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No-patch 23-gauge vitrectomy under topical anesthesia: a pilot study.

Deka S, Bhattacharjee H, Barman MJ, Kalita K, Singh SK - Indian J Ophthalmol (2011 Mar-Apr)

Bottom Line: Four patients had Grade 0 pain during the surgery.One patient had Grade 1 pain during the placement and withdrawal of the micro cannulas.Further study is recommended to validate the outcome of this study.

View Article: PubMed Central - PubMed

Affiliation: Department of Vitreoretina Services, Sri Sankaradeva Nethralaya, Beltola, Guwahati-781 028, India. drsatyen@hotmail.com

ABSTRACT
A pilot study was designed to evaluate the safety and efficacy of 23-gauge vitrectomy under topical anesthesia. Five eyes of five patients underwent 23-gauge sutureless vitrectomy under topical anesthesia with a pledget soaked in 0.5% proparacaine hydrochloride anesthetic, for vitreous hemorrhage (four eyes), epiretinal membrane (one eye). Subjective pain and discomfort were graded using a visual analogue chart from 0 (no pain or discomfort) to 4 (severe pain and discomfort). At the end of surgery no patch was applied and patients were given dark glasses. Patients underwent an immediate postoperative assessment, followed by next day and one week postoperative evaluation. Four patients had Grade 0 pain during the surgery. One patient had Grade 1 pain during the placement and withdrawal of the micro cannulas. The surgical outcomes were favorable. 23-gauge vitrectomy under topical anesthesia is safe and effective in selected cases. Further study is recommended to validate the outcome of this study.

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Application of pledget soaked in 0.5% proparacaine hydrochloride at the proposed sclerotomy site
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Figure 0001: Application of pledget soaked in 0.5% proparacaine hydrochloride at the proposed sclerotomy site

Mentions: The three other patients did not have any appreciable systemic disease. Both the hypertensive patients were on amlodepine 5 mg daily dose and were well controlled at the time of surgery. After achieving maximum pupillary dilatation with 1% tropicamide and 5% phenylephrine, the conjunctival cul-de-sac was first anesthetized with a drop of 0.5% proparacaine hydrochloride (Paracain 0.5% eye drops). The eye and the surrounding area were then cleaned and painted with povidone iodine 5%. After draping, the eye was kept open using the universal speculum. Pledget soaked in 0.5% proparacaine hydrochloride anesthetic drop was placed at the three proposed sclerotomy sites for one minute just before entry [Fig. 1]. Using the 23-gauge trocar and cannula system (Alcon Labs, USA), three transconjunctival sclerotomy entries were made, 3.5 mm posterior to the limbus at the inferotemporal, superonasal and superotemporal locations, taking care to stretch the overlying conjunctiva with a sterile cotton bud. The trocar and cannula were pushed through the sclera parallel to the limbus initially at an oblique angle and then perpendicularly into the vitreous cavity, and the trocar was removed [Fig. 2]. The infusion was maintained through the inferotemporal sclerotomy. The core vitrectomy was performed without base excision using the dual dynamic drive technology on the accurus machine (Alcon Labs, USA). After completion of vitrectomy, endolaser photocoagulation was performed in four cases using 532 nm frequency doubled Nd:YAG laser through a 23-gauge laser endoprobe (Iridex Corporation, USA) as they were secondary to proliferative retinal vasculopathies. A 23-gauge forceps (Alcon Labs, USA) was used for membrane- peeling in one case. Fluid/air exchange and SF6 injection was done in the ERM case where persistent retinal wrinkling was present even after the ERM was removed. In all cases routine scleral indentation was performed to check the sclerotomies before removing the cannulas. At the end of the procedure, the superotemporal and superonasal cannulas were removed first, followed by the removal of the inferotemporal cannula with the infusion line, after closing the infusion. A drop of gatifloxacin eye drops and cyclopentolate hydrochloride 1% was instilled into the cul-de-sac and the eye was left open without any patch. The patients were given protective spectacles to wear. Immediately after the surgery each patient was shown a five-point subjective pain and discomfort visual analogue scale: 0 = no pain or discomfort, 1 = no pain but mild discomfort, 2 = mild pain and discomfort, 3 = moderate pain and discomfort and 4 = severe pain and discomfort [Fig. 3] and then asked to grade the level of pain and discomfort during the surgical procedure. All patients were started on prednisolone acetate eye drops every 2 h and tapered over three weeks, gatifloxacin eye drops every 2 h for one week. The patients were evaluated next day and at one week. None of the patients required any sedation intraoperatively or in the postoperative period.


No-patch 23-gauge vitrectomy under topical anesthesia: a pilot study.

Deka S, Bhattacharjee H, Barman MJ, Kalita K, Singh SK - Indian J Ophthalmol (2011 Mar-Apr)

Application of pledget soaked in 0.5% proparacaine hydrochloride at the proposed sclerotomy site
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3116543&req=5

Figure 0001: Application of pledget soaked in 0.5% proparacaine hydrochloride at the proposed sclerotomy site
Mentions: The three other patients did not have any appreciable systemic disease. Both the hypertensive patients were on amlodepine 5 mg daily dose and were well controlled at the time of surgery. After achieving maximum pupillary dilatation with 1% tropicamide and 5% phenylephrine, the conjunctival cul-de-sac was first anesthetized with a drop of 0.5% proparacaine hydrochloride (Paracain 0.5% eye drops). The eye and the surrounding area were then cleaned and painted with povidone iodine 5%. After draping, the eye was kept open using the universal speculum. Pledget soaked in 0.5% proparacaine hydrochloride anesthetic drop was placed at the three proposed sclerotomy sites for one minute just before entry [Fig. 1]. Using the 23-gauge trocar and cannula system (Alcon Labs, USA), three transconjunctival sclerotomy entries were made, 3.5 mm posterior to the limbus at the inferotemporal, superonasal and superotemporal locations, taking care to stretch the overlying conjunctiva with a sterile cotton bud. The trocar and cannula were pushed through the sclera parallel to the limbus initially at an oblique angle and then perpendicularly into the vitreous cavity, and the trocar was removed [Fig. 2]. The infusion was maintained through the inferotemporal sclerotomy. The core vitrectomy was performed without base excision using the dual dynamic drive technology on the accurus machine (Alcon Labs, USA). After completion of vitrectomy, endolaser photocoagulation was performed in four cases using 532 nm frequency doubled Nd:YAG laser through a 23-gauge laser endoprobe (Iridex Corporation, USA) as they were secondary to proliferative retinal vasculopathies. A 23-gauge forceps (Alcon Labs, USA) was used for membrane- peeling in one case. Fluid/air exchange and SF6 injection was done in the ERM case where persistent retinal wrinkling was present even after the ERM was removed. In all cases routine scleral indentation was performed to check the sclerotomies before removing the cannulas. At the end of the procedure, the superotemporal and superonasal cannulas were removed first, followed by the removal of the inferotemporal cannula with the infusion line, after closing the infusion. A drop of gatifloxacin eye drops and cyclopentolate hydrochloride 1% was instilled into the cul-de-sac and the eye was left open without any patch. The patients were given protective spectacles to wear. Immediately after the surgery each patient was shown a five-point subjective pain and discomfort visual analogue scale: 0 = no pain or discomfort, 1 = no pain but mild discomfort, 2 = mild pain and discomfort, 3 = moderate pain and discomfort and 4 = severe pain and discomfort [Fig. 3] and then asked to grade the level of pain and discomfort during the surgical procedure. All patients were started on prednisolone acetate eye drops every 2 h and tapered over three weeks, gatifloxacin eye drops every 2 h for one week. The patients were evaluated next day and at one week. None of the patients required any sedation intraoperatively or in the postoperative period.

Bottom Line: Four patients had Grade 0 pain during the surgery.One patient had Grade 1 pain during the placement and withdrawal of the micro cannulas.Further study is recommended to validate the outcome of this study.

View Article: PubMed Central - PubMed

Affiliation: Department of Vitreoretina Services, Sri Sankaradeva Nethralaya, Beltola, Guwahati-781 028, India. drsatyen@hotmail.com

ABSTRACT
A pilot study was designed to evaluate the safety and efficacy of 23-gauge vitrectomy under topical anesthesia. Five eyes of five patients underwent 23-gauge sutureless vitrectomy under topical anesthesia with a pledget soaked in 0.5% proparacaine hydrochloride anesthetic, for vitreous hemorrhage (four eyes), epiretinal membrane (one eye). Subjective pain and discomfort were graded using a visual analogue chart from 0 (no pain or discomfort) to 4 (severe pain and discomfort). At the end of surgery no patch was applied and patients were given dark glasses. Patients underwent an immediate postoperative assessment, followed by next day and one week postoperative evaluation. Four patients had Grade 0 pain during the surgery. One patient had Grade 1 pain during the placement and withdrawal of the micro cannulas. The surgical outcomes were favorable. 23-gauge vitrectomy under topical anesthesia is safe and effective in selected cases. Further study is recommended to validate the outcome of this study.

Show MeSH
Related in: MedlinePlus