Journal français d'ophtalmologie
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Randomized Controlled Trial Comparative Study Clinical Trial
[Peribulbar anesthesia: comparing 1% ropivacaine and a mixture of 0.5% bupivacaine--2% lidocaine].
To compare the efficacy of 1% ropivacaine with a mixture of 0.5% bupivacaine and 2% lidocaine in peribulbar anesthesia for elective cataract surgery. ⋯ No difference between the groups was noted during the study regarding not only onset time, but also the duration of anesthesia and perioperative analgesia. A greater incidence of pain on injection was significantly reported in group 2 (p<0.001). Patients in group 1 had less need for top-up injection and showed better ocular akinesia (p<0.01).
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The authors describe the case of a patient with bilateral retinal detachment. Immediately after surgery for the second eye under general anesthesia with nitrous oxide, the patient reported severe visual loss in the first eye successfully treated surgically 2 weeks before, with a residual gas bubble (C3F8) of 50%. In this case, nitrous oxide had rapidly entered the gas bubble and induced a transient expansion of the gas tamponade with a dramatic increase in intraocular pressure. ⋯ Nitrous oxide is regularly used but contraindicated if intraocular gas is present, due to its potential threat to visual function. We suggest that patients anesthetized with nitrous oxide carry a card or a bracelet detailing the risks of intraocular gas tamponades combined with nitrous oxide and with travel to high altitudes. This would inform not only patients but also medical personnel caring for these patients.
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Orbital emphysema is a common complication of orbital wall fractures (50% of blow-out fractures). It is generally a benign and self-limited condition. However, it may compromise retinal and optic nerve vascularization and therefore requires rapid management. ⋯ The development of orbital emphysema after an orbital fracture is a consequence of a forceful expiratory effort raising intranasal pressure. It must be drained, as described, in cases of vascular compression.
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To evaluate the French waiting list and the indications of registered patients, to compare the rates of registration, graft, and procurement between French regions. ⋯ Ophthalmologists will be able to register their patients directly on the waiting list, which will improve data quality for transplantation notification. Regional policies should be developed to decrease the inequalities of graft shortages between regions.