Ophthalmology
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Randomized Controlled Trial Clinical Trial
Bicarbonate-buffered lidocaine-epinephrine-hyaluronidase for eyelid anesthesia.
A double-masked, randomized clinical trial was conducted to determine if subcutaneous eyelid injections of a bicarbonate-buffered lidocaine-epinephrine-hyaluronidase mixture were less painful than unbuffered injections. Twenty-one patients received both buffered (pH = 7.4) and unbuffered (pH = 4.6) injections. ⋯ Seventeen (81%) of 21 patients ranked the buffered injection less painful. Use of a bicarbonate-buffered lidocaine-epinephrine-hyaluronidase mixture is effective in making ophthalmic anesthesia less painful.
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Seven hundred medicolegal claims in ophthalmology were reviewed by one ophthalmologist who served as an expert for four decades. The ophthalmologist was personally involved in 620 claims. ⋯ The reasons for the claims and some lessons derived from them are presented. Familiarity with the claims encountered by others may enable ophthalmologists to avoid similar claims.
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The rewards for suits for medical negligence have generated a service industry for plaintiff's lawyers. The provision of "experts" for a contingency fee and the solicitation of plaintiff's attorneys by some physicians to serve as "experts" for large fees may result in highly biased and inaccurate testimony. Ethical expert witness testimony involves knowledge of the commonly accepted principles of treatment at the time of the alleged negligence, recognition of possible multiple accepted avenues of therapy, and testimony that educates the court and jury rather than obfuscates and distorts for personal gain.
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Topical ocular anesthetic abuse is a serious disorder causing keratitis and persistent epithelial defects. It may be the result of either prescription by the patient's eye care practitioner, theft from the practitioner's office, or occult additives in therapeutic medications. The authors report observations of six individuals suffering from this disorder which suggest that persistent epithelial defects, corneal stromal ring infiltrates, disproportionate pain, and prescription or nonprescription substance abuse may be factors involved. ⋯ Two eyes had a relentless downhill course culminating in enucleation. Because five of the six patients were diagnosed and treated as having presumed Acanthamoeba keratitis during the course of their disease, topical ocular anesthetic use should be included in the differential diagnosis of chronic keratitis and may masquerade as Acanthamoeba keratitis. The authors believe that practitioners should not prescribe or dispense topical anesthetics and should avoid clinical settings which provide an opportunity for the theft of topical ocular anesthetics.