Intramuscular Bupivacaine Injection for the Treatment of Oculomotor Paresis.

The main goal of this study is to examine the effect of intramuscular bupivacaine in oculomotor paresis, analyzing whether it is possible to obtain a stronger muscle contraction due to the muscle hypertrophy caused by the drug. An injection of 4.5 mL of a 0.50% solution of bupivacaine was administered in the paretic muscle of three patients. Magnetic resonance imaging was performed before and 3 months after injection to compare muscle cross-sectional areas. The symptoms of two patients improved and an increase of muscle cross-sectional area was observed. However, it is necessary to be prudent when employing intramuscular bupivacaine in oculomotor paresis treatment until there are more and larger studies.

Topical anesthesia in strabismus surgery: a review of 101 cases.

PURPOSE: To analyze the results over a 10-year period with a different type of strabismus surgery performed with topical anesthesia, to describe the differences in technique compared with surgery performed with general anesthesia, and to detail current indications and technical changes made according to the experience accrued during these years. METHODS: A total of 101 patients undergoing strabismus surgery with topical anesthesia in a single hospital were analyzed. These patients were randomly selected from a total of 567 patients who had undergone extra-ocular muscle surgery in the past 10 years. RESULTS: A good result was obtained (squint angle < 10 prism diopters and absence of diplopia) in 95% of patients immediately after surgery and in 85% at final follow-up (mean follow-up: 3.1 years). The mean operating time for each muscle was 29 minutes. Surgery was well tolerated in every patient. Conversion to general anesthesia was not necessary in any case. Atropine was used in three patients (3%) because of induction of the vagal reflex. CONCLUSION: Topical anesthesia in strabismus surgery is a useful technique in the treatment of extraocular muscle pathology, with few limitations. Appropriate monitoring by an anesthetist is vital to ensure adequate control of pain and possible side effects and to enable conversion to general anesthesia. The oculocardiac reflex is infrequent. For experienced strabismus surgeons, the total surgical time is comparable with topical and general anesthesia.

Ocular dominance diagnosis and its influence in monovision.

PURPOSE: To analyze the response of normal emmetropic subjects to different ocular dominance tests and to analyze the influence of this response in surgically induced monovision. DESIGN: A prospective study of diagnostic accuracy was carried out to analyze the different tests to determine ocular dominance, without a gold standard test. METHODS: Nine different tests were carried out in a group of 51 emmetropic subjects to determine both motor and sensory ocular dominance. For analysis, patients were divided into two groups according to age. Normal ophthalmologic examination results were the inclusion requirement, with normal binocular vision and good stereoacuity. RESULTS: A significant percentage of uncertain or ambiguous results in all tests performed was found, except in the hole-in-card and kaleidoscope tests. When the tests were compared, two by two, the correlation or equivalence found was low and was much lower if tests were compared three by three. CONCLUSIONS: No clear ocular dominance was found in most studied subjects; instead, there must be a constant alternating balance between both eyes in most emmetropic persons, but not in those with pathologic features. This fact would explain the great variability both between and within different kinds of tests. Also, it would establish that the monovision technique is well tolerated in most patients, with unsuccessful results only in those patients with strong or clear dominance. Consequently, it seems appropriate to evaluate patient's dominance before monovision surgery to exclude those individuals with clear dominance.