RESUMO
Purpose: Effect of intravenous sedation on patients' visual experience and vital signs during cataract surgery under topical anesthesia: a randomized controlled trial. Design: Prospective, double masked, randomized controlled trial. Methods: 150 eyes of 150 patients undergoing phacoemulsification and IOL implantation under topical anesthesia were randomized to receive either intravenous midazolam (0.015 âmg/kg) or normal saline. The patients' experience was evaluated using a questionnaire. Vital signs including blood pressure and heart rate were measured before, during and after surgery. Mean arterial pressure (MAP) was calculated. Results: Both groups were comparable except that fewer patients in the control group were pseudophakic in the fellow eye (25.3% vs. 41.3%). More patients in the control group perceived hand movements (p â< â0.01), surgeon/medical staff (p â= â0.04) and sudden increase in vision during surgery (p â< â0.01) compared to midazolam group. More control group patients experienced fear (p â< â0.001), pain (p â= â0.06) and unpleasant surgical experience (20.3% vs. 1.3%, p â< â0.001). They also experienced greater fluctuation in MAP (16.9 â± â7.9 vs.7.2 â± â5.3, p â< â0.001) and this was accentuated in hypertensives. After adjusting for age, gender, hypertension status and other eye lens status, multivariable logistic regression analysis revealed that subjects in the control arm (OR â= â11.7, 95% [CI] â= â1.3-108, p â= â0.03), had a longer duration of surgery, experienced pain and more likely to report unpleasant experience. Adjusting for similar covariates, multivariable linear regression analysis showed that control group patients (ß â= â8.5 âmmHg, 95% CI â= â6.2-10.8, p â= â0.03) had hypertension, experienced fear during surgery and greater fluctuations in the MAP. Conclusions: A sedative dose of intravenous midazolam during phacoemulsification under topical anesthesia significantly reduces patients' visual experience, fear and fluctuations in MAP and improves overall surgical experience.
RESUMO
Neovascular glaucoma (NVG) is a potentially blinding form of secondary glaucoma, with radiation being one of the rare causes. This report is aimed to discuss a case of NVG caused secondary to radiotherapy (RT) given for a nasal malignancy. A 50-year-old male presented with enophthalmos, dry eye, and NVG 3 years after receiving RT for chondrosarcoma of nasal and paranasal cavities. He was given topical antiglaucoma medications, retinal laser, and intravitreal bevacizumab injection and thus prevented the eye from becoming a painful blind eye. The radiation oncologist and ear, nose, and throat specialists have to liaise closely with ophthalmologist when patients receive radiation involving the eye in the treatment field to prevent, diagnose, and treat this devastating condition.
Assuntos
Neoplasias Ósseas/radioterapia , Condrossarcoma/radioterapia , Glaucoma Neovascular/patologia , Neoplasias Nasais/radioterapia , Neoplasias dos Seios Paranasais/radioterapia , Radioterapia/efeitos adversos , Neoplasias Ósseas/patologia , Condrossarcoma/patologia , Glaucoma Neovascular/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Nasais/patologia , Neoplasias dos Seios Paranasais/patologia , PrognósticoRESUMO
BACKGROUND: Topiramate is a drug commonly used by physicians. However, it has various systemic and ocular adverse effects. Bilateral angle closure crisis is a potentially blinding adverse reaction that is seldom reported in non-ophthalmic journals. OBJECTIVE: This article aims to report a case series of topiramate-induced angle closure crisis in the eyes. METHODS AND MATERIAL: Most patients presented to us with blurred vision and high intra-ocular pressure within days of starting topiramate tablet for headache. However, the attack resolved in those who presented early with prompt treatment, which included stopping topiramate. CONCLUSIONS: Physicians prescribing topiramate must be well aware of this potentially blinding adverse effect. Educating the patient about this possible side effect is important. Timely referral and treatment can prevent blindness in these individuals.
