Ophthalmic anaesthesia: Journals & articles

Aims: This international survey was conducted to study the impact of Covid-19 pandemic on the provision and practices of ophthalmic anaesthesia, evaluate the methods employed by parent ophthalmic units for safeguarding their anaesthesia providers and patients during lockdown, and to assess pandemic's effect on anaesthesia providers as individuals. The study was done with the hope that the results will help in protecting patients and safeguarding precious human resource by better management if this pandemic was to continue or there was to be another pandemic.

Methods: An anonymous questionnaire survey was distributed electronically between December 2020-January 2021 to the practicing ophthalmic anaesthesia providers in different parts of the world.

Results: The survey identified that apart from reducing elective operating services, the ophthalmic units were ill prepared for the pandemic and the overall management was lacklustre. There was a definite lack of effective peri-operative patient screening, and, streaming processes. Measures for personal protection of staff were not optimal especially during regional/local ophthalmic anaesthesia. Severity of the pandemic, sudden job plan changes, and redeployment to intensive care units/acute covid wards had an adverse psychological impact on the affected staff.

Conclusion: Ophthalmic anaesthesia services worldwide have had poor attentiveness to the life-threatening menace and reality of Covid-19 pandemic. A review of the institutional practices to address correctible deficiencies is urgently required. Robust, mandatory, elective, timely preventative strategies need to be implemented to protect patients, and, the precious ophthalmic workforce from potential adverse physical and psychological injuries.

Purpose: This secondary analysis of a clinical trial that measured surgeon, anesthesiologist, and patient satisfaction following ophthalmic surgery under monitored anesthesia care (MAC) with a benzodiazepine investigates the degree of association between patient satisfaction with anesthesia compared to surgeon and anesthesiologist satisfaction with anesthesia.

Patients and methods: Data from analogous 6-point surgeon satisfaction surveys and anesthesiologist satisfaction surveys were compared to data from a 6-point validated patient satisfaction survey collected from a clinical trial investigating satisfaction with different forms of benzodiazepine for patients undergoing cataract, retina, cornea, or glaucoma surgery. Relationships between measures were analyzed using Pearson's correlation coefficient, with further subgroup analysis based on language groups and single-question measures of satisfaction.

Results: A total of 283 ophthalmic surgical cases were analyzed. Mean surgeon satisfaction was 5.27 (range, 1.33-6.00), mean anesthesiologist satisfaction was 5.12 (range, 1.17-6.00), and mean patient satisfaction was 5.28 (range, 2.58-6.00). The correlation between surgeon and patient satisfaction was 0.333 (p = 9.06e-9), while the correlation between anesthesiologist and patient satisfaction was 0.319 (p = 4.28e-8). There was no difference between English and non-English speaking patients in correlation between surgeon and patient satisfaction (p = 0.08) and anesthesiologist and patient satisfaction (p = 0.47).

Conclusion: The data demonstrate a low level of association between patient satisfaction with anesthesia and provider satisfaction, even when patient language is taken into consideration. This suggests that providers are poor predictors of patient satisfaction with anesthesia and are unreliable judges of patient comfort perioperatively.

This study aims to evaluate the safety and patient satisfaction of a fast-track procedure for cataract surgery under topical anaesthesia without perioperative anaesthesia care. This is a prospective single-centre study including all cataract procedures in the Centre Ambulatoire de la Chirurgie de la Cataracte at the Hospital of Bourges between May and August 2018. Procedures were performed under topical anaesthesia without the presence of a nurse anaesthesiologist or anaesthesiologist, the patient had not fasted, and no peripheral venous line was placed. Only heart rate and oxygen saturation were monitored intraoperatively with pulse oximetry. Incidence and nature of intraoperative adverse events and surgical complications were recorded. Patient satisfaction was assessed using the Iowa Satisfaction with Anaesthesia Scale (ISAS). In total, 651 cataract surgeries were performed among which 614 (94.3%) were uneventful. Thirty (4.6%) intraoperative adverse events and 8 (1.2%) surgical complications were recorded. All surgeries were successfully completed. No medical emergency team intervention or hospital admittance was encountered. The mean ISAS score was 5.7/6, indicating high patient satisfaction. Cataract surgery in an ambulatory cataract surgery centre without perioperative anaesthesia care is a safe procedure with high patient satisfaction for screened patients. Anaesthesia ressources are scarce and may be more beneficial to more complex ophthalmic or non-ophthalmic surgeries.

We report the anesthetic management of a child diagnosed with Marinesco-Sjogren syndrome (MSS) scheduled for bilateral lens aspiration. MSS is an autosomal recessive multisystem disorder clinically characterized by cerebellar ataxia, cataract, myopathy, global developmental delay, and variable intellect first described by Marinesco et al in 1931.The neuro-radiologic hallmarks include cerebellar hypoplasia and a small posterior fossa.1 Sixty percent of patients have been found to have SIL1 gene mutation linked to chromosome 5q31.

Key points:
• Ophthalmic conditions requiring surgery in children are common.
• Anaesthetic techniques should minimise increases in intraocular pressure, particularly in glaucoma surgery and traumatic eye injuries.
• Ophthalmic surgery can elicit the oculocardiac reflex and is associated with a high incidence of postoperative nausea and vomiting.
• With improved neonatal care, there are increasing numbers of premature and ex-premature infants that require ophthalmic surgery.

Abstract
Purpose: Congenital corneal anesthesia (CCA) is a rare clinical entity that poses a diagnostic dilemma, particularly in the pediatric age group with very little literature on this. Accurate initial diagnosis, evaluation, early identification of risk factors, aggressive systemic workup, and appropriate therapy are paramount to prevent visual loss due to long-term complications of corneal anesthesia. The purpose of the study was to estimate and compare the corneal neural architecture using real time, in vivo confocal microscopy (IVCM) in patients with CCA as against a control population.

Methods: This was a retrospective nonconsecutive, comparative clinical case series in a tertiary hospital in South India from June 2015 to December 2018.

Methods: IVCM was accomplished in cooperative children in whom central cornea was relatively clear. The clearest three to five images from each eye were selected, and the nerves were analyzed for length, thickness, density, dichotomous pattern, and beading. Statistical analysis was done using Origin v7.0 (Origin Lab Corporation, Northampton, MA, USA).

Results: In total, 15 eyes of 11 cases and 20 eyes of 10 controls were imaged. Measurements on corneal nerve density showed a significant difference (P = 0.0005), cases having a lower mean (3.85 ± 1.38 mm per mm2) compared to the controls (6.74 ± 1.75 mm per mm2). Measurements on corneal nerve length (P = 0.28), thickness (P = 0.45), and presence of beading (P = 0.97) and dichotomous pattern (P = 0.07) did not reveal a significant difference between cases and controls.

Conclusion: There is a strong relationship between the functional loss (absent corneal sensation) and anatomical decrease (reduced subbasal nerve density) of corneal nerves in congenital corneal anaesthesia.

BMC Ophthalmology is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of eye disorders, as well as related molecular genetics, pathophysiology, and epidemiology.

his peer-reviewed, open-access journal publishes original case reports covering the entire spectrum of ophthalmology, including prevention, diagnosis, treatment, therapy, supportive care, and quality-of-life issues. Case Reports in Ophthalmology provides clinicians and researchers with a platform to disseminate their findings to a broader ophthalmology community. In addition to single case studies, the journal also accepts papers discussing case series and case reports dealing with the use of novel technologies, both in the area of diagnosis and treatment. Submission of negative results may be considered. Supplementary material is welcomed.

Eye is the official journal of The Royal College of Ophthalmologists. It aims to provide the practising ophthalmologist with information on the latest clinical and laboratory based research. Whilst principally aimed at the practising clinician, the journal contains material of interest to a wider readership including optometrists, orthopists, other health care professionals and research workers in all aspects of the field of visual science.

RANZCO regularly communicates its activities and achievements in eye-health, as well as information deemed of interest to its Fellows and members. Furthermore, RANZCO publishes relevant information relating to eye health and the wellbeing of patients.

Journal of Ophthalmic Surgery is an open access, peer reviewed journal publishes leading-edge research conducted by physicians and ophthalmologists to share, contribute and promote the most advanced diagnostic capabilities and treatment options.

Therapeutic Advances in Ophthalmology is a peer-reviewed, open access journal delivering the highest quality articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of ophthalmology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in ophthalmology, providing a forum for publishing the highest quality articles in this area.