Revue médicale de la Suisse romande
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Primary open angle glaucoma may be a severe ocular disease and may lead to blindness if not diagnosed and/or treated in time. The pathogenic mechanism is a progressive loss of ganglion cells leading to cupping of the optic nerve head. The main risk factor is an elevated intraocular pressure, but optic nerve vascular deficiency, neuronal degeneration or genetic factors have to be considered as other potential risk factors. The actual diagnostic tools and the latest technologies for the medical, laser and surgical treatment are described in this paper.
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The optimization of local anesthesia will be one essential condition to enlarge and improve the ambulatory surgery and its acceptation by the patients. Indication to local anesthesia can be increased by prolongation of its duration through adjunction of adrenaline to lidocaine at a 1:200,000 concentration and by diminishing injection-related pain through buffering the anesthetic solution with a 8.4% sodium bicarbonate solution at a concentration of 1 ml to 10 ml of lidocaine. However, this preparation is unstable and must be utilized within a few days.