Donald R. May

Cardiopulmonary Arrest after Retrobular Block

A 61-year-old woman experienced a cardiopulmonary arrest immediately after the retrobulbar injection of a mixture of 2 ml of 0.5% bupivacaine HCl, 2% mepivacaine HCl, and hyaluronidase. The patient was immediately resuscitated but remained unconscious for a total of 20 minutes. All neurologic deficits resolved completely over the two hours following the cardiopulmonary arrest and no adverse sequelae were noted. We assumed that this cardiopulmonary arrest was precipitated by the local anesthetic being transported via retrograde flow through the ophthalmic artery and then by antegrade flow through the internal carotid artery to the thalamus and other midbrain structures.

Xenon arc panretinal photocoagulation for central retinal vein occlusion: a randomised prospective study.

Thirty-three patients with central vein occlusion were evaluated for the effects of scatter xenon arc panretinal photocoagulation. Thirty-four eyes (2 eyes of 1 patient) were randomly divided into a treatment (15 eyes) and a nontreatment group (19 eyes). The average follow-up per eye has been 29 months. The visual prognosis was not significantly better in either group. There was no difference in the development of fundus neovascularisation between groups. None of the patients in the treated group developed rubeosis or neovascular glaucoma. Two patients in the nontreatment group initially had rubeosis and 3 developed it after entry. All 5 involved eyes developed neovascular glaucoma. A significantly greater amount of central retinal capillary drop-out was present in the untreated eyes that developed rubeosis than those untreated eyes which did not. The eyes in the treated group had a similar range of capillary drop-out area, but none of these eyes developed rubeosis or neovascular glaucoma. Panretinal photocoagulation prevented the development of rubeosis and neovascular glaucoma in susceptible eyes.

Treatment of Neovascular Glaucoma with Transscleral Panretinal Cryotherapy

Transscleral panretinal cryotherapy was used to treat six eyes with neovascular glaucoma. The media of each involved eye were sufficiently cloudy at the time of treatment to prevent adequate panretinal photocoagulation. A checkerboard pattern of eight 2.5-mm cryotherapy applications was placed in each quadrant. Five of the eyes were also treated with 180 degrees of cyclocryotherapy. Within 72 hours of treatment, the intraocular pressure in each eye returned to a controllable level. The iris neovascularization in each eye regressed or totally disappeared within six weeks.

Central retinal artery occlusion following cosmetic blepharoplasty.

A case is presented of a 70-year-old white male who underwent a bilateral cosmetic lower lid blepharoplasty with fat removal. He subsequently developed a right orbital haemorrhage which resulted in the occlusion of the central retinal artery. The patient had no light perception with his right eye for approximately 1 hour, but vision was eventually restored to 20/20 after emergency therapeutic measures. There are many possible causes of visual loss following blepharoplasty, with orbital haemorrhage being the most common. Visual loss secondary to blepharoplasty can be prevented in the preoperative, intraoperative, and postoperative phases of surgery. Blindness as a complication of cosmetic blepharoplasty can be reversible if recognised early and treated appropriately. These facts must be kept in mind by all surgeons who perform blepharoplasties.

Effect of hypothermic perfusion on corneal endothelial morphology.

The effect of moderate in-vivo hypothermic perfusion on corneal endothelial integrity was studied in the cat. Eleven cats underwent in-vivo anterior chamber perfusion for 30 minutes with either normothermic (23 degrees C) or hypothermic (5 degrees C) perfusate. Corneas were then evaluated clinically (biomicroscopy), functionally (vital staining), and morphologically (scanning electron microscopy) for changes attributable to hypothermic perfusion. All 3 modes of evaluation suggested no difference in corneal endothelial integrity under the 2 experimental perfusion conditions. At the clinical and scanning electron microscope levels hypothermic perfusion does not show any effects on the corneal endothelium. Regional hypothermia is of theoretical and potential utility in procedures involving prolonged intraocular perfusion.

Results of 110 Vitrectomies with a Portable Vitrectomy System

We retrospectively evaluated the VITAC (vitreous-tissue aspiration cutter), a portable vitrectomy system with an end-cutting vitrectomy probe with a self-sharpening oscillating blade and a monoblock design, in 110 vitrectomy procedures, 34 performed at the University of California Davis Medical Center and 76 performed at the Eye and ENT Hospital in Shanghai, China. The indications for vitrectomy included penetrating injuries (22 eyes), intraocular foreign bodies (28 eyes), vitreous hemorrhages (18 eyes), cataracts (17 eyes), endophthalmitis (seven eyes), pupillary-block glaucoma (five eyes), bullous keratopathy (five eyes), aphakic penetrating keratoplasty (three eyes), pupillary membranes (two eyes), massive preretinal proliferation (one eye), and cystoid macular edema (one eye). Vitrectomy resulted in visual improvement in 19 of 34 eyes in the California series (56%) and in 60 of the 76 eyes in the Shanghai series (79%). This difference was attributable to the higher percentages of cases involving the posterior segment and vitreous hemorrhage in the California series. When results from both institutions were combined, surgery with the VITAC produced visual improvement in 79 of 110 cases (72%), comparable to the results obtained with other vitrectomy systems.