Eye
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Clinical Trial
Combined radiotherapy and medical immunosuppression in the management of thyroid eye disease.
Although systemic steroids or orbital radiotherapy are effective in limiting the inflammatory response in thyroid eye disease (TED), there are reports of over 70% of treated patients requiring subsequent rehabilitative surgery: either orbital decompression or strabismus correction. This study investigated whether combined immunosuppression with primary orbital radiotherapy together with azathioprine and low-dose prednisolone, applied early in the active disease state, was more effective in treating TED. Forty consecutive patients with active TED were recruited. ⋯ One patient required subsequent cosmetic orbital decompression, 6 had successful strabismus surgery and 13 required minor cosmetic lid surgery. Compared with previously reported treatment regimes we think that combined orbital radiotherapy and medical immunosuppression is far more effective than either treatment alone in the management of active TED, and led to fewer side effects of high-dose steroids. In particular there was more than a four-fold reduction in the requirement for orbital decompression and strabismus surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Peribulbar anaesthesia for cataract surgery: prilocaine versus lignocaine and bupivacaine.
Prilocaine has recently been introduced for use in ocular local anaesthesia. A prospective randomised double-masked study was undertaken to assess the efficacy of prilocaine 2% plain versus a mixture of lignocaine 1% and bupivacaine 0.5%, each with hyaluronidase. ⋯ Prilocaine is a useful alternative anaesthetic agent for eye surgery that has low toxicity and is effective without adrenaline.
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Randomized Controlled Trial Comparative Study Clinical Trial
Warming lignocaine reduces the pain of injection during local anaesthetic eyelid surgery.
The injection of local anaesthetic solutions is frequently a painful and unpleasant experience for patients. A double-masked randomised controlled trial was performed to study the potential benefit of warming lignocaine during local anaesthetic minor surgical procedures on the eyelids. The pain of subcutaneous injection of 1.5 ml of 2% lignocaine at room temperature (cold) and body temperature (warm) was compared in 60 patients during the surgical incision of solitary meibomian cysts of one eyelid. ⋯ The median pain score for the group receiving cold anaesthetic (19.5) was found to be greater than that for the warm group (10.0; p = 0.02). In conclusion, the simple process of warming lignocaine to 37 degrees C was found to reduce the pain associated with its injection significantly. It is recommended that this technique be more widely adopted in order to minimise patients' discomfort.