Surgical application of Ong speculum in simple limbal epithelial transplantation and pterygium surgery

Ong speculum is used in glaucoma surgeries such as trabeculectomy to expose the superior part of the globe. The large inferior blade pushes the inferior conjunctival fornix, due to which the eyeball rotates downwards. It has not been used in other anterior segment surgeries before. We used this speculum in simple limbal epithelial transplantation (SLET) and pterygium surgery to expose superior bulbar conjunctiva for harvesting limbal and conjunctival grafts, respectively. As the superior conjunctiva and sclera become exposed, it facilitates the steps of harvesting limbal biopsy and conjunctival graft in SLET and pterygium surgery. This eliminated the need for a superior rectus suture or an assistant who would keep the globe rotated downwards. Its position could also be maneuvered to adjust the site of exposure when dissecting the area of pannus in SLET. Thus, it makes the superior conjunctiva more accessible.

Effect of Lubricant Use on Cervicovaginal Cytology - What's the Evidence? / Efeito do uso de lubrificante na citologia cervicovaginal - Qual a evidência?

Abstract Objective To determine if the use of lubricating gel on the speculum during the cervicovaginal cytology examination interferes with the results obtained, as well as whether it reduces reported discomfort in patients. Data sources A systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, with a search in the Pubmed/Medline, Scielo, Cochrane Library, Embase databases of articles published between January 2011 and May 2022. The keywords used were cytology, speculum, lubricant, result, and pain. Selection of studies The initial search resulted in 306 articles, of which were excluded three because they were duplicates, 257 after reading the title and abstract and 41 after reading the full text. Thus, five articles were selected for the study: four randomized clinical trials and one metanalysis. Data collection The selection of articles was performed by two investigators. The 5 selected articles were read in full and submitted to a comparative analysis. Data synthesis Screening through cervicovaginal cytology allows for early diagnosis and reduction of associated mortality, but the procedure can be associated with pain. A small amount of aqueous lubricating gel in the speculum can be used to reduce the discomfort associated with performing cervicovaginal cytology. Conclusion The use of lubricating gel in the speculum does not seem to be associated with a change in the cytology result and reduces the discomfort associated with its insertion into the vagina.

Resumo Objetivo Determinar se o uso de gel lubrificante no espéculo durante o exame de citologia cervicovaginal interfere com os resultados obtidos e se diminui o desconforto relatado por pacientes. Fontes de dados Foi realizada uma revisão sistemática segundo as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), com pesquisa nas bases de dados Pubmed/Medline, Scielo, Cochrane Library, Embase, de artigos publicados entre janeiro de 2011 e julho de 2022. Utilizaram-se as palavras-chave citologia, espéculo, lubrificante, resultado e dor. Seleção dos estudos A pesquisa inicial resultou em 306 artigos, dos quais foram excluídos três por se encontrarem duplicados, 257 após a leitura do título e do resumo e 41 após a leitura integral. Assim, foram selecionados cinco artigos para o estudo: quatro ensaios clínicos aleatorizados e uma metanálise. Coleta de dados A seleção dos artigos foi realizada por dois investigadores. Os cinco artigos selecionados foram lidos na íntegra e submetidos a uma análise comparativa. Síntese dos dados O rastreio através da citologia cervicovaginal permite um diagnóstico precoce e redução da mortalidade associada, mas a sua realização pode estar associada a dor. Uma pequena quantidade de gel lubrificante aquoso pode ser utilizada no espéculo para diminuir o desconforto associado à realização da citologia cervicovaginal. Conclusão A utilização de gel lubrificante não está associada a alteração do resultado da citologia e diminui o desconforto associado à sua introdução na vagina.

Can lubrication of the eyelid speculum reduce overall pain perception associated with cataract surgery by phacoemulsification performed under topical anesthesia?

This study aimed to evaluate the effect of using the lubricated eyelid speculum on the overall pain perception by the subject patients who underwent cataract surgery by phacoemulsification technique under topical anesthesia. Methods: A prospective interventional randomized comparative study was conducted at the tertiary eye care center, wherein adult patients scheduled for bilateral cataract surgery with phacoemulsification techniques under topical anesthesia were randomized to undergo surgery with two different modes of eyelid speculum insertion, either with or without lubrication of the eyelid speculum. Fifty percent of the patients underwent surgery with eyelid speculum without lubrication, and 50% with lubrication of the eyelid speculum. The primary outcome was to compare the level of overall pain perception among the subject patients of the two groups by using the Visual Analogue Scale (VAS) in the immediate postoperative period. Results: The study included 130 patients who underwent bilateral cataract surgery (n = 260 eyes) under topical anesthesia, wherein n = 130 eyes underwent surgery using lubricated eyelid speculum and n = 130 eyes underwent surgery with dry eyelid speculum. Pain perception score assessed on the VAS (0–10 cm) ranged from 0.5 to 6, with a mean ± standard deviation of 2.06 ± 1.12. A significant correlation was found with two different methods of eyelid speculum insertion with reduced overall pain perception in patients with the use of lubricated eyelid speculum compared to the dry eyelid speculum (P = 0.0001). Conclusion: The overall pain perception associated with cataract surgery performed by phacoemulsification technique under topical anesthesia can be further minimized by lubricating the eyelid speculum prior to insertion for exposing the globe

Evaluación del cérvix anteparto: importancia práctica en obstetricia / Antepartum cervix evaluation: practical significance in obstetrics

La evaluación anteparto del cérvix constituye un procedimiento necesario en la práctica obstétrica para predecir la respuesta a la preinducción, la inducción y el inicio del trabajo de parto según la madurez cervical. La revisión efectuada persigue proporcionar una herramienta más para valorar la condición del cuello antes del parto mediante la evaluación cruzada de su inspección con espéculo, como una alternativa que puede ser empleada en los servicios de obstetricia. El método, además de útil y no invasivo, permite reducir la variabilidad interobservadores.

Antepartum evaluation of the cervix is a necessary procedure in obstetric practice to predict the response to pre-induction, induction, and onset of labor according to cervix ripening. The review aims to provide one more tool to evaluate the condition of the cervix before the labor by means of cross evaluation of its speculum examination, as an alternative that can be used in obstetrics. The method, besides being useful and noninvasive, reduces interobserver variability.

Factors Associated with the Successful Separation of Corneal Epithelium in Epi-LASIK

PURPOSE: To determine the incidence and perioperative factors of flap-related complications from Epi-LASIK. METHODS: In this study, 122 eyes of 66 patients who had Epi-LASIK using Centurion SES(TM) epikeratome (Norwood Eye Care, Australia) were enrolled. Associations of pre-operative corneal curvature, white-to-white distance, central corneal thickness, refractive error, dry eye, punctate corneal erosion, pannus, and history of wearing contact lenses with flap-related complications were investigated. To decrease flap-related complications, surgeons pressed patients' eyelids with a speculum during epithelial separation, and the effect of this method was verified. RESULTS: Complete epithelial separation was achieved in 74 eyes (60.6%), incomplete separation in 29 eyes (23.8%), and free epithelial sheet in 19 eyes (15.6%). Thin corneas (P=.041), a history of wearing contact lenses (P=.008), and the duration of contact lens use (P=.003) significantly decreased the incidence of successful epithelial separation. Pressing down the eyelids with a speculum while separating the epithelial sheet increased the incidence of complete separation from 50.6% to 83.8% (P=.003). CONCLUSIONS: The risk of flap-related complications from Epi-LASIK may be higher in people who use contact lenses and in people who have thin corneas. The risk can be reduced by pressing the eyelids with a speculum during epithelial separation.

The nasal speculite

OBJECTIVE: To design a cost effective, handy, easy to fabricate, ergonomic nasal speculum with a built-in light source. DESIGN: Instrumentation SETTING: Tertiary Government Hospital MATERIALS AND METHODS: Two 3cc syringes were mounted on each side of a nasal speculum to serve as battery cases for the two 1.5 volts battery. A laryngoscope bulb, connected to a metallic plate, made from the two long arms of a paper fastener, was then suspended from the speculum screw, with the bulb positioned in between the speculum blades. An electric wire connected the batteries and the metallic plate. The upper negative pole wire was connected to a ballpen spring and was glued near the fulcrum. The device illuminates automatically with opening of the speculum blades. RESULTS: Nasal speculite provided comparable visualization of the nasal cavity as that with a nasal speculum with head mirror and light source. The illumination was adequate and there was no more need for light focusing. There were no complaints of discomfort from the subjects. CONCLUSION: The Nasal speculite is a cost effective, handy, easy to fabricate ergonomic instrument that can be used by the ENT specialist at his/her own convenience, obviating the need for head mirrors and light source, in the examination of the nasal cavities. (Author)

Different Cleaning Methods for Gynecological Bivalve Speculum:A Comparison of Results / 中华医院感染学杂志

OBJECTIVE To compare the effects of cleaning the bloodstain and other organic matter left on the bivalve speculum by 5 different cleaning methods.METHODS The following methods were adopted for 400 bivalve speculums with bloodstain left from gynecological operations:manual cleaning method,ultrasonic cleaning method,fully automatic cleaning method,artificial cleaning plus ultrasonic cleaning method,artificial cleaning plus fully automatic cleaning method,and the effects were detected by visual observation method,magnifier detection method and occult blood test method.RESULTS The positive rate of visual observation on 5 groups of bivalve speculums was 5.00%,3.75%,2.50%,0 and 0,respectively,the positive rate of magnifier detection was 7.50%,5.00%,3.75%,1.25% and 1.25%,respectively,and the positive rate of occult blood test was 15.00%,12.50%,8.75%,4% and 2%,respectively.CONCLUSIONS There are significant differences among 5 cleaning methods(P

Key Words: Blepharoptosis, Pterigium excision, Eyelid speculum Correction Cases of Blepharoptosis Following Pterygium Excision

Blepharoptosis following pterigium excision is a rare complication, and there is no published report on its etiology, incidence, and surgical pathology. We report 4 cases of persistant blepharoptosis following pterigium surgery. The main clinical features are high or absent upper lid crease, thinning of ptotic eyelid above tarsal plate, good levator function, 2-3mm of ptosis degree, abnormal drooping of upper eyelid at downward gaze, and deepening of the upper sulcus. They have a specific anatomic defect in the aponeurosis of levator palpebrae superioris(LPS) muscle. It has been assumed that eyelid speculum leads to injury of upper border of tarsal plate and disinsertion of aponeurosis of LPS muscle in the patient who had vulnerable aponeurosis of LPS muscle during surgery. Disinsertion of aponeurosis of LPS muscle from its epitarsal attachment was discovered during blepharotosis surgery and it was repaired anatomically to correct the blepharoptosis.