To investigate the effect of cataract extraction on the visual fields of patients with open-angle glaucoma. Methods: Patients in a prospective cohort study in a tertiary center underwent standard automated perimetry every 6 months. We compared the mean results of the 2 examinations immediately before and 2 examinations immediately after phacoemulsification cataract extraction and intraocular lens implant (effect analysis) and the mean results of the first 2 and last 2 examinations from 4 consecutive examinations obtained more than 1 year after the cataract surgery (control analysis). Results: Our sample contained 34 eyes of 26 patients (mean±SD age, 69.2 ± 10.8 years). While the mean log-MAR best-corrected visual acuity improved significantly by approximately 2 Snellen lines after surgery (PϽ.001), the average change in mean deviation in both
To evaluate optic disc topography changes after intraocular pressure (IOP) modulation in patients with glaucoma. Methods: Twenty-three patients with glaucoma were studied. Three mean optic disc topography images were obtained with the Heidelberg Retina Tomograph II at baseline and weeks 1, 2, 4, and 8 (visits 1, 2, 3, 4, and 5, respectively). Topical medications were discontinued in the study eye after visit 1 and resumed after visit 4 but maintained in the contralateral control eye. Central corneal thickness was measured at the last visit. Topographic changes were determined by stereometric parameters (rim area and mean cup depth) and at discrete topographic locations using the Topographic Change Analysis program (from the Heidelberg Retina Tomograph II). Results: In the study eyes, IOP increased significantly (5.4 mm Hg at visit 4; PϽ.001) after withdrawal of topical medications but returned to baseline levels after resuming medications; no statistically significant topographic changes, however, were observed. Moreover, no relationship between change in IOP and stereometric parameters was observed. Central corneal thickness was not associated with changes in optic disc topography induced by IOP modulation. Conclusion: In patients with glaucoma, significant but relatively moderate IOP increases and decreases on the order of 5 mm Hg did not appear to have an effect on optic disc topography.
Aims: To compare the analgesic properties of lidocaine 2% jelly versus sub-Tenon's anaesthesia with lidocaine 2% without adrenaline (epinephrine) for trabeculectomy surgery. Methods: A prospective randomised clinical trial. 59 consecutive patients scheduled for trabeculectomy at the Toronto Western Hospital were randomly assigned to topical unpreserved lidocaine 2% jelly or sub-Tenon's anaesthesia with 2% lidocaine. Both groups received a standardised sedative consisting of midazolam, fentanyl. and/or propofol. The visual analogue scale was utilised to measure intraoperative pain. Patient comfort, physician assessment of intraoperative patient compliance, volume of local anaesthetic used, need for supplemental anaesthesia, and any complications were recorded. The two groups were compared using the Student's t test. Results: The sub-Tenon's anaesthesia group and the lidocaine 2% jelly group did not vary significantly in subjective pain score (18.3 (SD 16.2) v 19.8 (12.4) respectively, p = 0.739) and surgeons' satisfaction scale (3.6 (0.7) and 3.8 (0.6) respectively, p = 0.328). Four patients required additional anaesthesia, all of them in the sub-Tenon's group. Conclusion: Topical lidocaine 2% jelly is as effective as subTenon's anaesthesia for pain control in patients undergoing trabeculectomy. Lidocaine 2% jelly is similar to sub-Tenon's anaesthesia in patient comfort and surgeon satisfaction.
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