Ultra-rapid cooling of eye may provide effective non-pharmacologic anaesthesia

The first-in-human feasibility trial comparing non-pharmacologic, ultra-rapid focal cooling and standard-of-care pharmacological anaesthesia showed the novel method was quicker, was well-tolerated by patients and resulted in similar patient-reported pain scores, according to a speaker American Society of Retina Specialists annual meeting in Vancouver, Canada.

“Ultra-rapid cooling of the eye was well-tolerated and provided effective non-pharmacologic anaesthesia, Dr Cagri Besirli, MD, PhD, said.

“This first-in-human proof-of-concept study indicates that ultra-rapid cooling may be useful for ocular anaesthesia, and we believe that this novel method may be an improved way of delivering anaesthesia and improve patient care of intravitreal delivery,” DrBesirli said.

Current methods have drawbacks

“Thecurrent methods of ocular anaesthesia have a variety of drawbacks, including patient risk for corneal toxicity and subconjunctival haemorrhage. Additionally, surgeons must wait between three and 10 minutes for the anaesthesia to take adequate effect, he said.

Dr Besirli and colleagues created a focal cooling device to provide patients with ocular anaesthesia.

“You put the device about 3 mm to 4 mm from the limbus … activate the cooling and the cold temperatures rapidly penetrate the deep tissue, block the nerve conduction, and once you have this within 10 to 20 seconds, you perform intravitreal injection using standard technique,” he said.

To test the feasibility and efficacy of the technique, 22 patients were included in a single-centre,

Read More >

By | August 1st, 2018|Surgery|

Lasik-surgery’s side-effects attract US attention

Side-effects of Lasik eye surgery is attracting increasing attention in the United States, with patients complaining about impaired vision and chronic pain that has led to job loss and disability, social isolation, depression – and even suicides.

In a feature article, The New York Times newspaper on 11 June reported

the Food and Drug Administration approved the first lasers to correct vision in the 1990s, with roughly 9.5 million Americans having had laser eye surgery, “lured by the promise of a quick fix ridding them of nettlesome glasses and contact lenses”.

The New York Times report said there is also a wide perception among patients, fostered by many ophthalmologists who do the surgery, that the procedure is virtually fool-proof.

However, as far back as 2008, patients who had received Lasik and their families testified at an FDA meeting about impaired vision and chronic pain that led to job loss and disability, social isolation, depression – and even suicides, the report said.

Even now, serious questions remain about both the short- and long-term risks and the complications of this increasingly common procedure, it said.

Nearly half of all people who had healthy eyes before Lasik developed visual aberrations for the first time after the procedure, the trial found. Nearly one-third developed dry eye for the first time.



Read More >

By | June 24th, 2018|Surgery|

Kids who have general anaesthetic perform worse at NAPLAN: Sydney University study

Children who have a general anaesthetic in the first four years of life have substantially worse literacy and numeracy skills a new study has found.

University of Sydney researchers compared the developmental and NAPLAN results of nearly 38,880 children who had a general anaesthetic to 197,301 who had no exposure to anaesthetic.

Compared to children with no exposure to general anaesthesia, those exposed to general anaesthesia had a:

  • 17 per cent increased risk of poor child development
  • 34 per cent increased risk of lower numeracy scores on school tests
  • 23 per cent increased risk of lower reading scores on school tests.

The children were born in New South Wales at 37-plus weeks’ gestation without major congenital anomalies or neurodevelopmental disability.

When the researchers restricted their analyses to children who’d had only one hospitalisation involving a procedure requiring general anaesthesia, they found no increased risk for poor development or reduced reading scores, however the risk of poor numeracy scores remained.

“There are many reasons why a child requires surgery or investigation, and, in some cases, this may be lifesaving or unavoidable,” said the study’s senior author, Professor Natasha Nassar of the University of Sydney.

“For these children, our findings suggest that it is important to follow-up and monitor their literacy and numeracy skills when they reach school,

Read More >

By | April 29th, 2018|Surgery|

Ocular inflammation risk linked to drug syringes

 

Ophthalmologists in the United States report having seen an increase in a rare side effect in patients receiving injections of Regeneron’s Eylea.

After the drug is injected into the eye, a small number of people in the US have had a sharp decline in sight and experience pain.

Australia is not affected by the side effects from the injection.

The effect is treatable and doesn’t lead to long-term vision loss. Regneron says an extensive investigation shows that this side effect has been tied to syringes used to inject Eyelea into the eye.

The company plans to stop distributing some Eylea kits that contain syringes made from batches that were linked to higher rates of the condition, known as intraocular inflammation.

Regeneron disclosed the association between the syringes and the inflammation in a letter sent to ophthalmologists and posted on the company’s website on 7 March, following a report by Bloomberg News the previous week about an unexplained increase in the side effect.

In a separate statement Regeneron said ophthalmologists shouldn’t use syringes that are included in some – but not all – Eylea packages.

The investigation, which is still under way, didn’t find any specific flaw with the syringes, though their use was more common among patients who developed the side effect, the company said.

Regeneron will exchange

Read More >

By | March 11th, 2018|Surgery|

‘Bionic’ retina implant to undergo clinical feasibility study in US

A ‘bionic’ retina implant is to undergo clinical feasibility study in the United States.

The study follows the United States Food & Drug Administration’s approval of the study of Pixium Vision’s PRIMA device.

France-based Pixium Vision says the clinical feasibility study should begin in the first half of this year at the University of Pittsburgh Medical Center.

Up to five patients who have lost their sight because of atrophic dry AMD are set to be fitted with a ‘bionic’ retinal implant designed to restore some basic visual function. Pixium’s FDA approval comes just a few months after health authorities in France permitted a similar trial there, with five patients set to receive the implant at a Paris hospital.

The PRIMA system, which uses external glasses in combination with the implant, is designed to provide partial restoration of the patient’s visual function through electrical stimulation of retinal neurons, with the sub-retina implanted stimulator replacing part of the degenerated photoreceptors.

More information: http://optics.org/news/8/12/44.

By | February 4th, 2018|Surgery|

Transplanted retinal cells cause swelling to retina; not likely to affect future clinical studies

A patient who underwent transplant surgery using retinal cells derived from artificially-derived induced pluripotent stem cells has suffered a swollen retina, according to researchers from Kobe City Medical Center General Hospital and the Japan-government-backed Riken Institute.

The research team said it is the first time a patient has developed a serious adverse reaction during the clinical research to assess the feasibility of using iPSCs.

Surgeons operated on the patient, who is in his 70s, to remove pre-retinal membrane, deemed to be the cause of the retinal oedema. The team was unable to improve the symptoms despite the administration of steroid and anti-VEGF medication.

Dr Masayo Takahashi, MD, a researcher at Riken who heads the team, said: “We cannot deny the causal correlation with iPS cells.”

Dr Takahashi said the symptom falls into the category of serious cases, as it requires hospital admission for treatment, but stressed that it is “neither a matter of great urgency nor life-threatening.”

The incident most likely will not affect future clinical studies on the transplantation of iPS-derived retinal cells in patients with severe eye diseases, Dr Takahashi said.

The patient’s condition improved after the removal of pre-retinal membrane. The team believes the oedema was caused by a reverse in the flow of a liquid solution containing retinal cells derived from iPS

Read More >

By | February 4th, 2018|Surgery|

‘Bionic’ retina implant to undergo clinical feasibility study in United States

A ‘bionic’ retina implant is to undergo clinical feasibility study in the United States.

The study follows the United States Food & Drug Administration’s approval of the study of Pixium Vision’s PRIMA device.

France-based Pixium Vision says the clinical feasibility study should begin in the first half of this year at the University of Pittsburgh Medical Center.

Up to five patients who have lost their sight because of atrophic dry AMD are set to be fitted with a ‘bionic’ retinal implant designed to restore some basic visual function. Pixium’s FDA approval comes just a few months after health authorities in France permitted a similar trial there, with five patients set to receive the implant at a Paris hospital.

The PRIMA system, which uses external glasses in combination with the implant, is designed to provide partial restoration of the patient’s visual function through electrical stimulation of retinal neurons, with the sub-retina implanted stimulator replacing part of the degenerated photoreceptors.

 

By | January 24th, 2018|Surgery|

Transplanted retinal cells cause swelling to retina; not likely to affect future clinical studies

A patient who underwent transplant surgery using retinal cells derived from artificially derived induced pluripotent stem cells has suffered a swollen retina, according to researchers from Kobe City Medical Center General Hospital and the Japan-government-backed Riken Institute.

The research team said it is the first time a patient has developed a serious adverse reaction during the clinical research to assess the feasibility of using iPSCs.

Surgeons operated on the patient, who is in his 70s, to remove pre-retinal membrane, deemed to be the cause of the retinal oedema. The team was unable to improve the symptoms despite the administration of steroid and anti-VEGF medication.

Causal correlation

Dr Masayo Takahashi, MD, a researcher at Riken who heads the team, said, “We cannot deny the causal correlation with iPS cells.”

She said the symptom falls into the category of serious cases, as it requires hospital admission for treatment, but stressed that it is “neither a matter of great urgency nor life-threatening.”

The incident most likely will not affect future clinical studies on the transplantation of iPS-derived retinal cells in patients with severe eye diseases, Dr Takahashi said. \The patient’s condition improved after the removal of pre-retinal membrane.

Reverse in flow of liquid

The team believes the oedema was caused by a reverse in the flow of a liquid solution containing

Read More >

By | January 24th, 2018|Surgery|

248,000 cataract procedures in 2015-16

A total of 248,000 cataract-extraction procedures were carried out in Australian hospitals in 2015-16, according to a report by the Canberra-based Australian Institute of Health and Welfare.

Ninety-seven per cent of the procedures involved surgery and were carried out on the same day. They were the highest hospitalisations per 1,000 population.

The 248,000 procedures was 62 per cent of the total of 397,000 eye procedures undertaken during 2015-16 (the other two procedures totalling 56,000 for macular degeneration and 6,000 for glaucoma).

All up, there were 1,331 hospitals providing in-hospital services of all kinds – 701 public and 630 private – totalling 10.6 million hospitalisations.

There were about 360,000 full-time equivalent staff employed in providing public hospital services, of which 41 per cent were nurses, 12 per cent salaried medical officers and 16% diagnostic and allied health professionals.

Private hospitals employed about 66,800 full-time equivalent staff, 56 per cent of whom were nurses, 29 per cent were salaried medical officers and 6 per cent were diagnostic and allied health professionals.

Procedures on the eye and adnexa were carried out in private hospitals, including cataract surgery).

For cataract extraction, 3 per 1,000 hospitalisations were followed by a readmission within 28 days, compared to tonsillectomy and adenoidectomy, for example, of 35 per 1,000 readmission within 28 days.

Waiting time for public-hospital

Read More >

By | July 26th, 2017|Surgery|