Barak Azmon

Effectiveness of sub-Tenon’s versus peribulbar anesthesia in extracapsular cataract surgery ☆

PURPOSE To compare the effectiveness of sub-Tenons versus peribulbar anesthesia in extracapsular cataract surgery. SETTING Department of Ophthalmology and the Maccabi Eye Institute, Tel Aviv, Israel. METHODS Sixty-four consecutive patients who had extracapsular cataract surgery were randomized to have sub-Tenons or peribulbar anesthesia. Intraocular pressure (IOP) was measured before and 1 and 10 minutes after injection. The motility of the rectus muscles was evaluated before and 20 minutes after the injection, and the patients anxiety level was recorded immediately after the injection. Pain was assessed intraoperatively and 1 and 24 hours postoperatively by patient self-grading. RESULTS One minute after the injection, IOP increased significantly in the peribulbar group (mean 7.97 mm Hg +/- 8.80 [SD]) (P < .05). There was no significant increase in the sub-Tenons injection group (mean 0.12 +/- 3.09 mm Hg). In both groups, IOP returned to preinjection levels by 10 minutes postoperatively. Patients with peribulbar anesthesia reported a significantly higher level of anxiety than those who had sub-Tenons anesthesia (P < .05). Although the intraoperative pain levels were the same, the sub-Tenons group reported significantly higher levels of pain 1 and 24 hours postoperatively; 16% in the sub-Tenons group and none in the peribulbar group reported moderate pain 24 hours after anesthesia. Ocular motility was the same except for the inferior rectus muscle, which was less motile on average in the peribulbar group. CONCLUSION Sub-Tenons anesthesia led to less IOP elevation than peribulbar anesthesia and provided similarly good globe immobilization and approximately the same pain levels intraoperatively.

Macular hole secondary to branch retinal vein occlusion diagnosed by Retinal Thickness Analyzer.

The Retinal Thickness Analyzer is a laser slit biomicroscopy imaging device that produces accurate measurements of retinal thickness and displays the images in a two-dimensional pattern, superimposed on a fundus image. This article reports a patient with decreased vision following branch retinal vein occlusion in whom the Retinal Thickness Analyzer was used to establish the diagnosis of a macular lamellar hole that was not apparent clinically.

Colchicine in tear fluid of treated patients with familial Mediterranean fever.

Purpose. The study aimed to determine whether detectable concentrations of colchicine are present in the tear fluid of treated patients with familial Mediterranean fever (FMF) and thus demonstrate a possible route by which colchicine reaches the corneal surface. Methods. Tear fluid samples (50–100 &mgr;L) were collected from eight FMF patients on long-term colchicine treatment. Colchicine tear fluid concentrations were determined in all patients by radioimmunoassay using goat anticolchicine antibodies and [3H]colchicine (Dupont, Wilmington, DE). Results. Detectable concentrations of colchicine, with no apparent effect on the ocular surface, were found in all tear fluid samples (median, 0.46 ng/mL; range, 0.24–1.05 ng/mL). Conclusions. This study provides evidence of the route by which colchicine, given systemically, reaches the corneal surface and thus gives credence to the possible inhibitory effect of this drug on corneal wound healing in the cases described in the literature.