- Variation in intraocular pressure caused by repetitive positional changes during laparoscopic colorectal surgery: a prospective, randomized, controlled study comparing propofol and desflurane anesthesia. [Journal Article]
- JCJ Clin Monit Comput 2018 Feb 19
- Laparoscopic surgery is often prolonged and requires positional changes to facilitate surgical access. Previous studies reported intraocular pressure (IOP) changes in one fixed position. This study i...
Laparoscopic surgery is often prolonged and requires positional changes to facilitate surgical access. Previous studies reported intraocular pressure (IOP) changes in one fixed position. This study investigated the effect of desflurane and propofol anesthesia on IOP during repeated positional changes. A total of 46 patients undergoing laparoscopic colorectal surgery were randomized into desflurane or propofol groups. IOP was measured using a handheld tonometer at seven time points: before induction (baseline), after endotracheal intubation, after pneumoperitoneum, after the first Trendelenburg and right tilt position, after reverse Trendelenburg and right tilt position, after the second Trendelenburg and right tilt position and before endotracheal extubation. Trendelenburg positioning raised IOP in both groups. In the desflurane group, IOP at the first Trendelenburg position was 6.27 and 8.48 mmHg higher than baseline IOP in left and right eye, respectively; IOP at the second Trendelenburg position was 7 and 9.44 mmHg higher than baseline in left and right eye, respectively. In the propofol group, IOP at the first Trendelenburg position was 2.04 and 4.04 mmHg higher than baseline in left and right eyes, respectively. It was 3.04 and 4.87 mmHg higher than baseline in left and right eye, respectively, at the second Trendelenburg position. In the desflurane group, 56.52% patients exhibited high IOP (≥ 25 mmHg) compared with 13.04% in the propofol group at the second Trendelenburg position in the right eyes (P = 0.005). There was a positive correlation between IOP and peak inspiratory pressure (P < 0.001). Propofol anesthesia mitigated wide variations in IOP caused by repetitive positional changes during laparoscopic colorectal surgery.
- EXTRAHEPATIC TOXICITY OF ACETAMINOPHEN: CRITICAL EVALUATION OF THE EVIDENCE AND PROPOSED MECHANISMS. [Journal Article]
- JCJ Clin Transl Res 2018 Jan 15; 3(3)
- Research on acetaminophen (APAP) toxicity over the last several decades has focused on the pathophysiology of liver injury, but increasing attention is being paid to other known and possible adverse ...
Research on acetaminophen (APAP) toxicity over the last several decades has focused on the pathophysiology of liver injury, but increasing attention is being paid to other known and possible adverse effects. It has been known for decades that APAP causes acute kidney injury, but confusion exists regarding prevalence, and the mechanisms have not been well investigated. More recently, a number of experimental, clinical and epidemiological studies have reported evidence for pulmonary, endocrine, neurological and neurodevelopmental toxicity, but the quality of evidence from those studies varies. It is important to consider these data due to implications for regulation and clinical practice. Here, we review the evidence and proposed mechanisms for extrahepatic adverse effects of APAP and weigh weaknesses and strengths in the data. We consider results from clinical, epidemiological and experimental research. Our goal is to determine the strength of claims regarding extrahepatic toxicity of APAP and to identify areas of need for future research. It is especially important to view claims of developmental effects of antenatal APAP exposure with a critical eye because APAP is currently the only over-the-counter medication recommended for pregnant women to self-treat pain and fever.
- Effects of Higher Versus Lower Threat Contexts on Pain-Related Visual Attention Biases: an Eye-Tracking Study of Chronic Pain. [Journal Article]
- JPJ Pain 2018 Feb 13
- CONCLUSIONS: Through integrating dot-probe and impending pain task paradigms, we assessed effects of lower versus higher threat contexts on visual attention biases of persons with chronic pain via eye-tracking. Under higher threat conditions featuring possible pain, state fear levels were elevated and maintenance of attention on painful depictions was more prolonged.
- Delta Opioids: Neuroprotective Roles in Preclinical Studies. [Journal Article]
- JOJ Ocul Pharmacol Ther 2018 Jan/Feb; 34(1-2):119-128
- Since ancient times, opioids have been used clinically and abused recreationally. In the early stages (about 1,000 AD) of opium history, an Arab physician, Avicenna, administered opioids to control d...
Since ancient times, opioids have been used clinically and abused recreationally. In the early stages (about 1,000 AD) of opium history, an Arab physician, Avicenna, administered opioids to control diarrhea and eye diseases.1Opioids have very strong pain relieving properties and they also regulate numerous cellular responses. Opioid receptors are expressed throughout the body, including the nervous system, heart, lungs, liver, gastrointestinal tract, and retina.2-6Delta opioid receptors (DORs) are a very attractive target from the perspective of both receptor function and their therapeutic potential. Due to a rapid progress in mouse mutagenesis and development of small molecules as DOR agonist, novel functions and roles of DORs have emerged in recent years. This review article focuses on the recent advances in the neuroprotective roles of DOR agonists in general and retina neuroprotection in particular. Rather than being exhaustive, this review highlights the selected studies of DOR function in neuroprotection. We also highlight our preclinical studies using rodent models to demonstrate the potentials of DOR agonists for retinal neuroprotection. Based on existing literature and our recently published data on the eye, DOR agonists possess therapeutic abilities that protect the retina and optic nerve injury against glaucoma and perhaps other retinopathies as well. This review also highlights the signaling events associated with DOR for neuroprotection in the eye. There is a need for translational research on DORs to recognize their potential for clinical application such as in glaucoma.
- Orbital cellulitis and brain abscess - rare complications of maxillo-spheno-ethmoidal rhinosinusitis. [Journal Article]
- RJRom J Ophthalmol 2017 Apr-Jun; 61(2):133-136
- Sinus infections can be complicated by ocular infections and, in late phases, by brain parenchyma infection. The article debates the case of a 12-year-old patient suffering from paucisymptomatic maxi...
Sinus infections can be complicated by ocular infections and, in late phases, by brain parenchyma infection. The article debates the case of a 12-year-old patient suffering from paucisymptomatic maxillo-spheno-ethmoidal rhinosinusitis, which was later complicated by orbital cellulitis, ending with the development of a brain abscess. The treatment is complex, initially targeting the source of the infection through draining the collection by middle maxillary antrostomy and anterior posterior ethmoidectomy, then the ablation of the brain abscess and postoperatively with prolonged massive antibiotherapy.Abbreviation:URI = upper respiratory infection, CT = computer tomography, MRI = magnetic resonance imaging, BA = brain abscess, VAS = visual scale of pain, ENT = ear, nose, throat, RE VA = right eye visual acuity, RE = right eye, CSF = cerebrospinal fluid.
- IRIDEX MicroPulse P3: innovative cyclophotocoagulation. [Journal Article]
- RJRom J Ophthalmol 2017 Apr-Jun; 61(2):107-111
- Purpose: To present the new IRIDEX MicroPulse P3 (MP3) technology in patients with refractory glaucoma and our preliminary results at 1 week and 1 month postoperatively.Methods:IR...
Purpose: To present the new IRIDEX MicroPulse P3 (MP3) technology in patients with refractory glaucoma and our preliminary results at 1 week and 1 month postoperatively.Methods:IRIDEX MP3 laser cyclophotocoagulation was performed in 7 eyes of 7 patients under retrobulbar anaesthesia with lidocaine 2% in the operating room. Each eye received two treatments of 80-90s over the superior and inferior hemisphere, avoiding the temporal- and nasal-most clock hours. 810nm IRIDEX MP3 was set to 31,3% duty cycle (0,5ms treatment pulse followed by 1,1 ms of rest). Postoperative topical steroids were prescribed for 1 week.Results:Mean IOP decrease at 1 week was 60,3% and 33,4% at 1 month, with a mean topical hypotensive treatment reduction of 0,71 therapeutic agents. The procedure was safe in all cases and effective in 71% of the patients. Neovascular glaucoma patients registered high IOP levels 1 month postoperatively in spite of medical and MP3 laser treatment. BCVA remained unchanged after undertaking the laser procedure. No significant inflammation, discomfort, or pain was reported. There were no complications such as hypotony, phthisis bulbi, and macular edema.Conclusions:IRIDEX MP3 represents an innovation in cyclophotocoagulation. It is non-destructive, repeatable, non-invasive, with a high safety profile. A mean IOP decrease of 33,4% was registered at 1 month. Patient comfort and recovery are favorable. Long-term results will prove its efficacy in the future.
- Intraocular ossification. Case report. [Journal Article]
- RJRom J Ophthalmol 2017 Jan-Mar; 61(1):65-68
- Objective: To report a case of intraocular ossification, describe its particularities and review some of the pathogenesis theories.Methods:We described the case of a 31-year-old w...
Objective: To report a case of intraocular ossification, describe its particularities and review some of the pathogenesis theories.Methods:We described the case of a 31-year-old woman with a history of perforating trauma ten years before, who presented in our clinic for right eye pain. The patient wanted a cosmetic improvement so an evisceration was proposed. An intraocular hard yellowish mass, which had a histopathological examination, was found intraoperatively.Results:We diagnosed the case as an intraocular ossification, based on the medical history and histopathological specimen examination, which proved to be an ossified structure.Conclusions:In spite of a rare occurrence, our case emphasized the theory that trauma and subsequent neurogenic inflammation could lead to osseous metaplasia.
- Penetrating corneal wound with traumatic cataract and intraocular foreign body-case report. [Journal Article]
- RJRom J Ophthalmol 2017 Jan-Mar; 61(1):54-59
- Open globe injuries complicated with the presence of an intraocular foreign body mostly affect young males and represent a vision threatening condition. We presented the case of a 48-year-old male wh...
Open globe injuries complicated with the presence of an intraocular foreign body mostly affect young males and represent a vision threatening condition. We presented the case of a 48-year-old male who presented to our emergency service due to ocular pain and blurred vision in his right eye. A metallic foreign body situated between 1 and 12 o'clock, near the corneoscleral limbus, that perforated the cornea, the iris, the anterior capsule of the lens and the lens, was detected at the slit-lamp examination. We decided to immediately remove the foreign body that was approximately 20 mm long. The following day, traumatic cataract had already developed, so we performed cataract extraction. Despite the dimensions of the intraocular foreign body, the retina was attached and there were no sign of retinal tears or vitreous haemorrhage. The proper management in this case led to good results in spite of the dimensions of the intraocular foreign body.Abbreviations:IOFB = Intraocular Foreign Body, IOL = Intraocular Lens, PVR = Proliferative Vitreo-Retinopathy.
- Necrotizing retinitis of multifactorial etiology. [Journal Article]
- RJRom J Ophthalmol 2017 Jan-Mar; 61(1):49-53
- Introduction. We present the case of a 73-year-old woman with osteoporosis, who presented to the emergency room with a sudden vision loss and ocular pain in the right eye, which a...
Introduction. We present the case of a 73-year-old woman with osteoporosis, who presented to the emergency room with a sudden vision loss and ocular pain in the right eye, which appeared two days before. The patient mentioned loss of appetite, weight loss for three months and low fever for two weeks.Materials and methods.Among the ophthalmological findings, the most important were panuveitis, and large confluent necrotic areas in the peripheral retina. The patient was diagnosed with RE Panuveitis and acute necrotizing retinitis.Results.Blood exams showed leukocytosis and monocytosis, thrombocytosis and anemia. Further investigations showed high levels of Cytomegalovirus (CMV) anti IgG and Herpes Simplex (HS) type 1 virus anti IgM, urinary infection, and secondary hepatic cytolysis. The CT and MRI of the thorax and abdomen showed no sign of neoplastic disease, and no explanation for the CMV infection was found. The patient received general corticotherapy and antiviral therapy, and, after one month, RE BCVA was 20/ 30.Particularity of the case.Acute necrotizing retinitis in an old patient with CMV and HSV type 1, associated with secondary hepatic cytolysis, without any other immunosuppressive disease and very good outcome.
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- [Prospective, monocentric, uncontrolled study of efficacy, tolerance and adherence of cyclosporin 0.1 % for severe dry eye syndrome]. [Journal Article]
- JFJ Fr Ophtalmol 2018 Feb 12
- CONCLUSIONS: Ikervis®is an effective treatment of severe dry eye. Its indications tend to evolve towards less severe dry eye. However, the tolerability profile remains poor, and an improvement in this would be desirable.