1 / 38

Comparison of 2 Anaesthesia techniques for pediatric refractive surgery

Comparison of 2 Anaesthesia techniques for pediatric refractive surgery. Magraby Eye and Ear Centre - OMAN. Background. Difficulties with children and LA Reports of NO2 interference with Laser function Aim – compare propfol / fentanyl and ketamine / midazolam. Method.

gada
Télécharger la présentation

Comparison of 2 Anaesthesia techniques for pediatric refractive surgery

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Comparison of 2 Anaesthesia techniques for pediatric refractive surgery Magraby Eye and Ear Centre - OMAN

  2. Background • Difficulties with children and LA • Reports of NO2 interference with Laser function • Aim – compare propfol/fentanyl and ketamine/midazolam

  3. Method • Prospective • 30 patients • Randomized to 2 groups • Age 3 to 12 years • Aniso/Amblyopia

  4. Method • NBM overnight • Clear fluids till 4 hours before • LASIK or LASEK

  5. Monitoring • Heart rate • MABP • SaO2 O2 by nasal cannula if SaO2 ≤ 90%

  6. Results • Matched for: age weight duration of anesthesia duration of surgery

  7. Results • Time to recovery shorter in P/F group • Opposite effects on BP and HR • P/F group 3 patients needed O2 • Post-op agitation and vomiting higher in K/M group • Airway obstruction (needing jaw thrust) higher in P/F group

  8. Ophthalmologist satisfaction • Bells phenomenon • Nystagmus • Overall intra and post-op state • No significant difference • (used suction ring for fixation)

  9. Conclusions • Propofolpreferred • Shorter acting • Lower incidence of dysphoric effects • Greater potential for airway compromise.

  10. PRK and LASIK in accommodative esotropia University of L’Aquila, Italy

  11. Methods • Prospective • 18 consecutive patients • Mean age 32.4 (range 21 to 52) • Accommodative eso (normal AC/A) • No suppression • 8 – PRK (Group A) • 10 – LASIK (Group B)

  12. Pre-op – Group A Without correction • ET’ 14.4 ∆(10 to 19) • ET 11.6 ∆(8 to 14) With correction • ET’ 5 ∆(4 to 6) • ET 2.4 ∆(2 to 4) • Mean 71.2 sec/arc

  13. 30 days in CL • 2∆esophoria – near • 1.2 ∆esophoria – distance • Refraction +4.6 D (mean) (range +3.50 to +6.00) • Mean BSCVA – 20/20

  14. Post –op results 1 Year • ET’ 1.2 ∆esophoria • ET – orthophoric 2 Years • ET’ 2 ∆esophoria • ET 0.4 ∆

  15. Pre-op Group B Without correction • ET’ 13.4 ∆(8 to 21) • ET 11.5 ∆(6 to 19) With correction • ET’ 5.4 ∆(2 to 8) • ET 2.8 ∆(orthophoria to 6) • Mean 81 sec/arc

  16. 30 days in CL • 2.5 ∆esophoria – near • 1.1 ∆esophoria – distance • Refraction +6.46 D (mean) (range +5.00 to +8.50) • Mean BSCVA – 20/20

  17. Post –op results 1 Year • ET’ 1.7 ∆esophoria • ET 0.2 ∆esophoria 2 Years • No change

  18. Only 1 case of regression • Recurrence of ET

  19. Essentials to success • Good binocular function • Good acuity • Careful selection of patients • ? Timing of surgery

  20. Possible application to older children and young adults?????

  21. Refractive surgery for Children Review by L.Tychsen

  22. Corneal surface ablation • Phakic IOL • Clear Lens Exchange

  23. Who • Anisometropia – spectacle non-compliant 2.0 D - hypermetropes 3.0 to 4.0 D - myopes • Intolerance of specs or CL • Neuro-behavioural disorders

  24. Who • Iso-ametropia • Spectacle non-compliant • Amblyopia approaching 50% • Neuro-behavioural disorders • Visual autism

  25. Who • Other special needs Craniofacial deformities • High hyperopia and esotropia Poor spectacle compliance

  26. Strategy • Baseline Repeated examinations EUA • Surface ablation +6.0 to -10.0 D • ACD ≥ 3.2 mm Phakic IOL • Remainder - Clear lens extraction

  27. Surface ablation • Volatile induction • Intravenous anaesthetic • EUA • LASEK or PTK/PRK • BCL and goggles • Epithelial healing as in adults • Better tolerated

  28. Phakic IOL • Artisan iris enclaved • Bilateral sequential – 1 month interval • Absorbable sutures • Limbal relaxing incisions • Arm band restraints

  29. Refractive lens exchange • Above 20.0 D • ACD ≤ 3.2 mm • Lensectomy • Posterior capsulectomy • Anterior vitrectomy • Acrylic IOL • AL ≥ 29 mm - Prophylactic laser

  30. Efficacy • Improvement in UCVA • Best with bilateral ametropia • Modest with anisometropia

  31. Results - Surface ablation • Ametropia avg 7.1 D • UCVA 20/180 to 20/60 (mean) • If glasses worn - BCVA 2-fold improvement

  32. Results – Phakic IOL • Ametropia – mean 15.0 D • UCVA 20/3400 to 20/57 (mean) • Similar results with CLE

  33. Surface ablation and Anisometropia • 90% within 1.5 D of emmetropia • Variable improvement in UCVA and BCVA • No reported loss of acuity • 50% improvement in fusion and stereopsis

  34. Complications • Low • Several years follow up • Small numbers

  35. Surface ablation • 260 eyes - 1998 to 2008 • Negligible rate of sight-threatening complications • LASIK – flap complications • LASEK – thicker residual stroma • Regression - 1.0 D/year • ? Over-correction for myopes

  36. Phakic IOL • No regression • Corneal endothelium? Low rate of loss • ? Posterior chamber IOLs • ? Glaucoma/ Cataract

  37. Clear lens extraction • Accomodation • Multifocal IOLS? • RD risk – 3% long term

  38. Conclusions • Substantial benefits for selected patients • Need more information/scrutiny/disclosure

More Related