The clinical features, treatment, and visual outcome of 52 eyes from 43 patients who developed scleritis following surgery were reviewed. In all patients the scleral inflammation developed adjacent to a surgical wound. Ninety six per cent had necrotising disease and 23% also had evidence of secondary posterior scleritis. Many different types of ocular surgery were implicated and the majority (75%) of the patients had two or more surgical procedures before the onset of the scleritis. Although cataract extraction through a limbal incision resulted in the largest subgroup, scleritis also followed glaucoma, strabismus, and retinal detachment surgery. The latent period between surgery and the appearance of inflammation was short (mean 9 months) except for a small group in whom scleritis occurred many years after squint surgery. Sixty three per cent ofpatients had evidence of a systemic disease. Early diagnosis and aggressive medical treatment significantly improved the visual outcome. The precipitating factors, pathogenesis, and course of this condition are discussed.
Background-Treatment of retinopathy of prematurity (ROP) in the UK is subject to considerable regional variation in terms of anaesthetic support. Change in practice at St Mary's neonatal medical unit from topical to general anaesthesia and, subsequently, to sedation/analgesia allowed comparison of the impact of these three modalities on infants' early postoperative course in a consecutive, non-randomised, observational study. Methods-The study population consisted of 30 babies undergoing treatment of threshold ROP. Twelve were treated using topical anaesthesia alone (group A), six using general anaesthesia (group B), and 12 using sedation/analgesia combined with elective intubation and artificial ventilation (group C). Daily measurements of infant health were recorded starting 4 days preoperatively and continuing for 7 days postoperatively to facilitate the formulation of a cardiorespiratory stability index as follows: (0) improvement from baseline, (1) no change from baseline, (2) mild instability, (3) marked instability, and (4) life threatening event.Results-Within the first 48 hours postoperatively in group A 5/12 showed mild instability and 4/12 showed marked instability (including three babies suVering life threatening events requiring emergency resuscitation). In group B within the first 48 hours postoperatively 1/6 showed mild and 1/6 showed marked instability, and in group C 5/12 babies showed mild instability alone. There was a significant diVerence for cardiorespiratory stability scores between the three groups overall for the 7 days postoperatively (repeated measures ANOVA, p = 0.018). Conclusions-Premature infants undergoing cryotherapy for ROP who were treated using topical anaesthesia alone had more severe and protracted cardiorespiratory complications. (Br J Ophthalmol 1997;81:283-287)
(BrJ7 Ophthalmol 1994; 78: 605-607) Local anaesthesia has become increasingly popular for a variety of intraocular procedures, particularly with the increasing popularity of day case surgery. The main techniques used to administer local anaesthesia are peribulbar and retrobulbar injections. However the effect of these on intraocular pressure (IOP) has received little attention in patients with glaucoma, in whom transient severe increases in IOP may have the potential to cause further compromise of visual function.This study was initiated to examine the effect on IOP of peribulbar and retrobulbar injections, in patients with and without glaucoma, undergoing extracapsular cataract extraction or trabeculectomy. (TABLE 1) In all subjects, there was a mean increase in IOP of 5-8 mm Hg (SD 6-0, 95% confidence interval 4-6, 7-0) at 1 minute after injection. The mean increase in IOP at 5 minutes in those patients who did not undergo ocular compression was 3-6 mm Hg (SD 5-9, 95% CI 2-2, 5 0), compared with baseline. In those patients who received ocular compression, there was a mean decrease in IOP of 5 2 mm Hg (SD 5 5, 95% CI -3*3, -7 0). The maximum IOP rise was 25 mm Hg at 1 minute and 23 mm Hg at 5 minutes (Table 3) (TABLE 1) Both the peribulbar and retrobulbar injection techniques produced a similar increase in IOP at 1 minute and 5 minutes. The difference between techniques was not statistically significant. The mean volume used in the peribulbar injection was 9 ml, and in retrobulbar injection 3-5 ml (p<0-01, unpaired t test).
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