Propofol-remifentanil-based anaesthesia vs. sevoflurane-fentanyl-based anaesthesia for immediate postoperative ophthalmic evaluation following strabismus surgery.

BACKGROUND AND OBJECTIVE: Following strabismus surgery, immediate postoperative ophthalmic evaluation may be desired. Thus, an anaesthetic technique allowing rapid recovery of ocular motility is required. Saccadic eye movements is a biophysical monitor of ocular motility and may be used to assess recovery from anaesthesia. The aim of this study is to compare the time to the recovery of saccadic eye movements in patients, following one of two anaesthetic techniques: Propofol-remifentanil-based anaesthesia vs. sevoflurane-fentanyl-based anaesthesia. METHODS: Fifty adult patients undergoing strabismus surgery were randomly assigned to one of two groups: patients in Group R received induction and maintenance of anaesthesia with propofol and remifentanil, while patients in Group S received induction of anaesthesia with propofol and fentanyl and maintenance of anaesthesia with sevoflurane. Recovery from anaesthesia was measured from the time all anaesthetics were turned off and was assessed every 2 min. Recovery time was attained when patients were able to generate brisk saccadic eye movements. At recovery time, the ophthalmic evaluation was started. RESULTS: The mean recovery time of saccadic eye movements was significantly shorter in the Group R when compared to the Group S (12.1 +/- 4.3 min vs. 21.5 +/- 4.7 min, respectively, P < 0.0001). More patients in Group S experienced nausea and vomiting postoperatively as compared to Group R (9/25 vs. 2/25, respectively, P = 0.037). CONCLUSIONS: Propofol-remifentanil-based anaesthesia may be a useful technique in strabismus surgery when immediate postoperative ophthalmic evaluation is desired. When compared to sevoflurane maintenance of anaesthesia, it allows for a more rapid recovery from anaesthesia as judged by recovery of saccadic eye movements and a decreased incidence of postoperative nausea and vomiting.

Anterior segment ischemia after the Jensen procedure in a 10-year-old patient.

PURPOSE/METHODS: We recently encountered anterior segment ischemia in a young healthy girl with traumatic abducens nerve palsy after the Jensen procedure and ipsilateral recession of the medial rectus muscle. The patient was treated with topical dexamethasone and homatropine 2% and oral prednisone. RESULTS/CONCLUSION: The patient's condition improved, and six weeks postoperatively, visual acuity was 20/20. As this complication of anterior segment ischemia is potentially serious and unpredictable, we think that an alternative surgical approach should be used when treating patients with muscle palsies.

Posterior chamber lens implantation for primary repair of corneal lacerations and traumatic cataracts in children.

Children older than 3 years of age rarely tolerate contact lenses for unilateral surgical aphakia. This problem is even more pronounced following repair of corneal lacerations or perforations that are associated with traumatic cataracts. Even if surgery is successful, such eyes are functionally doomed because of deep anisometropic amblyopia. We evaluated prospectively in 15 children (3 to 8 years) the results of combined operation of corneal repair, aspiration of traumatic cataract, and primary posterior chamber lens implantation. Postoperative occlusion treatment was carefully monitored. Follow up ranged from 6 to 60 months, with an average of 39.2 months. The final best corrected visual acuity at the patient's last visit was 20/40 or better in 11 of 15 children (73.3%). The most frequent complication was a nonfunctional pupil due to traumatic iris damage or posterior synechiae in 13 cases. The most visually significant complication was posterior membrane formation and/or posterior capsule opacification, which required additional surgeries in six children.

Topical cyclosporine in vernal keratoconjunctivitis.

In a placebo-controlled, double-masked clinical trial, the authors evaluated the effects of topical 2% cyclosporine on 20 patients with vernal keratoconjunctivitis (VKC). Nineteen patients were male and one was female. Patients ranged in age from 5 to 19 years (mean, 9.7 years). Symptoms of itching, tearing, photophobia, discharge, and foreign body sensation were evaluated and recorded at weekly intervals for a period of 6 weeks. There was a statistically significant decrease in the conjunctival hyperemia, papillary hypertrophy, punctate keratitis, and Trantas' dots in the group of patients treated with cyclosporine but not in the group treated with placebo. No adverse effects and no detectable levels of cyclosporine were noted in the blood in the cyclosporine-treated group. Cyclosporine appears to be safe and effective for the short-term treatment of VKC.