Efficacy of peribulbar bupivacaine at the end of surgery in the management of postoperative pain after scleral buckling.

PURPOSE: To compare the efficacy of peribulbar bupivacaine with routine analgesics for pain management in patients undergoing scleral buckling. METHODS: In total, 72 patients undergoing scleral buckling or combined with vitrectomy were enrolled in this study. Patients were randomized into two groups, each containing 36 patients. Patients of group A received 5 mL of bupivacaine (0.5%) injection at the end of surgery, whereas group B patients received routine analgesics. The postoperative pain score was assessed in the first 24 hours of the postoperative period with the visual pain analog score. RESULTS: Maximum postoperative pain scores were lower in patients receiving bupivacaine block (median: 3; range: 3-7) than in the control group (median: 5; range: 3-9). Pain scores in group A were lower than in the control group both at 3 and 6 hours after surgery, which was statistically significant ( P < 0.001). Four patients in group A and 17 patients in group B needed additional analgesia in the first 24 hours of the postoperative period. In addition, two patients in group A and seven patients in group B experienced episodes of nausea and vomiting in the first 24 hours of surgery. CONCLUSION: The results of this study suggest that the postoperative experience of patients undergoing scleral buckling surgery can be made more comfortable with the use of bupivacaine block at the end of surgery.

Endogenous Endophthalmitis A Complication of COVID-19 Pandemic: A Case Series.

PURPOSE: To report six patients with endogenous endophthalmitis as a complication of COVID-19 infection. METHODS: A multicentric retrospective database review of patients with a diagnosis of endogenous endophthalmitis and a history of COVID-19 infection. RESULTS: Four of six patients were diabetics. All presented after an average duration of 40 days (Range 17-90 days) of COVID-19 infection. Two of six patients had bilateral involvement. Five of six patients had received intravenous corticosteroid for COVID-19. Two of six vitreous samples showed fungi (Candida and Bipolaris species), two showed bacteria (Staphylococcus species) and two samples were culture negative. Control of infection with good visual outcome in four out of eight eyes. CONCLUSIONS: COVID-19 patients with a history of hospitalization and prolonged use of systemic corticosteroids and comorbidities, for example, diabetes mellitus have a high risk of endogenous endophthalmitis. A high index of clinical suspicion with timely intervention can salvage many eyes.

Modified balanced two-string technique of internal scleral fixation of posteriorly dislocated intraocular lens.

Posterior dislocation of the intraocular lens (IOL) is a rare but potentially dangerous complication encountered by a cataract surgeon. We describe a modified balanced two-string technique of internally fixing a posteriorly dislocated rigid IOL using the pars plana approach in eyes which lack adequate capsular support. Five eyes of five patients underwent the procedure. All eyes had successful IOL refixation. One eye had mild temporal decentration. BCVA improved in all patients. Our technique is an alternate method of scleral fixation of posteriorly dislocated IOL with advantages of minimal postoperative astigmatism, minimal anterior segment manipulation, and good IOL centration.

Retropupillary fixation of iris-claw lens in visual rehabilitation of aphakic eyes.

CONTEXT: Surgical outcome of retropupillary fixation of iris claw lens. AIMS: To evaluate the various indications, intra and post-operative complications, and visual outcome of retropupillary fixation of iris claw lens in aphakic eyes. SETTINGS AND DESIGN: The study design is a retrospective study at a tertiary eye care center. METHODS: Review of medical records of 61 aphakic eyes of 61 patients, who were rehabilitated with retropupillary fixation of an iris claw lens, with a follow-up duration of at least 1 year. STATISTICAL ANALYSIS USED: Data analysis was performed using paired t-test and Chi-square test. RESULTS: Mean preoperative uncorrected visual acuity was 1.66 ± 0.3 LogMAR and postoperative acuity at 1 year was 0.53 ± 0.5 LogMAR (P = 0.00001). Preoperative distant best-corrected visual acuity was 0.30 ± 0.48 LogMAR and postoperative acuity at 1 year was 0.27 ± 0.46 LogMAR (P = 0.07). Mean preoperative astigmatism was 1.43 ± 1.94 D and postoperatively was 1.85 ± 2.16 D (P = 0.0127). Mean endothelial cell count was 2353.52 ± 614 cells/mm2 preoperatively which decreased to 2200 ± 728 cells/mm2 at 1 year follow-up (P = 0.006). There was no significant difference in central macular thickness and intraocular pressure pre and post-surgery. Complications included ovalization of pupil in 9.83%, hypotony in 1.63%, toxic anterior segment syndrome in 1.63%, cystoid macular edema in 11.47%, epiretinal membrane in 3.27%, and iris atrophy in 6.55%. CONCLUSION: Iris claw is a safe and an effective method of rehabilitating aphakic eyes.

Transscleral drainage of subretinal/suprachoroidal silicone oil.

Silicone oil migration into the subretinal space following vitreoretinal surgery may occur in complex cases of retinal detachment with proliferative vitreoretinopathy. This complication prevents achievement of the primary goal (ie, to attach the retina) and fails to provide the internal tamponade, leading to a permanent decrease in visual acuity. Successful and complete removal of the subretinal oil is a challenge. Internal drainage as described earlier in the literature advocates a large relaxing retinotomy. The authors describe two similar cases, one with retinal detachment secondary to type II iridochoroidal coloboma wherein the oil had passed into the subretinal space and the other with diabetes mellitus and retinal detachment with oil in the suprachoroidal space. In both cases, silicone oil was removed successfully through a transscleral approach. The transscleral approach for removal of subretinal/suprachoroidal oil appears to be relatively safe, less time-consuming, and effective.