Objective: To assess the effects of prior caffeine intake on tremor control and internal limiting membrane peeling proficiency of experienced retinal surgeons using a microsurgical simulator. Methods:Experienced vitreoretinal surgeons were included. On two separate days, each subject underwent a test on a level 4 anti-tremor test and internal limiting membrane peeling test on a microsurgical simulator (Eye-Si/ Series 199, VRMagic, Sofware 2.9, Mannheim, Germany) first with no caffeine intake and after 40 minutes of taking an oral dose of caffeine (200 mg and 400 mg). Each subject underwent blood pressure and heart rate measurements before and 40 min after caffeine intake. The same technician measured both surgical performances.Results: Mean age was 46.4 ± 10.1 years. All subjects were male. The mean anti-tremor results were: baseline scores 61.2 ± 19.15, 200 mg 61.6 ± 12.63 and 400 mg 75.4 ± 15.09. The mean internal limiting membrane peeling results were: baseline score 55.9 ± 5.46, 200 mg 54.8 ± 10.05 and 400 mg 62.6 ± 9.63. Blood pressure and heart rate remained stable. After consumption of higher doses of caffeine some adverse effects were reported such as headache and a transient episode of anxiety. Conclusion:Caffeine consumption prior to surgery is discouraged by microsurgeons due to potential adverse effects. Our results showed no significant change on the surgical ability after 200 and 400 mg of oral caffeine. There was a non-significant improvement on the overall score after 400 mg.
The incidence of the disease was first reviewed in the Cryotherapy for Retinopathy of Prematurity Cooperative Group CRYO-ROP study, based on a multicentre trial in the United States.infants from centres were recruited, and . % of those premature babies with a birthweight less than grams were noted to have some form of ROP. % developed stage disease and % were treated [ ].The Early Treatment of ROP study ET-ROP study [ ] looked at newborns from different centres with birth weight less than grams. The incidence was very similar at The classification system has always been based on basic paradigms location, extent and staging of the disease. . . LocationThe original classification in describes concentric zones of retinal involvement to define the antero-posterior location of the retinopathy. Each zone is centered on the optic disc rather than the macula, since normal retinal growth proceeds forward from the optic disc towards the ora serrata in a systematic fashion although it is observed that the extent of retinal vascularisation and ROP may be observed closer to the optic disc nasally than temporally .Zone I posterior pole or inner zone consists of a circle , the radius of which extends from the centre of the optic disc to twice the distance from the centre of the optic disc to the centre of the macula. The radius of this zone subtends an angle of degrees. The limits of the zone are consequently defined as twice the disc-foveal distance in all directions from the optic disc an arc of degrees.Retinopathy of Prematurity http://dx.doi.org/10.5772/58585 289Zone II is the area extending from the edge of zone I peripherally to a point tangential to the nasal ora serrata at the o clock position in the right eye and the o clock position in the left eye. The temporal edge of zone II cannot be more accurately defined as the anatomic landmarks needed to identify the equator in premature infants are obscured.Zone III is the residual crescent of retina anterior to zone II. "y convention zones I and II are considered mutually exclusive. Retinopathy of prematurity should be considered in zone II until it can be confirmed that the nasal most clock hours are vascularised to the ora serrata.For the clinician as a practical approach, using a D or diopter D condensing lens can help to determine the approximate temporal extent of zone I. The limit of zone I is at the temporal field of view by placing the nasal edge of the optic disc at one edge of the field of view. . . ExtentThe extent of the disease specified as the hours of the clock or as degree sectors. "s the observer looks at each eye, the o clock position is to the right and nasal in the right eye and temporal in the left eye. The o clock position is to the left and temporal in the right eye and nasal in the right eye. . . Staging of the diseaseThis refers to the amount of abnormal vascular response observed. Prior to ROP development in the premature infant, vascularisation of the retina is incomplete. There are now stages used to describe the abnormal vascular response at th...
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