This study aimed to assess the efficacy of suprachoroidal TA injection for treating diabetic macular edema resistant to anti-VEGF agents. A prospective study was conducted in Ophthalmology Department Service Hospital, Lahore, from December 2020 to December 2021. A total of 60 patients were included in the study. Suprachoroidal TA injection 4 mg/0.1 mL was given after diagnosing resistant DME. The injection was administered every 3 months during the follow-up period (12 months) if intraretinal cysts, intraretinal or subretinal fluid persisted and CMT remained > 250 µm. The primary endpoint was CMT reduction and BCVA improvement after 12 months of injection. The secondary endpoint was assessing the safety of TA injection. The mean CMT at baseline was 478.6±170.1 µm, and after 12 months, it was 230.1 ± 47.5 µm. This decrease was statistically significant (P< .001). The mean BCVA at baseline was 1.194±0.1; after 12 months, it was 0.75±0.2 (P<.001). After one month of injection, IOP reached the maximum value (13.2±0.4 mmHg) compared to the baseline (12.32±0.1mmHg). It gradually declined with the use of topical beta blockers and reached baseline value at 3rd month, and glaucoma surgery was not needed in any patient. Suprachoroidal TA injection effectively treats resistant DMA and leads to SCVA improvement and CMT reduction.
Objective: Brachial plexus block is one of the commonly used anesthetic technique for upper limb procedures in orthopedics. A number of drugs have been used as adjuvants to local anesthetic agents, to prolong the duration and enhance the quality of the block. Some of these are clonidine, dexmedetomidine, ketamine, dexamethasone and magnesium sulfate. We conducted this study to evaluate dexmedetomidine and dexamethasone with respect to the onset and duration of sensorimotor block. Their effects on hemodynamic parameters as well as duration of analgesia after surgery were also recorded. Study Design: Prospective Randomized controlled design. Settings: Anesthesia, ICU and pain management department of Services Hospital/SIMS, Lahore Pakistan. Duration: From 15th September 2019 till 15th March 2020. Methodology: Sixty patients fulfilling the inclusion criteria were enrolled in the study after taking informed written consent for upper limb procedures under supraclavicular brachial plexus block. These patients were divided into two groups BD and BG with 30 patients in each group. Patients in Group BD received 32ml of 0.375% bupivacaine (30 ml) with 100microgram of dexmedetomidine(2ml). Group BG patients received 32ml of 0.375% bupivacaine(30ml) with 8mg of dexamethasone (2ml). The onset and duration of sensory and motor block, time to request for first rescue analgesic and hemodynamic changes in both groups of patients were recorded. Results: The results of our study revealed that the patients in group BD had earlier onset and longer duration of sensory and motor block with minimal hemodynamic changes. Conclusion: Dexmedetomidine is superior to dexamethasone as an adjuvant, in terms of rapid onset and prolonged duration of sensorimotor block and postoperative analgesia after supraclavicular block, with minimal hemodynamic changes.
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