ABSTRACT
AIMS: To evaluate the safety of topical anaesthesia (TA) versus peribulbar anaesthesia (PBA) in patients undergoing routine cataract surgery on the basis of systemic adverse events. METHODS: In this retrospective study, a total of 2,020 consecutive cases of cataract surgery performed by one surgeon on 1,621 patients with PBA (n = 1,010; between 1998-1999) or TA (n = 1,010; between 1999-2001) were evaluated on the basis of intra-operative and early postoperative adverse events requiring medical intervention. RESULTS: The rate of pre-existing risk factors in patients undergoing cataract surgery is high (97%). Complications are significantly less frequent in TA than in PBA in the intra-operative (p < 0.001) and postoperative (p = 0.022) courses. The incidence of intra-operative complications is higher in elderly patients (>or=65 years of age) than in younger patients (p < 0.001). CONCLUSION: The results from the present study indicate that intra-operative complications are less likely in patients that receive TA, suggesting the use of TA for routine cataract surgery both in young patients and particularly in elderly patients when there are no contraindications in the individual case.
Subject(s)
Anesthesia, Local/adverse effects , Anesthetics, Local/administration & dosage , Cataract Extraction , Administration, Topical , Adult , Age Distribution , Aged , Aged, 80 and over , Female , Humans , Incidence , Injections/adverse effects , Intraoperative Complications/epidemiology , Male , Middle Aged , Orbit , Retrospective StudiesABSTRACT
PURPOSE: To investigate the effects of areal corneal ablations of different depth on the biomechanical properties of the cornea. METHOD: The qualitative change of the holographic interferometric fringe pattern of enucleated bovine corneas due to areal mechanical ablations (group A) of 35% and 70% depth of the central cornea and 15, 30, and 50% excimer laser ablations in each eye (group B) was investigated. RESULTS: Ablations of 50% (group B) and 70% (group A) showed a significant variation of the fringe pattern as an effect of the corneal weakening. 15% excimer laser ablations of 5 mm diameter did not result in noticeable changes of the fringe pattern. Half of the 30% ablated corneas in group B showed newly appearing fringes within the area of ablation, indicating a local reduction of the corneal stiffness after ablation. CONCLUSION: The thickness of the remaining tissue is very important for the biomechanical behavior of the cornea after areal ablations. There are interindividual differences regarding the change of material properties due to excimer laser ablation of 30% depth of ablation.
Subject(s)
Cornea/physiology , Holography/methods , Interferometry/methods , Photorefractive Keratectomy , Animals , Biomechanical Phenomena , Cattle , Cornea/surgery , Lasers, ExcimerABSTRACT
PURPOSE: To compare the results of traditional laser photoablation and wavefront-supported customized ablation (WASCA) in hyperopic photorefractive keratectomy (H-PRK). METHODS: This was a prospective study, comparing two treatment groups, each comprising 40 eyes of 20 patients. Wavefront aberrations were examined using a Shack-Hartmann aberrometer. Preoperative refraction was similar in the two groups; in the traditional H-PRK group (Group 1) it was +3.10 +/- 0.85 D, and in the WASCA-guided group (Group 2) it was +2.90 +/- 0.80 D. H-PRK was performed with the Asclepion-Meditec MEL 70 flying-spot excimer laser. The follow-up time was 6 months. RESULTS: In Group 1, mean postoperative refraction was +0.14 +/- 0.24 D, and in Group 2, -0.10 +/- 0.25 D; mean uncorrected visual acuity was 0.92 +/- 0.16 in Group 1 and 0.95 +/- 0.18 in Group 2. Mean best spectacle-corrected visual acuity was 0.96 +/- 0.04 in Group 1 and 1.06 +/- 0.13 in Group 2. In Group 1, 67.5% (27 of 40 eyes), and in Group 2, 85% (34 of 40 eyes) were within +/-0.50 D of target refraction. Regarding change of spectacle-corrected visual acuity in Group 1, 5% (2 of 40 eyes), and in Group 2, 20% (8 of 40 eyes) gained one Snellen line compared to the preoperative; in Group 1, 10% (4 of 40 eyes), and in Group 2, 12.5% (5 of 40 eyes) lost two Snellen lines. In Group 2, the root mean square value for the higher order aberration increased from the initial 0.134 to 0.257 microm at 6 months after surgery. CONCLUSIONS: WASCA-guided hyperopic-PRK treatment was found to be safe and predictable. The results were better than those achieved with traditional PRK performed using the same flying-spot type excimer laser.
Subject(s)
Cornea/surgery , Hyperopia/surgery , Photorefractive Keratectomy/methods , Adult , Female , Humans , Lasers, Excimer , Male , Middle Aged , Prospective Studies , Refraction, Ocular , Safety , Treatment Outcome , Visual AcuityABSTRACT
A 43-year-old woman in good health was admitted to the hospital 3 days after photorefractive keratectomy (PRK) in the left eye with postoperative bandage contact lens application. She had developed a severe keratitis with ulceration and hypopyon. Upon the patient's admission to the hospital, the contact lens was removed. Ofloxacin eyedrops were prescribed 4 times a day. In the hospital, the patient was successfully treated with immediate thermocautery application, followed by full-thickness keratoplasty the next day and intensive systemic and topical antibiotics. Cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). Severe MRSA keratitis is a rare cause of infection after PRK.
