[Single center analysis of the dermatosurgical patient cohort of a tumor center in Germany]. / Betrachtung des dermatochirurgischen Patientenkollektivs an einem Hauttumorzentrum in Deutschland.

BACKGROUND: The incidence of skin cancer continues to increase. However, little is known about the dermatosurgical characteristics of the patients. PATIENTS AND METHODS: In this single center, retrospective study, dermatosurgical reports of all patients treated because of basal cell carcinomas (BCC), squamous cell carcinomas (SCC), and malignant melanoma (MM) between 2004 and 2013 were analyzed. RESULTS: During the observed period, the number of operated BCC rose by a factor of 1.86 and the number of MM by a factor of 2.3. In comparison to BCC/MM, there was a disproportionately high increase of SCC by a factor of 4.02. The average age was 71.5 ± 13.4 years (minimum: 14 years; maximum: 104 years), whereupon a significant increase of male age and a significant decrease of female age occurred. Almost 70% of all tumors were located in the head and neck area. The nose was most commonly treated. CONCLUSIONS: During the last 10 years, the cohort of dermatosurgical patients changed in the tumor center. This should be verified in multicenter studies.

Efficacy of lidocaine 2% jelly as a topical agent in cataract surgery.

PURPOSE: To determine whether lidocaine 2% jelly is an effective topical anesthetic agent for cataract surgery. SETTING: Private practice and surgicenter. METHODS: One hundred eighty cataract surgery patients were randomly assigned to 1 of 4 groups of 45 patients each: Group 1-topical eyedrop anesthesia; Group 2-intracameral lidocaine; Group 3-lidocaine 2% jelly applied once, on arrival at the surgicenter; and Group 4-lidocaine 2% jelly applied on arrival and about 5 minutes prior to surgery. Each patient was asked about pain or pressure sensation during the operation and afterward. RESULTS: Single instillation of lidocaine 2% jelly was associated with pain scores comparable to those with topical eyedrop anesthesia. When the jelly was readministered shortly before surgery, the pain scores were comparable to those with intracameral anesthesia. CONCLUSION: Lidocaine 2% jelly was an effective agent in cataract surgery.

Preoperative and postoperative medications of anesthesia.

Three interesting developments in perisurgical medication were evaluated during the past year. After years of discussion concerning the prophylactic use of anti-inflammatory agents prior to cataract surgery, a report was published describing the results of a prospective study on this subject. There were many papers on anesthesia, some evaluating comfort, some comparing different methods of anesthesia, and others discussing ways to minimize the necessity of anesthesia. There were also several reports studying the postoperative effects of several anti-inflammatory agents.

Anterior chamber irrigation with unpreserved lidocaine 1% for anesthesia during cataract surgery.

PURPOSE: To assess the effectiveness of using anterior chamber irrigation of unpreserved lidocaine 1% as anesthesia during cataract surgery. SETTING: Private group ophthalmology practice. METHODS: This study prospectively evaluated 1000 of 1012 consecutive eyes having temporal corneal incision cataract surgery to determine whether anterior chamber lidocaine provides adequate anesthesia for cataract surgery. Twelve eyes were excluded because the patients had preoperative sedation. Surgery on the remaining 1000 eyes was performed by one surgeon without patients receiving preoperative or intraoperative sedation or other medications other than the local anesthetic and dilating agents. Each received one drop of topical proparacaine before entering the operating room. After an initial corneal stab incision was made, 0.25 to 0.50 cc of unpreserved lidocaine 1% was irrigated into the anterior chamber. RESULTS: One patient was so uncomfortable from the microscope that he required supplemental retrobulbar anesthesia. A second patient was extremely uncomfortable during the case but did not require supplemental anesthesia. Two patients received additional dosages of anesthetic because of discomfort late in the operation. The remaining 996 patients were comfortable and pain-free during the operation with a single dose of the anesthetic. CONCLUSION: Anterior chamber irrigation with unpreserved lidocaine 1% was an effective method for anesthetizing an eye for temporal corneal incision cataract surgery.

Evolving trends in cataract surgery techniques and timing.

Evolution in cataract surgery developed along two fronts: technique and timing. New cannulae with very wide aspiration ports permit nucleosuction; a manual small incision method that fractionates and aspirates the nucleus. Phacoemulsification is made easier and safer with phaco sweep. Posterior capsule polishing is gentle if the only vacuum is generated by the infusion passing through the system and the aspiration tubing is not used. Fibrin glue may make long corneal incisions as stable as short ones. Several studies challenge our conventional thoughts simultaneous bilateral cataract surgery and whether patients need to be examined on the first postoperative day.

The evolving technique of cataract surgery.

Advances in cataract surgery revolved around using existing technology in more efficient manners. Recent reports described methods that purport to offer simpler techniques for phacoemulsification, capsulotomy, nucleus expression, and even for reducing postoperative inflammation.

New techniques for cataract surgery.

Several new techniques have been described to facilitate nucleus removal all of which share a common theme. Each technique seeks to avoid excessive tissue manipulation; avoid stress on the zonules, thereby minimizing the potential for related complications, such as vitreous loss; and simplify the operation to further reduce surgical morbidity. Nucleus expression is facilitated by the gliding nucleus, using anterior chamber hydrostatic pressure to push the nucleus out. Phacoemulsification is made simpler with "V-style" sculpting, and with the split and lift, crack and flip, and stop and chop techniques.

Stop and chop phacoemulsification.

We present a method for phacoemulsification within the capsular bag in which sculpting is performed to provide space for nuclear manipulation and then the posterior plate is cracked into two halves. The nuclear rim is chopped into bite-size pieces for removal using a modified lens hook that is buried in the nuclear periphery and pulled toward the center. The procedure begins as a routine nuclear cracking technique and then stops. It continues as a chop technique.

Techniques and instruments for cataract surgery.

New techniques for cataract surgery have evolved around access to the cataract, a renewed interest in nuclear expression extracapsular techniques, and a near-completion of the developmental cycle of phacoemulsification back to the original "divide and conquer" strategies. Options to improve access to the cataract include surgical pupil revision, self-retaining iris retractors, and surgical techniques for operating through a small pupil. Nucleus expression through a capsulorhexis is facilitated by global hydrodissection and hydrostatic tilting of the nucleus before removal. New phacoemulsification strategies revolve around the Phaco-Chop method that emphasizes nuclear rim fracturing.

Visual acuity recovery rates following cataract surgery and implantation of soft intraocular lenses.

To determine whether eyes receiving soft optic lens implants had faster visual recovery times than eyes receiving firm optic lens implants, we calculated the visual acuity recovery rates following our standard cataract operation. Visual acuity of 20/50 or better without correction was obtained in 31% of eyes on the first day following surgery, 55% at one week, 74% at three weeks, and 89% at six weeks and three months. Fifty best-case soft optic lens implant cases were reviewed and their visual recovery rates were calculated. There were no statistically significant differences in the visual acuities without correction at any follow-up point. There was a slightly significant difference at one week with correction and a significant difference at three weeks with correction favoring the soft lens/small incision group. Because optical correction is generally not provided on these visits, we conclude that soft lens implants with small incisions did not provide clinically significant improvement in visual acuity recovery over our standard cataract procedure.

Structural analysis of cataract incision construction.

This report examines the structural components of incision construction for cataract surgery so the causes of corneal instability and astigmatism can be understood. Changing the shape of the external incision, from limbus-parallel to linear to curved away from the limbus, results in a more stable external incision. The internal entry incision is more directly associated with corneal instability, however, and its construction and closure are crucial. Corneal stability improves as the closure changes from radial to horizontal to corneal valve autoclosure. Hyphema rates also improve with this progression because blood is directed into the anterior chamber with posterior incision closure, but out of the eye with anterior corneal valve closure.

Ultrastructure of human lenticles in keratophakia.

Three patients experienced technical failures from their keratophakia procedures and their lenticles were removed at intervals of three days, 2 1/2 months, and nine months, respectively, postoperatively. All three lenticles displayed, by both light and electron microscopy, degeneration of their keratocytes without any evidence of repopulation by the host's keratocytes. Small increases in amorphous material were noted between the collagen fibrils, but the stromal lamellae were otherwise well preserved and oriented. There was not clear evidence of new collagen production at the edges of the lenticles. One failure was caused by the mistaken inclusion of Descemet's membrane in the lenticle. Another specimen with epithelial ingrowth also displayed degeneration of the collagen fibrils along one edge; this degeneration was possibly the result of collagenase activity.

An aid for the diagnosis of a vertical muscle paresis.

I have described a simple method involving a diagram and circles for dealing with the results of the three-step examination of the vertical muscles used in diagnosing a single paretic muscle. It may prove beneficial for those who evaluate these muscles infrequently as using the diagram allows immediate appreciation of the functional anatomy of the muscles, the physiologic implications of each step of the examination, and a permanent record of the selection through elimination of the paretic muscle.