Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft
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Review Comparative Study
[Blunt ocular trauma. Part I: blunt anterior segment trauma].
Blunt ocular traumas include contusions and ruptures of the globe--open and closed globe injuries. Characteristic damage results in anterior and posterior segment trauma. Typical patterns of injuries are combinations of (1) hyphema grade II-IV, iris-lens injury, vitreal bleeding--choroidal rupture and increased risk of rebleeding, (2) angle recession >180 degrees--secondary open-angle glaucoma, and (3) vitreal prolapse and lens dislocation-retinal detachment. Patients with blunt eye trauma should be under steady observation by an ophthalmologist to handle late complications.
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Postoperative nausea and vomiting (PONV) are the most common side effects following anesthesia. It is unpleasant for the patients and has significant impact on postoperative well-being. After ophthalmic surgery arterial hypertension caused by retching and vomiting can cause intraocular bleeding with detrimental effects on the result of surgery. ⋯ Also, dexamethasone is a potent antiemetic drug that can favorably be combined with the 5-HT(3) antagonists. Dimenhydrinate is well accepted and an effective antiemetic for pediatric patients. By combining these antiemetic measures PONV can be lowered to a clinically satisfying level even in high-risk patients.
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In recent years anesthesia modalities have changed in ophthalmic surgery. A growing trend toward the use of topical anesthesia in cataract surgery is apparent. ⋯ Injectable anesthesia (RBA, PBA, STA) provides a higher level of analgesia and globe akinesia. With injection techniques the risks of vis a tergo and anesthetic complications increase; the level of analgesia after topical anesthesia could be improved by supplementation with i.v. narcotics.