ABSTRACT
A 33-year-old man presented with an ulcerated nodule on his left eyelid and eyebrow that was unresponsive to broad-spectrum antibiotics. Incisional biopsies were performed, and cultures were positive for Coccidioides immitis. An extensive work-up revealed no systemic involve ment of disseminated coccidioidomycosis. The patient was treated with oral itraconazole for 6 months with resolution of the lesion. Few cases of primary cutaneous coccidioidomycosis have been reported. The authors describe a primary cutaneous coccidioidomycosis lesion of the eyelid without disseminated disease.
Subject(s)
Coccidioides/isolation & purification , Coccidioidomycosis/microbiology , Dermatomycoses/microbiology , Eye Infections, Fungal/microbiology , Eyelid Diseases/microbiology , Administration, Oral , Adult , Antifungal Agents/therapeutic use , Coccidioidomycosis/diagnosis , Coccidioidomycosis/drug therapy , Dermatomycoses/diagnosis , Dermatomycoses/drug therapy , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Eyelid Diseases/diagnosis , Eyelid Diseases/drug therapy , Humans , Itraconazole/therapeutic use , MaleABSTRACT
PURPOSE: To compare the intraoperative pain, anxiety, undesired movement, and cooperation between patients receiving oral diazepam or intravenous (IV) midazolam for conscious sedation during cataract surgery under topical anesthesia. SETTING: Ambulatory surgical center, Honolulu, Hawaii, USA. DESIGN: Prospective randomized controlled trial. METHODS: Patients having first-time cataract extraction with topical anesthesia were randomized to receive sedation with oral diazepam 30 minutes before surgery or IV midazolam immediately preceding surgery. The outcomes of intraoperative pain, anxiety, undesired movement, and poor cooperation were observed by the surgeon and recorded during surgery. RESULTS: One hundred fifty-six cataract surgeries were included, 83 in the IV midazolam group and 73 in the oral diazepam group. Twenty-four patients (29%) in the IV group and 7 patients (10%) in the oral group showed undesired movement (P < .02). Seven patients (8%) in the IV group and 2 patients (3%) in the oral group showed poor cooperation (P > .05). Fifteen patients (18%) in the IV group and 9 patients (12%) in the oral group had anxiety (P > .05). Three patients (4%) in the IV group and 3 patients (4%) in the oral group experienced pain (P > .05). CONCLUSIONS: Fewer patients receiving oral diazepam 30 minutes before cataract surgery than patients receiving IV midazolam immediately preceding surgery showed undesired movement during surgery. There was no statistically significant difference in the number of patients showing poor cooperation or experiencing pain or anxiety between the 2 groups. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
Subject(s)
Conscious Sedation/methods , Diazepam/administration & dosage , Hypnotics and Sedatives/administration & dosage , Lens Implantation, Intraocular , Midazolam/administration & dosage , Phacoemulsification/methods , Administration, Oral , Aged , Anesthetics, Intravenous , Anesthetics, Local/administration & dosage , Eye Pain/diagnosis , Eye Pain/physiopathology , Female , Humans , Kinesis , Male , Pain Measurement , Prospective StudiesABSTRACT
UNLABELLED: This review examines the anatomic and physiologic rationale for accessing the suprachoroidal space in the management of glaucoma. The potential benefits and limitations of past and present attempts to tap into the intraocular pressure-lowering effects of the suprachoroidal space are highlighted. FINANCIAL DISCLOSURE: The author has no financial or proprietary interest in any material or method mentioned.
