ABSTRACT
PURPOSE: To evaluate the effect of local lidocaine application on the incidence of the oculocardiac reflex (OCR) during scleral buckling (SB) for rhegmatogenous retinal detachment (RRD) under general anesthesia. METHODS: In a randomized clinical trial, eyes with RRD scheduled for SB under general anesthesia were randomized to adjunctive local application of 1 ml lidocaine 2% versus normal saline to the muscles after conjunctival opening. Surgical stimulation was initiated 5 minutes afterwards. Additionally, 100 mg of lidocaine 2% was added to 50 ml of normal saline in the treatment group which was used for irrigation during surgery; control eyes were irrigated with normal saline. The incidence of the OCR, rate of postoperative nausea/vomiting (PONV), total intravenous (IV) analgesic dose, duration of surgery, and period of hospitalization were compared between the study groups. RESULTS: Thirty eyes of 30 patients including 22 (73.3%) male and 8 (26.7%) subjects with mean age of 49.4±16.3 years were operated. OCR and PONV occurred less frequently, and total intravenous analgesic dose was significantly lower in the lidocaine group (P < 0.05 for all comparisons). However, no significant difference was noted between the study groups in terms of duration of surgery and period of hospitalization. CONCLUSION: Adjunctive local application of lidocaine during SB under GA for RRD decreases the rate of OCR and PONV, reduces the intravenous analgesic dose, but does not affect the duration of surgery or hospitalization.
ABSTRACT
PURPOSE: To compare two phakic intraocular lenses, Artiflex and STAAR(®) implantable contact lens (ICL), in high myopia. SETTING: Isfahan Ophthalmology Clinic, Iran. MATERIALS AND METHODS: In a randomized, prospective clinical trial study, 40 eyes of 20 patients who came to Isfahan ophthalmology clinic to correct their refractive error were examined. Artiflex was inserted in 20 eyes and ICL in the other 20 eyes. After 1 year, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), contrast sensitivity, intraocular pressure (IOP), and specular microscopy of corneal endothelium were assessed in both the groups. RESULTS: In this study, there was no statistical difference between UCVA, BCVA, IOP, cataract incidence, contrast sensitivity, and specular microscopy, 1 year after surgery. 40% of eyes in the Artiflex group developed anterior chamber cell and flare reaction 1 year postoperatively, but no patient in the ICL group developed the same. So, there is obvious difference in the rate of anterior chamber cell and flare reaction between these two groups. CONCLUSION: These two lenses have similar outcomes except in the incidence rate of anterior chamber cell and flare reaction that is greater in the Artiflex group. So, these two lenses are safe with predictable outcome in treating high myopia.
ABSTRACT
PURPOSE: To compare the outcomes and complications of alcohol-assisted versus mechanical corneal epithelial debridement for photorefractive keratectomy (PRK). METHODS: This randomized controlled trial included 1,250 eyes of 625 patients undergoing PRK for correction of myopia and myopic astigmatism. Each patient was randomly assigned to alcohol-assisted or mechanical epithelial removal. RESULTS: A total of 658 eyes underwent alcohol-assisted epithelial removal while the epithelium was removed mechanically in 592 eyes. Mean spherical equivalent was -4.37±2.3 D in the alcohol group and -3.8±1.3 D in the mechanical group (P = 0.78). There was no significant difference in postoperative pain between the study groups (P = 0.22). Uncorrected visual acuity ≥ 20/20 and ≥ 20/40 was achieved in 90.9% versus 93.4% (P = 0.08), and 98.9% versus 99.5% (P = 0.36) of eyes in the alcohol and mechanical groups, respectively. Final refractive error within 1D of emmetropia was achieved in 90% versus 92.2% of eyes in the alcohol and mechanical groups, respectively (P = 0.23). Alcohol-assisted debridement required less time than mechanical debridement (96±18 vs. 118±26 seconds, P=0.035). There was no significant difference between the two groups in terms of early and late postoperative complications. CONCLUSION: Alcohol-assisted and mechanical epithelium removal are comparable in terms of efficacy and side effects. The method of epithelial debridement in PRK may be left to the surgeon's choice.
