Single-injection percutaneous peribulbar anesthesia with a short needle versus sub-Tenon's anesthesia for cataract extraction

This study compared the efficacy of single-injection percutaneous peribulbar anesthesia [PBA] with a short needle with sub-Tenon's anesthesia [STA] to produce optimal operating conditions for cataract extraction in patients with complicated cataract. Two hundred patients with complicated cataract were enrolled in this prospective, double-blinded, randomized study. Adequate akinesia was a surgical requisite for all cases included in the study because of the expected difficult surgery. The patients were divided into two equal groups to receive either peribulbar anesthesia [PBA] with a 16-mm needle or sub-Tenon's anesthesia. Surgical akinesia [as a primary end point], analgesia, incidence of complications, as well as patient and surgeon satisfaction [as secondary end points] were assessed. Both techniques provided similar analgesia during the operation and similar rates of incidence of chemosis with no serious complications; while the PBA group provided higher degree of akinesia 10 minutes after injection of the local anesthetic, a lower incidence of subconjunctival hemorrhage [SCH] and higher patient and surgeon satisfaction compared to the STA group. We concluded that when globe akinesia is necessary during surgery, the single-injection technique for percutaneous peribulbar anesthesia with a short needle proved to be more suitable than the STA in providing akinesia for cataract surgery. Also, this PBA technique demonstrated a lower incidence of SCH and was preferred to STA by the patients and surgeon

Reconstruction of large upper eyelid defect with two composite lid margin grafts

To evaluate the results of reconstruction of large defects in the upper lid using two composite contra-lateral eyelid margin grafts. This is an interventional case series in which a large full thickness defect of the upper lid was reconstructed in 7 patients using two composite eyelid margin grafts and myocutaneous advancement. The grafts were taken from both eyelids of the contra lateral eye and the final outcome was evaluated. Cosmetic results were achieved in both donor and recipient eyes satisfying to all patients5 no graft sloughing was seen. Transient edema, punctate epithelial erosions, lid notching, madarosis and ptosis were seen in the early postoperative period. Reconstruction of a large defect in the upper lid with two composite eyelid-margin grafts is an easy, safe, effective technique with minimal complications

Comparative study between two methods of endoscopic endonasal dacryocystorhinostomy [surgical and office-based laser-assisted]

In this work, a comparison was made between the endoscopic endonasal surgical dacryocystorhinostomy [EES-DCR] and the endoscopic endonasal office-based laser-assisted dacryocystorhinostomy [EEOL-DCR]. A number of modifications were applied in the laser-assisted technique to improve its lower success rate reported in the literature. The results concerning EEOL-DCR were satisfactory and comparable to some extent to the EES-DCR results. It was concluded that the EEOL-DCR is a safe, effective and rapid procedure that could be done under local anesthesia as an office-based technique. It was indicated for selected cases as in patients with bleeding disorders and anticoagulated patients as well as in patients in whom general anesthesia is difficult or contraindicated or in revision cases after external DCR