An ocular compression device for reduction of elevated post anesthetic intraocular pressure.
06 Nov 2014-Vol. 2014, pp 4819-4822
TL;DR: The design, development and clinical validation of an air pressure based compression device that makes the compression procedure safe and reliable by quantifying all compression parameters applied and considering safety limits for individual subjects are presented.
Abstract: Rise in Intra Ocular Pressure (IOP), after administration of regional ophthalmic anesthesia for surgery, is a commonly observed clinical phenomenon. Rise in IOP increases risk of retinal ischemia and leads to surgical complications. The current clinical practice for reduction of IOP, after delivery of local anesthesia, is manually administered digital compression. The highly subjective nature of manual compression, results in unknown duration and magnitude of the pressure applied, thus limiting the clinical effectiveness of the procedure. The work presented here addresses the need for a device that delivers all the benefits of digital compression, while eliminating the uncertainty and risks involved. Design, development and clinical validation of an air pressure based compression device have been presented in this paper. This device makes the compression procedure safe and reliable by quantifying all compression parameters applied and considering safety limits for individual subjects.
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TL;DR: Clear evidence is beginning to uncover that abnormalities in the optic nerve head and retina may influence relative susceptibility to IOP and explain progressive optic nerve damage and visual field loss, in spite of apparent, clinically adequate IOP control.
239 citations
"An ocular compression device for re..." refers background in this paper
...The range was selected considering the fact that pressure applied on the eye never exceeds 40 mmHg [5]....
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...The total duration of digital compression should be maintained such that it does not cause optic nerve damage [5]....
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TL;DR: There is a large and individually variable rise in intraocular pressure following peribulbar anaesthesia and ocular compression with the Honan balloon is effective in reversing this rise even when the initial rise is large.
Abstract: AIM: Two prospective studies were carried out in order to investigate (1) the rise in intraocular pressure (IOP) following peribulbar anaesthesia with a fixed volume of anaesthetic agent administered by a single surgeon, and (2) the efficacy of ocular compression with the Honan balloon for lowering IOP. Glaucomatous eyes were excluded from both studies. METHODS: In study group 1, 36 eyes of 36 patients undergoing cataract and/or implant surgery each received peribulbar injections consisting of 5 ml of anaesthetic from an inferotemporal site through the conjunctiva and a further 5 ml from a medial injection through the caruncle. IOP values were measured immediately before and after the injections and then after a variable period of external ocular compression. In study group 2, 20 eyes of 20 patients undergoing cataract surgery received peribulbar injections of local anaesthetic as above. IOP values were measured immediately before and after the injections and after 20 minutes without ocular compression. After a further 20 minute period with ocular compression the IOP was again measured. RESULTS: In study group 1, the mean immediate rise in IOP induced by the injections was 11.44 (95% confidence interval 8.97-13.90) mm Hg. The mean change in IOP after ocular compression was an overall fall of 2.42 (0.49-4.34) mm Hg from the pre-injection value. In study group 2, the mean injection induced rise in IOP was 9.45 (6.90-12.00) mm Hg. The mean fall in IOP during the first 20 minutes without ocular compression was 2.85 (1.20-4.50) mm Hg. During the second 20 minutes with ocular compression the mean fall in intraocular pressure was 11.05 (8.14-14.96) mm Hg. CONCLUSIONS: There is a large and individually variable rise in IOP following peribulbar anaesthesia. Ocular compression with the Honan balloon is effective in reversing this rise even when the initial rise is large.
85 citations
TL;DR: In this review, the anatomy is described with reference to relevant drawings and diagrams and with the economical use of descriptive text to show structural relationships as they exist in the living.
Abstract: Tradi ti onal techni ques of di ssecti on fai l to show structural relationships as they exist in the living. Newer methods of cadaveric orbital fixing and thick section examination, and CT and MRI scanning techniques have added to the ease of understanding the system of connective tissue septa supporting the globe within the orbit. These tissues allow extensive mobility and also divide the orbit into functional adipose compartments allowing distribution of injected local anaesthetic solutions to gain access to neural tissue. In this review, the anatomy is described with reference to relevant drawings and diagrams and with the economical use of descriptive text. Excellent detailed texts are available for further study.
26 citations
"An ocular compression device for re..." refers background in this paper
...Intermittent ocular compression accelerates perfusion of the anesthetic agent by increasing the pressure gradient thereby increasing fluid absorption by the surrounding tissue [2]....
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TL;DR: The Honan device would appear to be safe for eyes undergoing routine anterior segment surgery, but the pressures that may be generated in hypertensive eyes (IOP greater than or equal to 35 mm Hg) might put these eyes at risk for vascular occlusion.
Abstract: • Although use of the Honan intraocular pressure reducer is believed to be clinically safe and effective in reducing IOP and the risk of vitreous loss, the IOPs achieved during application of the device have not been directly measured. Intraocular pressure dynamics in ten eyes of five patients were measured shortly after death, using a pressure transducer within the anterior chamber as the Honan device was applied. Pressures were measured again after enucleation. The peak IOPs produced in eyes in situ were much lower than in the same eyes after enucleation. The peak IOP increased as the initial IOP was raised. The Honan device would appear to be safe for eyes undergoing routine anterior segment surgery, but the pressures that may be generated in hypertensive eyes (IOP ≥35 mm Hg) might put these eyes at risk for vascular occlusion.
25 citations
"An ocular compression device for re..." refers methods in this paper
...The protocol followed for clinical validation is given below [8], [9]....
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Patent•
30 Jun 1977
TL;DR: In this paper, a cup-shaped bellows member was removed from an adjustable headband and placed against the closed eyelid of a patient being prepared for intraocular surgery and upon whose head the headband has been placed.
Abstract: Disclosed is a cup-shaped bellows member removably attached to an adjustable headband. One end of the member is positioned to bear against the closed eyelid of a patient being prepared for intraocular surgery and upon whose head the headband has been placed. The opposite end of the bellows member is closed by a plate having a tubular portion communicating with the interior of the bellows portion and adapted to be connected to a means for increasing the pressure in monitored increments inside the chamber formed by the bellows and plate.
18 citations