proparacaína en gotas y midazolam intravenoso. Resultados: en grupo A se incluyeron 31 pacientes con una edad 34.1 DE (desviación estándar) 11.3 años con rangos de 18 a 56 años. Desviación 28.4 DE 15.5 dioptrías prismáticas. La cirugía más realizada fue la corrección de estrabismos verticales, y la técnica más comúnmente usada fue cirugía de dos músculos prefiriendo para el reforzamiento el plegamiento muscular. El promedio de seguimiento fue de 9.06 DE 6.3 meses. Se obtuvieron buenos resultados en 25 pacientes, 3 regular, 3 malo. El diagnóstico de estrabismo paralítico se concluyó en 17 pacientes, 8 de III nervio; 5 de IV nervio, 4 de VI nervio. Las causas del estrabismo fueron: tumoral: 6, trauma craneal: 3, aneurisma cerebral: 1, ambliopía sensorial 1, uno por cirugía de región, uno por cirugía de estrabismo bajo técnica ajustable tardía con gran reforzamiento de recto medial, trauma ocular 3 con un músculo perdido recto inferior, y un músculo perdido recto medial, endotropia congénita 7. En el grupo B se ingresaron a estudio 30 pacientes. Edad: 31.9 D.E 15.1 años, con rangos de 12 a 64 años. La desviación fue de 37.83 DE 21.8 dioptrías prismáticas, el estrabismo más operado fue la exotropia antigua especialmente consecutiva a corrección de estrabismo infantil. Se operaron mayor cantidad de músculos. El seguimiento fue de 6.03 DE 7 meses.

Objective: to demostrate the efficacy of topical anesthesia in paralitic strabismus. Method: This is a retrospective and comparative study in patients older than 12 years old, with strabismus of different etiologies. Group A: strabismus corrected under topical anesthesia. Group B: strabismus corrected under general anesthesia. For topical anesthesia we used proparacain and mydazolam. Results: group A: 31 patients, age 34.1 +/- 11.3 years old , 18-56 range. Strabismus deviation: 28.4 +/- 15.5 diopters. Vertical strabismus was the most common surgery. Two muscles technique was the most frequently used, but using tacking preferable. Follow up: 9.06 +/- 6.3 month. We obtainer good results in 20 patients, regular 3, and bad 3. Paralysis was diagnosed in 17 patients, III nerve: 8, IV nerve: 4 causes: 6 tumor, 3 cerebral trauma, 1 cerebral aneurism, 1 sensorial amblyopic, 1 posterior to pterigion surgery. 1 secondary to adjustable surgery for strabismus, 3 ocular trauma with lost muscle, 7 congenital esotropia. We didn't have complications and conversion to general was no necessary. Gruop B: 30 patients average age: 31.9 +/- 15.1 years old. Strabismus: 37.83 +/- 21.8 diopters. The most operated strabismus were old exotropias especially after infantile esotropias. We made more muscles for same quantity of deviation. Follow up: 6.03 +/- 7 months. Results for surgery: good 26, regular 3, bad 1. Conclusions: we could see the preferences for using topical anesthesia in paralysis. Results were good and we could evaluate muscles action under surgery. We could evaluate the effect of recessions in inferior oblique for paralytic strabismus, and effect of tucking in superior oblique avoiding Brown iatrogenic syndrome.

Influencia de la anestesia tópica en los valores tonométricos de la presión intraocular / Influence of the topic anaesthesic in tonometric values of the intraocular pressure

Objetivos: 1. Comparar valores tonométricos (PIO) promedio antes y después del uso de proparacaína y oxibuprocaína, respectivamente. 2. Demostrar y establecer variación estadísticamente significativa en las tomas con y sin anestésico y comparar un anestésico con el otro. Métodos: Diseños observacional prospectivo. Población y muestra: De un total de 400 ojos (n = 400), 210 hombres, 190 mujeres, 248 jóvenes, 152 viejos, todos de raza blanca. Se hicieron dos grupos de pacientes distintos, un grupo por cada droga: propacaína 200 (PIO) ojos, oxibuprocaína 200 ojos. En cada grupo se sacó un promedio de PIO de 3 medidas antes, y 5 minutos después de la instilación del anestésico local. Mediciones hechas por un solo examinador y un solo tonómetro de aire (CT 8 Computerized Tonometer; Topcon). Resultados: Diferencia estadísticamente significativa entre valores promedio de PIO antes y después de la instalación de los anestésicos tópicos. Comparación entre medidas antes y después con promedio de más de 1 mmhg, alcanzando valores de hasta 7 mmhg en algunos casos. Para proparacaína la evaluación global del grupo (n = 200), mediciones promedio de PIO antes y después 16,62 mmhg (ds = 3,63) y 15,41 mmhg (ds = 3,65), respectivamente (95 por ciento IC = 0,99 a 1,41). Diferencia de 121 mmhg, t = 11,16, prueba de test de student g. L 199 p = 0,0000, muy significativo. Para oxibuprocaína la evaluación global del grupo (n = 200), mediciones promedio antes y después de 16,70 mmhg (ds = 3,69) y 15,68 mmhg (ds = 3,58) respectivamente (95 por ciento IC = 0,80 a 1,23), t Student, t = 9,40, g 1,199; p < 0,001. Diferencia 1,01 mmhg fue significativa. Conclusiones: Promedio de disminución de la PIO fue moderado (más de 1 mmhg). Diferencia en toma de presiones antes y después de las gotas fue significativa estadísticamente. Efecto de disminución de la PIO dado por los anestésicos tópicos puede conducir a subestimación de la PIO real medida con tonómetro de aplanación, resultando los valores reales de la presión ocular considerablemente superiores.

Uso da anestesia tópica na cirurgia de anomalias oculomotoras / Use of topical anaesthesia in the surgery of oculomotor abnormalities

Dezesseis indivíduos adultos portadores de estrabismo de causas diversas foram operados, usando-se a anestesia tópica. A forma de aplicaçäo foi a instilaçäo de colírio de proximetacaína ou proparacaína a 0,5%. Näo ocorreram intercorrências graves e as cirurgias foram realizadas sem grandes dificulades