Context:Elevation of intraocular pressure (IOP) is an inherent and inadvertent association with the use of succinylcholine and alpha2 agonists can be used to obtund this effect.Aims:The study was aimed to assess the efficacy of intravenous dexmedetomidine and clonidine premedication in attenuating rise in IOP during laryngoscopy and intubation following administration of succinylcholine.Settings and Design:This prospective, observational study was conducted in 40 patients aged 20–60 years undergoing non ophthalmic surgical procedures.Subjects and Methods:For patients in Group D, dexmedetomidine 0.4 mcg/kg and in Group C clonidine 1 μg/kg over 10 min was administered before induction. All patients were induced with propofol. Laryngoscopy and intubation were performed 1 min after administration of succinylcholine 2 mg/kg.Statistical Analysis Used:Mann–Whitney, Chi-square and Wilcoxon tests.Results:Mean baseline IOP of both groups were comparable (15.4 ± 2.6 vs. 14.7 ± 2.3). Following premedication and induction, IOP decreased in both groups and the reduction was significantly more in Group D. Following administration of succinylcholine and 1 min after intubation IOP raised and exceeded the baseline value in Group C (16.0 ± 1.6 and 18.6 ± 2.2). Though there was an increase in IOP in Group D (12.0 ± 1.9 and 14.0 ± 2.1), it did not reach up to baseline values. Then there was a gradual reduction in IOP in both groups at 3, 5, and 10 min and Group D continued to have a significantly low IOP than Group C up to 10 min.Conclusions:Dexmedetomidine 0.4 μg/kg resulted in a reduction of IOP and blunted the increase in IOP, which followed administration of succinylcholine, laryngoscopy, and intubation. Though clonidine 1 μg/kg reduced IOP, it did not prevent rise in IOP following succinylcholine, laryngoscopy, and intubation.

Background:Robotic pelvic surgeries require steep Trendelenburg position which may result in rise in intraocular pressure (IOP).Aim:The aim of this study was to compare the changes that occur in IOP during robotic pelvic surgeries in steep Trendelenburg position with a restrictive intravenous fluid administration.Settings and Design:This prospective observational study was conducted in a tertiary care institution.Subjects and Methods:Twenty consenting patients scheduled for pelvic robotic gynecological surgeries were enrolled. All patients received general anesthesia following a standardized protocol. IOP was measured before induction of anesthesia, immediately after induction and intubation, at the end of surgery immediately after making the patient supine and immediately after extubation. Ringer's lactate was administered intravenously at a rate of 4 mL/kg/h targeting a mean arterial pressure of >65 mmHg and urine output of >0.5 mL/kg/h.Statistical Analysis Used:Paired t-test was used in this study.Results:There was a fall in IOP soon after induction from baseline which was not significant. Immediately, following intubation, there was a significant rise in IOP. At the end of surgery, though IOP remained high, it was not statistically significant. However, following extubation, IOP rose further and the difference from the baseline became statistically significant. Although there was a moderate increase in peak airway pressure and highest EtCO2 levels during Trendelenburg from baseline values, the differences were statistically insignificant.Conclusion:During robotic pelvic surgeries, adopting a restrictive intravenous fluid strategy with the maintenance of normal end-tidal carbon dioxide levels could abate effects of steep Trendelenburg position on IOP.

To assess the quality of analgesia, level of comfort of patients and surgeons and incidence of complications after topical anaesthesia with supplemental intracameral lignocaine as compared to peribulbar block in patients undergoing phacoemulsification.It was a prospective observational study done in 66 patients having uncomplicated senile cataracts who underwent phacoemulsification with foldable IOL implantation of both eyes. One eye of each patient was operated under peribulbar blockand the other eye under topical anaesthesia with supplemental intracameral lignocaine after 2 weeks. In Group T, topical anaesthesia was achieved by instilling proparacaine hydrochloride 0.5% and preservative free 1% lignocaine was used for intracameral analgesia. Peribulbar block was administered with 5-7 ml of 2% lignocaine with 1:10000 adrenaline. Patient comfort, feeling of pressure during block, quality of analgesia intraop and 4 hours postop, and surgeon’s comfort were documented. Group P patients had significantly higher pain score, discomfort and pressure on eye during administration of block compared to Group T. Both groups had comparable pain scores and patient’s discomfort. Pressure on eye intraop and postop and intraoperative positive pressure were also similar in both groups. Group P had significantly higher incidence of subconjunctival hemorrhage (80% vs 10%) and chemosis of conjunctiva. (80% vs 0%). Topical anaesthesia with supplemental intracameral lignocaine can be considered as a superior anaesthetic technique for phacoemulsification than peribulbar block as it is associated with significantly higher patient comfort and lower complications with comparable surgeon’s comfort.

To compare ocular biometric features of chronic angle closure glaucoma patients with normal subjects. Materials and Methods: 35 chronic angle closure glaucoma patients (group A) were compared with 35 normal subjects (group B). Chronic angle closure glaucoma was diagnosed in eyes with peripheral anterior synechiae [PAS] of > 270 degrees with a chronically elevated IOP with disc and field changes. Patients with history of intraocular surgeries or trauma, secondary angle closure, active keratitis or corneal opacities, previous history of Nd Yag laser peripheral iridotomy and those on miotic drops were excluded. Contact ultrasonic biometry was used for measuring ocular biometric parameters like axial length, AC depth, and lens thickness. LAF and RLP were calculated. Statistical analysis: Chi-square test and Independent sample t-test as applicable. Results: Mean age, gender distribution and axial length measurements in both the groups were comparable. Lens thickness and LAF were significantly higher in Group A (p <0.001) whereas AC depth, keratometry and RLP were significantly lower in group A. Pachymetry, best corrected visual acuity and spherical equivalents were comparable in both groups. Conclusion: It is concluded that the mechanism of chronic angle closure glaucoma can be explained by the ocular biometric parameters with possibility of some additional factors like variations in the iris thickness/ insertion.

Background: Large proportions of acquired cases of ocular toxoplasmosis are reported with atypical presentations. The objectives of the study were to find out whether any correlation existed between serological findings of typical and atypical presentations of ocular toxoplasmosis as compared to cases presenting with non-toxoplasmic uveitis and to find out the proportion of various atypical presentations of ocular toxoplasmosis.Methods: It was a prospective observational study.The study subjects of ocular toxoplasmosis were tested for immunoglobulin M (IgM) and immunoglobulin G (IgG) toxoplasma antibody levels in serum by ELISA (enzyme-linked immunosorbent assay) technique. The proportion of atypical presentation among total toxoplasma cases and distribution of atypical cases were calculated.  Fisher’s exact test, one-way analysis of variance and Kruskal-wallis test were used as applicable.Results: Among the cases (n=35) thirteen patients had typical presentation of a retinochoroidal focus with an adjacent scar and 22 patients had atypical features. Control group consisted of 24 patients. Various types of presentations in atypical cases were retinitis patch without an adjacent scar (31.8%), intermediate uveitis (27.3%), papillitis (22.7%) retinal vasculitis and dense vitritis (9.09% each).  Mean IgG levels in typical cases (85.3±82.9 IU/ml) and atypical cases (47.5±66.2) were significantly higher than control group (6.6±3.4, p<0.001).Conclusions: Serology is a useful tool in the diagnosis of ocular toxoplasmosis with a compatible clinical picture as serum IgG levels are significantly elevated in both typical and atypical presentations of ocular toxoplasmosis as compared to cases presenting with non-toxoplasmic uveitis.