IntroductionThe aim was to study the risk of non arteritic ischemic optic neuropathy after phacoemulsification cataract surgery.MethodsThis study was conducted at King Hussein Medical Center during the period between January 2015 and July 2016. Patients attending ophthalmology clinic complaining of decreased vision due to lens opacity were evaluated. Patients were divided into two groups. First group included patients with no medical illness and second group included patients with diabetes mellitus, hypertension or hyperlipidemia. The two groups were further divided into two subgroups. First subgroup included patients who had phacoemulsification surgery and second subgroup did not have surgery. All patients were followed up for 6 months. They were assessed by neuro-ophthalmologist looking for ischemic optic neuropathy.ResultsA total number of 568 patients were enrolled. Group 1A included patients with no medical illness who underwent surgery and group 1B did not undergo surgery. The number of patients in these two subgroups was 119 and 103 respectively. Number of patients in group 2A (medical illness and surgery) was 188 and number of patients in group 2B (medical illness and no surgery) was 130. The incidence of ischemic optic neuropathy was 4.3 % in group 2A, 4.2 % in group 1A, 0.8% in group 2B, and 0% in group 1B.ConclusionPhacoemulsification is a risk factor for non arteritic ischemic optic neuropathy independent of the presence of medical risk factors. Suggested mechanisms would be local anaesthesia, intraocular pressure fluctuation and local intraocular inflammation.

IntroductionA surgical fire is a rare but potential risk in surgical practice. Fire has been recognised as a potential complication of surgery for many years [1]. Fire occurs when the three elements of the fire triad, fuel, oxidiser and ignition coincide. Surgical fires are unusual in the absence of an oxygen-enriched atmosphere. The ignition source is most commonly diathermy but lasers carry a relatively greater risk. The factors that may initiate these fires are many and include alcohol based surgical prep solutions, electrosurgical equipment, and flammable drapes [2][3][4]6,10].The majority of fires occur during head and neck surgery. In ophthalmic practice the incidence of surgical fires reported is very rare despite the presence of oxygen and the use of electrocautery [12]. PurposeWe describe a case of surgical flash fire causing thermal burn of eye lashes, eyelid skin and eye brow hair in a patient who had some residual mascara on her lashes while cautery was applied for an eyelid lesion after excision in clinical setting and in the absence of oxygen rich environment. Case reportWe report a 38 year old lady who had a small papilloma on the right upper eyelid skin for which she underwent excision. Surgical techniqueThe area was exposed and cleaned with povidine iodine. After the iodine was wiped off the area was left to dry for a minute and a small forceps was used to lift the papilloma. A 15 degree blade was then used to cut it from its base. Disposable pencil cautery was used to stop the bleeding by applying it onto the base of the lesion. A sudden blue flame of fire then caught the eyelashes, swept through the skin and burnt the eye brow hair successively. It also caused the surgical gloves used by the surgeon to be burnt and to scald his finger tips underneath. Cautery was abandoned immediately.Cold water was applied to the area, antibiotic ointment was given and the patient was examined at the slit-lamp. No conjunctival, corneal or any other ocular injury was noted and the patient was reviewed after one week and then after one month. By then the burns had recovered and all lashes and brown hair had re-grown. DiscussionCautery can be applied in several clinical settings in order to ensure haemostasis after excision of small lesions. Surgical fires have been described in several occasions within the operating room and in an oxygen-rich environment. Several igniting factors have been described and review of surgical flammable materials and safety issues in the operating room can be found in literature [2]. DiscussionThe fire triangle is a useful construct that describes the three elements necessary for initiation of a fire i.e. heat, fuel and an oxidizer [5,6,8,9,11]. spark from electrosurgical unit usually acts as the heat source. Experimental studies have shown that hot wire cautery or diathermy generates enough heat to ignite all alcohol based antiseptics even if these contain as little as 20% alcohol [3]. Fuels are abundant in the operative field that include prep solutions, drapes, sponges, endotrach...

Indications for orbital decompression exist in patients undergoing osteo-odonto-KPro or KPro to reduce pseudoproptosis or exposure.

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