Pain, photophobia, and retinal and optic nerve function after phacoemulsification with intracameral lidocaine.

OBJECTIVE: To evaluate differences in pain, photophobia, retinal and optic nerve function in test eyes given intracameral lidocaine compared with control eyes given intracameral saline after phacoemulsification under topical anesthesia. DESIGN: Prospective paired-eye intervention study with random treatment allocation. PARTICIPANTS: Thirty eyes of 15 patients underwent cataract surgery in both eyes under topical anesthesia. INTERVENTION: The first eye of each patient was randomly assigned to either 0.5 ml preservative-free 2% intracameral lidocaine or 0.5 ml of intracameral sterile saline. Within 5 months, the second eye automatically received intracameral saline if the first eye received intracameral lidocaine or vice versa. MAIN OUTCOME MEASURES: The duration of surgery was recorded. Immediately after surgery, each patient was asked to evaluate the degree of pain and photophobia experienced during surgery using a nominal scale. In addition, in five patients, electroretinography (ERG) and visual evoked response (VER) were performed within 1 week before surgery, immediately after surgery, and 1 day after surgery. Amplitudes and latencies were calculated. RESULTS: There was no difference in the duration of surgery comparing test eyes given intracameral lidocaine with control eyes given sterile saline (P = 0.81). There was no significant difference in the level of pain reported when comparing test eyes given intracameral lidocaine with control eyes (P = 1.00). None of the patients reported any significant difference in photophobia between their two eyes (P = 1.00). When comparing ERG measurements, test eyes given intracameral lidocaine did not show any significant decrease in ERG amplitudes or prolonged latencies compared with control eyes. When comparing VER measurements, test eyes given intracameral lidocaine did not show any increase in P1 latencies compared with control eyes (P = 0.31). When evaluating all postoperative ERG results 1 day after surgery, there was a suggestion of improved cone function. CONCLUSIONS: Although intracameral lidocaine does not depress retinal or optic nerve function, the addition of intracameral lidocaine to topical anesthesia during phacoemulsification does not significantly reduce intraoperative pain or photophobia.

Half-life and vitreous clearance of trifluorothymidine after intravitreal injection in the rabbit eye.

To determine the half-life and vitreous clearance of trifluorothymidine, a drug that demonstrates good toxicity against cytomegalovirus (CMV), we injected 200 micrograms of the drug intravitreally in the eyes of nine New Zealand white rabbits. None of the rabbits showed any adverse reactions to the injection or the drug. The rabbits were killed at 3, 6, 12, 24 or 72 hours. High-performance liquid chromatography was used to measure the vitreous trifluorothymidine concentration. The half-life of the drug was found to be 3.15 hours, and the vitreous concentration remained above the ID50 (concentration required to inhibit cytopathic effects by 50% compared with control cultures) for CMV for about 30 hours. We conclude that trifluorothymidine may be of future benefit in the management of CMV retinitis.

Posterior chamber lens implantation following pars plana lensectomy and vitrectomy in severe proliferative diabetic retinopathy.

In two patients secondary cataracts developed after pars plana vitrectomy. In both cases the lens was removed from the pars plana, and the anterior capsule was kept intact. In one patient a posterior chamber lens was placed in the ciliary sulcus 3 months after the lens had been removed, and in the other patient a posterior chamber lens was implanted intraoperatively after pars plana lensectomy and vitrectomy. Improved visual results were obtained in both cases, and there was no evidence of rubeosis or elevated intraocular pressure. In selected cases preservation of the anterior capsule may be important to implant posterior chamber lenses in eyes requiring pars plana lensectomy and vitrectomy. To our knowledge this technique has not previously been reported.

Prostaglandin E2 and protein release following Nd:YAG laser application to the anterior capsule of rabbit lens.

We compared the effects of Nd:YAG laser anterior capsulotomy and photophacofragmentation on the release of prostaglandin E2 (PGE2) and protein in the New Zealand rabbit aqueous humor. Following anterior capsulotomy, the concentration of PGE2 was significantly more elevated (P less than .025) than it was in the contralateral untreated eyes at intervals from one-half hour up to four hours, and rapidly decreased in 24 hours. The concentration of protein showed a relatively gradual increase which became significant (P less than .05) after two hours, and remained elevated 24 hours after anterior capsulotomy. In contrast, photodisruption into the lens without damaging the anterior capsule showed little effect on the release of PGE2 and protein in the aqueous humor.

Management of an extruded footplate of an anterior chamber lens with the Nd:YAG laser.

A footplate of an anterior chamber lens that extruded through clear cornea was treated by severing the protruding haptic with the Nd:YAG laser and removing it surgically. During the procedure, the remainder of the implant was repositioned and vitreous traction was relieved by pars plana vitrectomy. This technique appeared less injurious to the eye than attempting to cut all four fibrosed haptics and remove the entire implant.

Early anterior segment complications after silicone oil injection.

We analyzed retrospectively 45 patients who had received silicone oil injection for vitreoretinal problems and divided them into three groups: aphakic patients who had undergone an extracapsular cataract extraction (AEC), aphakic patients who had undergone an intracapsular cataract extraction (AIC) and phakic patients (PHA). Patients were followed up from 4 to 13 months (average: 8.5 months). Irreversible silicone keratopathy was found in 50% of the eyes in the AIC group between 4 and 8 weeks postoperatively. An intact lens or capsule correlated well with the absence of this complication. In phakic eyes, secondary cataract was the most prominent early complication, developing by the end of the eighth week in 60% of eyes. Other early complications were inflammatory surface silicone membranes, rubeosis, iritis, glaucoma and capsular opacification.

Inherited levator-medial rectus synkinesis.

We examined two sisters with lid retraction on adduction, the classic sign of levator-oculomotor synkinesis. In both women, the left eye was involved. No history of trauma or ocular surgery or complaints of diplopia were elicited, and both had good visual acuity and full ocular motility. Each exhibited 2 mm of left upper lid elevation on adduction and 4 to 6 mm of lid elevation on adduction with depression. In one of the sisters, 1 mm of ptosis was present in straight ahead gaze in the involved eye, which increased to almost 2 mm on abduction, but full levator function was observed. Four other family members in three consecutive generations were similarly affected, suggesting an autosomal-dominant mode of inheritance. To our knowledge, this type of isolated levator-oculomotor synkinesis has not been reported previously on a congenital and inherited basis.

Intravitreal trifluorothymidine and retinal toxicity.

Intraocular trifluorothymidine was administered to one group of albino rabbits as an intravitreal injection, and to a second group of albino rabbits in the infusion solution during pars plana vitrectomy. The eyes of both populations were evaluated with preoperative and postoperative indirect ophthalmoscopy, electroretinography, and histologic examination. From these data, it was determined that an intravitreal injection of 200 micrograms/0.1 ml and a vitrectomy solution containing a concentration of 60 micrograms/ml trifluorothymidine were nontoxic to the rabbit eye.