Transcutaneous anaesthetic nano-enabled hydrogels for eyelid surgery.

Local anaesthetics are administered as a diffuse superficial slow injection in blepharoplasty. Current transcutaneous local anaesthetic formulations are not licensed for use on the face due to safety concerns. Here we report for the first time the permeation of local anaesthetics (lidocaine, bupivacaine loaded SNEDDS and their hydrogels) across human eyelid and mouse skin as a novel and ocular safe formulation for eyelid surgery. SNEDDS were loaded with high levels of anaesthetics and incorporated within carbomer hydrogels to yield nano-enabled gels. Lidocaine hydrogels have a significantly reduced lag time compared to EMLA, while they enhance lidocaine flux across human eyelid skin by 5.2 fold. Ex vivo tape stripping experiments indicated localisation of anaesthetics within the stratum corneum and dermis. Initial histopathological studies have shown no apparent signs of skin irritation. These results highlight the potential clinical capability of nano-enabled anaesthetic hydrogels as a non-invasive anaesthetic procedure for eyelid surgery.

Engineering hydrogel nanoparticles to enhance transdermal local anaesthetic delivery in human eyelid skin.

Herein, we focused on developing the feasibility of nano-enabled local anaesthetic (LA) delivery to anaesthetise the full thickness of eyelid skin. For this purpose a temperature-responsive hydrogel poly(N-vinylcaprolactam-co-hyaluronic acid) (p(VCL-co-HA)) was prepared through aqueous emulsion polymerization with a Food and Drug Administration (FDA) approved p(VCL) and hyaluronic acid (HA) showing remarkably high LA drug loading capacity.

Report on the incidence of squamous cell carcinomas affecting the eyelids in England over a 15-year period (2000-2014).

AIMS: The authors report on trends in the incidence of squamous cell carcinoma (SCC) affecting the eyelids in England over a 15-year period and identify associations between demographic factors and SCC risk. METHODS: The National Cancer Registration and Analysis Service identified all cases of eyelid SCC in England between 2000 and 2014. The crude and age-standardised rates of eyelid SCCs in England were calculated. The association of SCC with several known demographic risk factors was then examined to assess their importance in periocular cases. RESULTS: Over the 15 years studied, there were 4022 patients in England diagnosed with a first episode of SCC affecting the eyelids. The age-standardised number of reported cases rose between 2000 and 2014 by a mean of 0.0137 cases per 100 000 population per year (equivalent to a rise in SCC incidence of approximately 2% per year). The mean age-standardised incidence rate of SCC during the study period was 0.63 cases per 100 000 population per year.Age was exponentially correlated with incidence, with an approximate doubling of the risk for every decade over the age of 60. The relative risk of eyelid SCC in men compared with women was 1.9. Social deprivation quintile by income was not found to be associated with risk of SCC. CONCLUSION: The incidence of eyelid SCC in England is rising. In addition, the age-standardised and population-standardised rate of SCC is also rising. A higher risk of SCC is strongly correlated with age and male sex but not with deprivation.

Scaling the punctum and canaliculus in patients undergoing punctoplasty surgery: A prospective cohort study.

Optical Coherence Tomography (OCT) is a safe and non-invasive method of high-resolution cross-sectional imaging of tissue microstructures using infrared radiation. This study investigates how the appearance of the punctum and proximal canaliculus differs pre- and post-operatively in patients undergoing punctoplasty surgery. Patients with symptomatic punctal stenosis warranting punctoplasty surgery were prospectively invited to enrol from a single centre. Spectral OCT images of the lower punctae were captured with a Topcon 3D OCT 2000 machine pre- and post-operatively (at their follow-up appointment). Measurements were made of the maximal punctal diameter, canalicular diameter and canalicular depth. Pre- and post-operative measurements were compared using a paired t-test. Twenty-three punctae of 18 patients with punctal stenosis were included in the study. They were 10 males and 8 females with a median age 71.0 (SD 12.1). Mean canalicular cross-sectional area was 56.9 × 10-3 mm2 pre-operatively and 267.2 × 10-3 mm2 post-operatively, showing a statistically significant increase (p = 0.0004). There was an increase in both mean canalicular width (0.253 to 0.524mm (p = 0.0001)) and depth (0.433 to 0.852mm (p = 0.0001)) from pre- to post-operatively. There was a significant improvement in symptoms from pre- to post-operatively, as measured subjectively by the Lac-Q questionnaire (p = 0.021). This study describes the change in the appearance of the punctum and proximal canaliculus in patients undergoing punctoplasty operations, by using spectral OCT to capture in vivo high-resolution images. It demonstrates that punctal OCT can be successfully applied to quantify the morphological changes of the punctum and canaliculus pre- and post-punctoplasty.

Non-arteritic Anterior Ischaemic Optic Neuropathy after Uneventful Cataract Extraction.

We present the case of a 74-year-old Caucasian female who suffered sudden visual loss after routine phacoemulsification cataract surgery. The patient was subsequently diagnosed with non-arteritic anterior ischaemic optic neuropathy. The case is described in detail, and a concise review of the literature is presented together with the authors' view on the subject outlined. This is a very rare complication after cataract surgery even in high-risk patients with associated systemic co-morbidities. We suspect that the previous history of obesity, coronary artery disease, and arteriosclerosis contributed to the development of this serious ocular complication. We suggest appropriate measures to reduce the risk of its occurrence.

Man versus Machine: Software Training for Surgeons-An Objective Evaluation of Human and Computer-Based Training Tools for Cataract Surgical Performance.

This study aimed to address two queries: firstly, the relationship between two cataract surgical feedback tools for training, one human and one software based, and, secondly, evaluating microscope control during phacoemulsification using the software. Videos of surgeons with varying experience were enrolled and independently scored with the validated PhacoTrack motion capture software and the Objective Structured Assessment of Cataract Surgical Skill (OSACCS) human scoring tool. Microscope centration and path length travelled were also evaluated with the PhacoTrack software. Twenty-two videos correlated PhacoTrack motion capture with OSACCS. The PhacoTrack path length, number of movements, and total procedure time were found to have high levels of Spearman's rank correlation of -0.6792619 (p = 0.001), -0.6652021 (p = 0.002), and -0.771529 (p = 0001), respectively, with OSACCS. Sixty-two videos evaluated microscope camera control. Novice surgeons had their camera off the pupil centre at a far greater mean distance (SD) of 6.9 (3.3) mm, compared with experts of 3.6 (1.6) mm (p ≪ 0.05). The expert surgeons maintained good microscope camera control and limited total pupil path length travelled 2512 (1031) mm compared with novices of 4049 (2709) mm (p ≪ 0.05). Good agreement between human and machine quantified measurements of surgical skill exists. Our results demonstrate that surrogate markers for camera control are predictors of surgical skills.

Developing transcutaneous nanoenabled anaesthetics for eyelid surgery.

PURPOSE: Local anaesthesia in eyelid surgery carries inherent risks, which has spurned ongoing investigation to identify needleless alternatives. Nanomedicines (particles ranging between 10 nm and 1000 nm in size) have shown promise in the transcutaneous delivery of certain drugs. In this study, we explore the feasibility of nanoenabled lidocaine delivery across an artificial skin analogue. MATERIALS AND METHODS: Three different lidocaine-loaded nanocarriers were characterised. Diffusion studies were performed through cellulose membranes using customised Franz cells. The nanocarriers included polymeric micelles (PMs) (Soluplus), solid lipid nanoparticles (SLNs) (Tripalmitin: Lecithin: Labrasol: polysorbate-20: water; 3.33:1:40:1:4.67 w/w) and self-nanoemulsifying drug delivery systems (SNEDDS) (Capryol-90: Transcutol: Labrasol; 1:3:6 w/w). Particles were characterised in terms of size, zeta-potential and morphology. One-way analysis of variance (ANOVA) with post hoc Tukey's tests were used to assess differences in permeation at a significance of p<0.05. RESULTS: Lidocaine loading was highest in SNEDDs (50±2.1 mg/g) compared with PMs (13.4±0.6 mg/mL) and SLNs (2.8±0.5 mg/mL). All particles possessed a size below 150 nm, illustrated good colloidal stability with a negative zeta-potential and a spherical morphology as demonstrated by transmission electron microscopy images. Cumulative lidocaine concentration after 6 h was significant for both PMs (345.7±23.8 µg/cm(2)/h) and SNEDDS (224.8±118.2 µg/cm(2)/h) compared with SLNs (127.3±25.4 µg/cm(2)/h). However, SLNs provided controlled release of lidocaine with a linear gradient that continued to increase up to 6 h. DISCUSSION: These results highlight the potential capability of nanoparticle lidocaine delivery in eyelid surgery. The achieved flux for all nanomedicines was higher than that reported for currently approved topical lidocaine formulations (including EMLA cream).

Neuropathic Pain in Multiple Sclerosis Improved With Oral Famciclovir: A Case Report.

Multiple sclerosis can be a debilitating disease that is often associated with neuropathic pain and discomfort in the trigeminal region. This can pose a therapeutic challenge as the benefits of the treatment options have to be outweighed against significant side effects. The authors present the case of a 67-year-old man, whose control of trigeminal neuralgia with botulinum toxin A injections was lost after an episode of herpes labialis and herpes zoster infection. The pain management of the patient during the episodes of herpes simplex and varicella zoster infections was greatly improved with famciclovir treatment, and subsequently control of trigeminal neuralgia was regained with botulinum toxin A injections. This case serves to highlight the potential association of multiple sclerosis with herpetic infections as well as the treatment challenges, especially management of pain, which they can possess.