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ABSTRACT: We report an atypical case of scleral perforation due to an inadvertent intravitreal lidocaine injection following palpebral anesthesia. We discuss the management of this rare complication and focus on the transient lidocaine toxicity on human retina.
A 29-year-old man presented with unilateral decreased vision during a lower right palpebral anesthetic injection for a chalazion removal procedure. The patient's vision was light perception. Examination revealed intraocular pressure at 55 mmHg, a wound of the posterior crystalloid, an intraocular gas bubble, and a central retinal artery spasm. On ERG, the b wave was decreased. The central retinal artery spasm resolved with prompt reduction of hypertony. Twenty-four hours later, the vision was 6/10 and the ERG showed an increased b wave activity. No clinical retinal toxicity of lidocaine was observed. Only a subcapsular cataract was observed, which had caused the loss of vision.
This case confirms that lidocaine is well tolerated by the retina and reminds us that superficial palpebral anesthetic injection should be done with great caution.
Journal francais d'ophtalmologie 03/2006; 29(2):176-80. · 0.51 Impact Factor
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ABSTRACT: Liposomes are vesicular lipidic systems allowing encapsulation of drugs. This article reviews the relevant issues in liposome structure (composition and size), and their influence on intravitreal pharmacokinetics. Liposome-mediated drug delivery to the posterior segment of the eye via intravitreal administration has been addressed by several authors and remains experimental. Liposomes have been used for intravitreal delivery of antibiotics, antivirals, antifungal drugs, antimetabolites, and cyclosporin. Encapsulation of these drugs within liposomes markedly increased their intravitreal half-life, and reduced their retinal toxicity. Liposomes have also shown an attractive potential for retinal gene transfer by intravitreal delivery of plasmids or oligonucleotides.
Journal Français d Ophtalmologie 12/2003; 26(9):981-5. · 0.51 Impact Factor
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ABSTRACT: To report incidence and circumstances of aphakic anterior chamber intraocular lens implantation.
Retrospective study of medical charts of anterior chamber intraocular lens implantation in the Ophthalmology Department, Hôtel Dieu, Paris, from 1996 to 2000, investigating the number of anterior intraocular lenses (ACIOL) implanted, circumstances, and incidence during cataract extraction.
One hundred and forty-three ACIOLs (139 patients, 60 men, 79 women) were implanted. The mean age was 75.98+/-10.6 years [range, 35-96 years]. All ACIOLs were of open-loop design: open C-loop or Kelman lens. Four circumstances leading to ACIOL implantation were reported: extracapsular cataract extraction with intraoperative complications (94 cases), intracapsular cataract extraction (13 cases), secondary implantation (20 cases), and penetrating keratoplasty with ACIOL (9 cases). Since 1996, the number of ACIOLs implanted each year has decreased (p<0.01): 1.09% of cataract extractions performed in 1996 were implanted with ACIOLs and 0.43% in 2000. At the end of the 5-year period, 12,580 cataract extractions had been performed in our department, with a mean incidence of ACIOL implantation at 0.85%.
ACIOLs continue to be implanted in some cases in the absence of capsular support. Because of endothelial complications, they must be reserved for elderly patients. Endothelial surveillance using specular microscopy remains indispensable.
Journal Français d Ophtalmologie 05/2003; 26(4):344-9. · 0.51 Impact Factor
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ABSTRACT: This is the first report of three cases of severe acute corneal graft rejection, treated by transscleral methylprednisolone (Solumédrol) iontophoresis. The efficacy of the treatment was evaluated by corneal transparency, visual acuity and corneal inflammation parameters. The patient was treated with Solumédrol iontophoresis once a day for 3 days with a topical corticotherapy reduced to three drops of dexamethasone per day. Iontophoresis was performed, under topical anesthesia, and lasted 3 minutes with a 1.5-mA current. The subjective and objective tolerance of iontophoresis was good. No side-effect was observed. Corneal transparency and visual acuity improved rapidly after the second iontophoresis procedure. These observations show that Solumédrol iontophoresis might be an alternative to pulse therapy in the treatment of corneal graft rejection. Further comparative studies are necessary to confirm these preliminary observations.
Journal Français d Ophtalmologie 05/2003; 26(4):391-5. · 0.51 Impact Factor
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ABSTRACT: Interesting results have been reported on the use of pars plana vitrectomy with adventitial sheathotomy for the decompression of branch retinal vein occlusions (BRVO). Recent onset BRVO responsible for a visual acuity of 20/40 or less have been estimated to be good candidates for this procedure. We report on the results of the prospective evaluation of three eyes (in three patients) with recent onset BRVO which underwent surgical decompression. Three men, aged 40, 50, and 68 years presenting with BRVO for 4, 4, and 3 weeks respectively, underwent surgical decompression. Initial visual acuity was 20/80, 20/80, and 20/200. After 11, 10, and 9 months follow-up, visual acuity was 20/80, 20/200, and 20/200. In two eyes, an increase of the area of retinal non-perfusion was treated with peripheral laser photocoagulation. No cataract, retinal tears or retinal detachment were observed. CONCLUSION: although feasible, sheathotomy did not lead to a significant visual improvement in our patients. Dissection of the arteriovenous crossing could have induced vascular trauma. Furthermore, vitrectomy with posterior hyaloid detachment alone could be of benefit in the treatment of branched retinal vein occlusions. A prospective randomised trial is needed to assess the effectiveness and the safety of this procedure and to determine the best candidates for surgery.
Albrecht von Graæes Archiv für Ophthalmologie 11/2001; 239(10):747-51. · 2.17 Impact Factor
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ABSTRACT: Purpose. The aim of this study was to characterize oligonucleotide-polyethylenimine (ODN/PEI) complex preparation for potential transfection of retinal cells in vitro and in vivo.
Methods. The effect of medium preparation [HEPES-buffered saline (HBS), water] on particle size and morphology was evaluated. Cultured Lewis rat retinal Muller glial (RMG) cells were transfected using fluorescein isothiocyanate (FITC)-ODN/PEI complexes specifically directed at transforming growth factor beta (TGF beta)-2. Efficacy of transfection was evaluated using confocal microscopy, and regulation of gene expression was assayed using quantitative real-time RT-PCR and ELISA assay. One, 24, and 72 h after injection of FITC-ODN/PEI complexes into the vitreous of rat eyes, their distribution was analyzed on eye sections.
Results. Complexes prepared in HBS were smaller than complexes prepared in pure water and presented a core-shell structure. These particles showed a high cellular internalization efficacy, along with a significant and specific down-regulation of TGFP-2 expression and production in RMG cells., correlating with specific inhibition of cell growth at 72 h. In vivo, complexes efficiently transfect retinal cells and follow a transretinal migration at 24 h. After 72 h, ODN seems to preferentially target RMG cells without inducing any detectable toxicity.
Conclusions. Specific down-regulation of TGF beta-2 expression using ODN/PEI complexes may have potential interest for the treatment of retinal diseases associated with glial proliferation.
Pharmaceutical Research. 23(4):770-781.
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ABSTRACT: IntroductionNous rapportons le cas d’une injection intravitréenne accidentelle de lidocaïne au cours d’une anesthésie locale palpébrale. Nous évoquons la prise en charge de cette rare complication et discutons de la toxicité rétinienne de la lidocaïne en situation intravitréenne.ObservationUn homme, âgé de 29 ans, se plaignit l’exérèse d’une baisse brutale d’acuité visuelle droite lors d’une injection intrapalpébrale d’anesthésique précédant l’exérèse d’un chalazion. L’examen retrouvait une acuité visuelle réduite à une perception lumineuse, une hypertonie, une effraction de la cristalloïde postérieure, une bulle d’air dans la cavité vitréenne ainsi qu’un spasme de l’artère centrale de la rétine. L’électrorétinogramme initial objectivait une diminution de l’amplitude de l’onde b. La levée de l’hypertonie en urgence permit de supprimer le spasme de l’artère centrale de la rétine. Vingt-quatre heures après, l’acuité visuelle était chiffrée à 6/10e et l’électrorétinogramme montrait une onde b plus ample. Aucune toxicité rétinienne n’a été cliniquement observée. Seule une cataracte sous-capsulaire limitait l’acuité visuelle.ConclusionCette observation confirme la relative bonne tolérance rétinienne de la lidocaïne en situation intravitréenne, et nous rappelle que les risques de blessures oculaires existent aussi lors d’anesthésies palpébrales superficielles.IntroductionWe report an atypical case of scleral perforation due to an inadvertent intravitreal lidocaine injection following palpebral anesthesia. We discuss the management of this rare complication and focus on the transient lidocaine toxicity on human retina.ObservationA 29-year-old man presented with unilateral decreased vision during a lower right palpebral anesthetic injection for a chalazion removal procedure. The patient's vision was light perception. Examination revealed intraocular pressure at 55 mmHg, a wound of the posterior crystalloid, an intraocular gas bubble, and a central retinal artery spasm. On ERG, the b wave was decreased. The central retinal artery spasm resolved with prompt reduction of hypertony. Twenty-four hours later, the vision was 6/10 and the ERG showed an increased b wave activity. No clinical retinal toxicity of lidocaine was observed. Only a subcapsular cataract was observed, which had caused the loss of vision.Conclusion
This case confirms that lidocaine is well tolerated by the retina and reminds us that superficial palpebral anesthetic injection should be done with great caution.
Journal francais d'ophtalmologie 29(2):176-180. · 0.51 Impact Factor
