Lower Eyelid Distraction Test: New Insights on the Reference Value.

PURPOSE: The evaluation of palpebral laxity can be performed by the distraction test (DT). Although widely used in ophthalmologic practice, there is no consensus about the results considered normal by the test. The objectives of this study are to obtain the value of DT in a group of individuals with healthy eyelids and to compare with the measurements in subjects with senile ectropion. METHODS: Lower eyelid DT was performed in 200 individuals without any eyelid pathology and in 30 individuals with lower lid ectropion. The results were analyzed by age and sex in the control group and compared with the results of the ectropion group. RESULTS: The mean value of DT in the control group was 6.96 mm, lower than in the ectropion group (9.48 mm) (p < 0.001). In the control group, the mean female DT was 6.70 mm, while the male was 7.22 mm. There were differences in the DT values in the subgroups of 20-39 and 40-59-year old according to gender, with men presenting higher measurements than women. In the other age subgroups, both genders presented similar DT values. Even when considering only individuals in the control group with the same range of age as in the ectropion group, the DT value was higher in individuals with ectropion (7.23 and 9.48 mm, respectively, p < 0.001). CONCLUSIONS: The mean DT value is 6.96 mm; however, the measurement varies according to age and sex in people without palpebral pathology. Individuals with senile eyelid ectropion present higher measurements than healthy ones.In this study, the authors performed the eyelid distraction test in 200 healthy individuals, bringing to the literature the new information that there is a variability of the normal test's value regarding age and gender.

Comparative Study Between Lidocaine Gel 2% and 5% for Ophthalmic Procedures.

PURPOSE: To compare same-day pain control and safety of 2 different anesthetic gels utilizing 5% and 2% lidocaine gel. Main outcome is to determine whether 5% lidocaine gel is more effective in decreasing pain during conjunctival clamping compared to 2% lidocaine gel 5 and 10 min after gel application. METHODS: This is a prospective, randomized double-blind clinical trial. Patients were randomized to receive 2% or 5% lidocaine gel in each eye. Discomfort during the gel instillation and pain during conjunctival clamping 5 and 10 min after gel application were compared. Extent of corneal conjunctival staining was graded according to the Oxford scale. RESULTS: Eighty eyes of 40 patients were enrolled. The groups were similar in gender, with a mean age of 48 ± 16.26 years. The 5% lidocaine gel resulted in higher discomfort during initial instillation (P = 0.092), however, the pain during conjunctival clamping was lower in the 5% lidocaine gel eyes (P = 0.564) in both 5 and 10 min later (P < 0.001). The majority of patients (80%) had no corneal conjunctival dye staining. The tear break-up time was not statistically different after lidocaine gel 2% (20.35 ± 7.37 s) and lidocaine 5% (19.75 ± 7.00 s). CONCLUSION: Five percent and 2% lidocaine gel have similar efficacy controlling pain 5 min after instillation, however, 5% lidocaine gel appears to be more effective with a longer duration of action, without corneal toxicity. There was no corneal toxicity noted with either concentration.

Safety and efficacy of various concentrations of topical lidocaine gel for intravitreal injection.

INTRODUCTION: Intravitreal injection (IVT) is one of the most common vitreoretinal procedures, a large majority are performed with local anesthesia. The purpose of this study was to investigate the safety to the cornea and anesthetic efficacy of five concentrations of lidocaine gel. METHODS: A prospective clinical trial was conducted testing lidocaine gel in five preparations: 2, 3.5, 5, 8 and 12%. Patients with macular degeneration, diabetic edema or retina vein occlusion were scheduled for intravitreal treatment received topical anesthesia with lidocaine gel 5 and 10 min before the procedure. Patients answered the visual analog scale for pain during the procedure. Corneal and conjunctival was evaluated using the Oxford scale. RESULTS: In total, 260 patients were randomized into five groups. The mean pain scores (± standard deviation) were 2.63 (± 1.68) in the 2% group, 2.08 (± 1.35) in the 3.5%; 2.00 (± 1.65) in the 5%, 1.93 (± 1.40) in the 8% and 1.83 (± 1.35) in the 12% group. Mean pain score among all groups was similar (p = 0.077). There was no significant difference between groups in regard to keratitis mean score (p = 0.897). CONCLUSIONS: Lidocaine gel at concentrations from 2 to 12% induced similar anesthetic effect for IVTs, without adverse effects on cornea and conjunctiva.

Ophthalmologic outcome of direct and indirect carotid cavernous fistulas.

Carotid cavernous fistulas (CCFs) can be classified as direct and indirect, depending on their flow rates and their etiology. Both forms can cause the same characteristic ophthalmological symptoms and signs. We analyzed these ocular characteristics and determined the prognostics factors associated with treatment outcome. Forty-seven patients with an angiographically confirmed diagnosis of CCF, a preoperative ophthalmic evaluation and at least one ophthalmic sign or symptom at the initial presentation were retrospectively evaluated. The patients were followed-up ophthalmically until the end of treatment, and the complications and the remaining ophthalmological signs and symptoms were then recorded. The patients' ages ranged from 13 to 89 years, with an average of 55.78 (±20.73) years, and a predominance of 28 female (57.8 %) patients. The patients with a direct CCF had a lower average age (p = 0.02). The most common symptoms were blurred vision in 17 (36.2 %) and proptosis in 37 (78.7 %) patients. Elevated intraocular pressure (IOP) was more prevalent in patients with an indirect CCF (p = 0.02). Thrill was more prevalent in patients with direct CCF (p = 0.01). The presence of an initial decrease of visual acuity at the first ophthalmic evaluation was significantly associated with the persistence of ocular symptoms after fistula treatment (odds ratio 3.33). In conclusion our study shows a slight difference in ophthalmic symptoms among patients with different types of fistula. Elevated IOP was significantly associated with indirect fistulas, whereas thrill was significantly associated with direct fistulas. The presence of an initial decrease of visual acuity was significantly associated with a worse ophthalmic prognosis.

Effect of needle type and injection technique on pain level and vitreal reflux in intravitreal injection.

PURPOSE: To evaluate the amount of reflux and degree of pain with intravitreal injection (IVT) using 6 different types of syringes/needles and 5 techniques of scleral incision, including 3 modifications of a beveled scleral incision. METHODS: This was a study conducted in 205 eyes of 205 patients. IVT of bevacizumab for retinal pharmacotherapy with 6 types of needles and 5 techniques of scleral incision. The severity of subjectively evaluated pain (0-10) and the width of the subconjunctival bleb arising from the vitreal reflux. Secondary outcomes were increase in intraocular pressure and complication rate. RESULTS: The straight technique caused greater vitreal reflux than the beveled approaches, when compared individually or as a group (P < 0.01). No difference in the severity of pain was found among all 5 types of incisions (P > 0.05). There was greater reflux with 26- and 27-gauge needles in comparison to 29- and 30-gauge needles (P < 0.001); however, the width of the needle significantly affected the degree of reflux only when using the nonbeveled incision (P < 0.001). The patients injected with the 26- or 27-gauge needle experienced more pain matched to the 29- and 30-gauge needles (P < 0.001). No difference was found between the incision technique or width of subconjunctival reflux and the increase in intraocular pressure (P > 0.05). Postinjection events included transient mild uveitis, disease-related vitreous hemorrhage, foreign body sensation, conjunctival hemorrhage, and mild punctuate keratitis. CONCLUSIONS: The beveled scleral incision showed benefit in performing IVTs. The 29- and 30-gauge needles caused less pain.

Tunneled scleral incision to prevent vitreal reflux after intravitreal injection.

PURPOSE: To investigate the efficacy of tunneled scleral incision compared with standard straight scleral incision to prevent vitreal reflux after intravitreal (IVT) injection. DESIGN: Prospective comparative controlled nonrandomized clinical study. METHODS: Eighty-eight eyes undergoing IVT-injection were allocated into four groups to compare the vitreal reflux after injection of 0.1 ml of triamcinolone acetonide (TA) and Avastin using a tunneled vs straight injection technique. The amount of intraoperative drug reflux was estimated by measuring the width of the subconjunctival bleb. RESULTS: The mean measured reflux of volume was statistically less with the tunneled scleral incision (1.13 mm standard deviation [SD] +/- 1.16 for TA; 1.13 mm SD +/- 1.39 for Avastin) than in eyes undergoing the straight scleral injection (3.00 mm SD +/- 1.77 for TA; 3.18 mm SD +/- 1.68 for Avastin) for both Avastin and TA IVT-injections groups (P < .001). CONCLUSIONS: The tunneled scleral incision promotes statistically significant less vitreal reflux for IVT drug injection.

Avaliaçäo da freqüencia cardíaca e da pressäo arterial em pacientes adultos após instilaçäo ocular de fenilefrina 10 por cento / Assessment of heart rate and blood pressure after ocular instillation of 10 por cento phenylephrine

Objetivo: Tem-se por objetivo avaliar possíveis alteraçöes cardiovasculares, tais como as da pressäo arterial e freqüência cardíaca, produzidas pela instilaçäo tópica de fenilefrina 10 por cento.Local: Serviço de Oftalmologia do Hospital Regional de Säo José -Homero de Miranda Gomes, Säo José, SC.Métodos: Sessenta pacientes adultos atendidos na emergência oftalmológica do Hospital Regional Säo José com indicaçäo de exame sob midríase foram divididos em dois grupos de 30, aleatoriamente.No primeiro foi instilada 1 gota de fenilefrina 10 por cento em cada olho e no segundo, utilizado como controle, 1 gota de tropicamida (mydryacil) também em ambos os olhos.Todos os pacientes em estudo tiveram sua freqüênia cardíaca e pressäo arterial monitoradas em 5 tempos distintos (pré, 1 minuto após, 5 minutos após e 30 minutos após a instalaçäo da droga) com auxílio de um esfigmomanômetro eletrônico (marca Omron, USA).Resultados: Näo houve diferença entre a idade, sexo e raça nos grupos estudados.a freqüência cardíaca média inicial foi de 79, 65(ñ11, 51) batimentos por minuto, sem diferença entre os grupos, näo sendo observada alteraçäo da freqüencia durante o acompanhamento(P>0.05).A pressäo diastólica média inicial foi de 92, 16(ñ17, 70)mmHg näo existindo diferença entre os grupos, sendo observada uma diminuiçäo significativa desta, nos dois grupos em estudo, a partir do 15º minuto(P<0.05).Conclusäo: Observou-se que a instalaçäo de uma gota de fenilefrina a 10 por cento em cada olho näo produziu alteraçöes na freqüência cardíaca ou pressäo arterial sistêmica em pacientes adultos.