INTRODUCTIONPerioperative glycaemic control is an important aspect of clinical management in diabetic patients undergoing cataract surgery under local anaesthesia. While poor long-term glycaemic control has significant implications for surgery, perioperative hypoglycaemia or hyperglycaemia may also compromise patient safety and surgical outcomes. We aimed to survey ophthalmologists and anaesthesiologists on their approach and to identify the prevalent practice patterns in Singapore.

METHODSThis was a cross-sectional questionnaire-based survey conducted in four public hospitals in Singapore with established ophthalmology and anaesthesia units. Respondents were approached individually, and the self-administered questionnaires comprised questions related to practice patterns, clinical scenarios and awareness of pre-existing guidelines.

RESULTSA total of 129 doctors responded to the questionnaire survey. 76 (58.9%) were from ophthalmology departments and 53 (41.1%) were from anaesthesia departments. The majority chose to withhold oral hypoglycaemic agents (82.9%) and/or insulin (69.8%), and keep the patient fasted preoperatively. A blood glucose level ≥ 17 mmol/L prompted 86.0%-93.8% of respondents to adopt a treat-and-defer strategy, while a level ≥ 23 mmol/L prompted 86.0%-96.9% of respondents to cancel the cataract surgery. The respondents were consistently more concerned about perioperative hyperglycaemia (n = 99, 76.7%) than intraoperative hypoglycaemia (n = 83, 64.3%).

CONCLUSIONThe current study presented the prevalent practice patterns of ophthalmologists and anaesthesiologists in the perioperative management of diabetic patients undergoing cataract surgery in four public hospitals in Singapore. Further research in this field is required, and may be useful for the future formulation of formal guidelines and protocols.

Adult ; Anesthesia, Local ; methods ; Anesthesiologists ; statistics & numerical data ; Blood Glucose ; analysis ; Cataract Extraction ; Cross-Sectional Studies ; Diabetes Mellitus ; blood ; epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Ophthalmologists ; statistics & numerical data ; Perioperative Care ; methods ; Singapore ; epidemiology ; Surveys and Questionnaires

PURPOSE: To compare pain levels in cataract surgery under topical anesthesia only and topical anesthesia under monitored anesthesia care. METHODS: We recruited 243 patients who were scheduled to undergo cataract surgery under topical anesthesia only or topical anesthesia with monitored anesthesia care (MAC) using fentanyl and midazolam. Anesthesia methods were selected based on the patient's preference. All patients completed an anxiety and information scale survey preoperatively. Vital signs during the operations were recorded. A 0-to-10 visual analog scale pain score survey was conducted immediately and at 2 hours, 6 hours, and 1 day after surgery. RESULTS: Of the 237 patients who completed the study, 183 patients selected topical anesthesia, and 54 patients selected MAC. Mean pain scores according to the aforementioned time points after surgery were 0.50, 0.58, 0.29, and 0.12 in the topical anesthesia group, and 0.22, 0.16, 0.06, and 0.09 in the MAC group, respectively. The differences in pain score between the two groups was statistically significant at 2 hours (p = 0.019) and 6 hours (p = 0.040) after surgery. The mean patient anxiety score for anesthesia was 10.50 in the topical anesthesia group and 11.41 in the MAC group (p = 0.280). Mean systolic blood pressure at the start of surgery was 140.6 mm Hg in the topical anesthesia group, and 158.2 mmHg in the MAC group. CONCLUSIONS: Monitored anesthesia care consistently resulted in less pain throughout the post-operative period. However, transient systolic blood pressure should be carefully monitored for a rise related to intravenous anesthetics.
Anesthesia* ; Anesthetics, Intravenous ; Anxiety ; Blood Pressure ; Cataract* ; Fentanyl ; Humans ; Midazolam ; Visual Analog Scale ; Vital Signs

PURPOSE: This study was conducted to develop effective timeout protocol in coordination with current practice and test its clinical effectiveness in pursuit of safety management for patients undergoing cataract surgery. METHODS: A total of subjects were 60 women, 50~65 years old, who visit C ophthalmology clinic in D city. They were assigned to 30 experimental group and 30 control group, respectively. Based on the comprehensive literature review, timeout protocol that was suitable for patients undergoing cataract surgery was developed, and then test its effectiveness by measuring blood pressure, pulse, anxiety and sense of well-being among surgical patients. RESULTS: The timeout protocol was found to reduce blood pressure, pulse, and anxiety and increase well-being among surgical patients. CONCLUSION: As a results, it is necessary to introduce an effective timeout protocol giving positive responses to surgical patients, hence it should be develop a timeout protocol and explore the effectiveness of the protocol.
Anxiety ; Blood Pressure ; Cataract* ; Female ; Humans ; Ophthalmology ; Safety Management

Diabetic retinopathy(DR) is the leading cause of new onset blindness among working-aged groups in industrialized countries, and its incidence is expected to increase along with the rising incidence of diabetes mellitus. Primary interventions such as strict glycemic control, tight blood pressure regulation, and lipid-lowering therapy can significantly reduce the risk of DR occurrence and progression. Currently, laser photocoagulation is the mainstay of treatment of proliferative DR and some cases of diabetic macular edema (DME). However, a considerable number of DR patients still suffer from severe visual impairment in spite of the application of laser photocoagulation and even of pars plana vitrectomy. Considering the limitations of current DR treatments, ongoing efforts have been devoted to the development of new therapeutic strategies, and it has become necessary to focus on pharmacologic treatment. Since inflammation has been identified as playing a substantial role in the pathogenesis of DR, corticosteroids with an anti-inflammatory effect can be included in the treatment of DR, though this may cause cataract and intraocular pressure elevation. The recent discovery of inhibitors of vascular endothelial growth factor is a revolutionary event in the management of DR, specifically DME. Some new agents aiming at the process of angiogenesis and increased vascular permeability are still under investigation, offering hope for a more effective future treatment of this sight-threatening disease. This paper reviews the current state of knowledge of the clinical presentation, preventive management, and clinical therapeutic strategies of DR and DME.
Adrenal Cortex Hormones ; Blindness ; Blood Pressure ; Capillary Permeability ; Cataract ; Developed Countries ; Diabetes Mellitus ; Diabetic Retinopathy* ; Hope ; Humans ; Incidence ; Inflammation ; Intraocular Pressure ; Laser Coagulation ; Light Coagulation ; Macular Edema ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factors ; Vision Disorders ; Vitrectomy

PURPOSE: To investigate the relationship between plasma TDRD7 mRNA and lens transparency, and to evaluate plasma TDRD7 mRNA as a potential marker for cataracts and its sub-type by quantitatively analyzing human peripheral blood. METHODS: Plasma RNA was extracted from 40 patients with cataracts, and 30 normal controls of matched age and gender. Blood cholesterol and fasting glucose were measured, and the RNA extracted from the sample was synthesized into cDNA. After polymerase chain reaction, the results were compared after quantifying the TDRD7 mRNA using ABL1 mRNA for normalization. We analyzed the relative gene expression data via the DeltaDeltaCt method. RESULTS: The normalized 2(-DeltaDeltaCt) of plasma TDRD7 mRNA based on ABL1 mRNA was 1.52 ± 0.63 in the case of the control group and 1.05 ± 0.34 in the case of the cataract patients, and the TDRD7 expression level of the cataract patients was lower than that of the control group (p = 0.048). The comparison of the genetic values of different types of cataracts demonstrated that the TDRD7 expression level of the cortical type and mixed type were lower than those of the nuclear type and posterior subcapsular opacity type (p = 0.017). CONCLUSIONS: Human cataracts and the TDRD7 gene loss-of-function mutations are strongly causally related, as the expression level of plasma TDRD7 mRNA in patients with cataracts was statistically significantly lower than in the normal control group.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cataract/*blood ; Child ; Female ; Gene Expression Regulation/*physiology ; Humans ; Male ; Middle Aged ; Proto-Oncogene Proteins c-abl/genetics ; RNA, Messenger/*blood ; Real-Time Polymerase Chain Reaction ; Ribonucleoproteins/*genetics

During long standing hyperglycaemic state in diabetes mellitus, glucose forms covalent adducts with the plasma proteins through a non-enzymatic process known as glycation. Protein glycation and formation of advanced glycation end products (AGEs) play an important role in the pathogenesis of diabetic complications like retinopathy, nephropathy, neuropathy, cardiomyopathy along with some other diseases such as rheumatoid arthritis, osteoporosis and aging. Glycation of proteins interferes with their normal functions by disrupting molecular conformation, altering enzymatic activity, and interfering with receptor functioning. AGEs form intra- and extracellular cross linking not only with proteins, but with some other endogenous key molecules including lipids and nucleic acids to contribute in the development of diabetic complications. Recent studies suggest that AGEs interact with plasma membrane localized receptors for AGEs (RAGE) to alter intracellular signaling, gene expression, release of pro-inflammatory molecules and free radicals. The present review discusses the glycation of plasma proteins such as albumin, fibrinogen, globulins and collagen to form different types of AGEs. Furthermore, the role of AGEs in the pathogenesis of diabetic complications including retinopathy, cataract, neuropathy, nephropathy and cardiomyopathy is also discussed.
Aging ; Arthritis, Rheumatoid ; Blood Proteins ; Cardiomyopathies ; Cataract ; Cell Membrane ; Collagen ; Diabetes Complications* ; Diabetes Mellitus ; Fibrinogen ; Free Radicals ; Gene Expression ; Globulins ; Glucose ; Glycosylation End Products, Advanced* ; Inflammation ; Molecular Conformation ; Nucleic Acids ; Osteoporosis ; Oxidative Stress

The adult form of myotonic dystrophy type 1 is a neuromuscular disorder with multisystem involvement, including the central nervous system (CNS). The presenting clinical features of this condition include distal muscle weakness, myotonia, intellectual decline, cataract, frontal baldness and testicular atrophy. Magnetic resonance (MR) imaging shows characteristic white matter changes in the CNS. The clinical presentation, characteristic white matter changes in the brain on MR imaging and electromyographic findings aid in the diagnosis of this disorder.
Adult ; Atrophy ; complications ; Brain ; pathology ; Cataract ; complications ; Central Nervous System ; pathology ; Electromyography ; methods ; Hearing Disorders ; complications ; Humans ; Lactic Acid ; blood ; Magnetic Resonance Imaging ; methods ; Male ; Muscle Weakness ; complications ; Myotonic Dystrophy ; diagnosis ; pathology ; Neuromuscular Diseases ; diagnosis ; pathology

BACKGROUND: Dexmedetomidine has a sedative analgesic property without respiratory depression. This study evaluated the efficacy of dexmedetomidine as an appropriate sedative drug for monitored anesthesia care (MAC) in outpatients undergoing cataract surgery on both eyes compared with combination of propofol and alfentanil. METHODS: Thirty-one eligible patients were randomly divided into two groups on the first operation day. Dexmedetomidine was administered in group D at 0.6 microg/kg/h, and propofol and alfentanil was infused concomitantly in group P at a rate of 2 mg/kg/h and 20 microg/kg/h, respectively. Sedation was titrated at Ramsay sedation score 3. Iowa satisfaction with anesthesia scale (ISAS) of the patients was evaluated postoperatively. Systolic blood pressure (SBP), heart rate (HR), respiration rate (RR), and peripheral oxygen saturation (SpO2) were recorded throughout the surgery. For the second operation, the group assignments were exchanged. RESULTS: Postoperative ISAS was 50.3 (6.2) in group D and 42.7 (8.7) in group P, which was statistically significant (P < 0.001). SBP was significantly lower in group D compared with group P from the beginning of the operation. HR, RR, and SpO2 were comparable between the two groups. There were 8 cases (25.8%) of hypertension in group P, and 1 case (3.2%) in group D (P < 0.05). In contrast, 1 case (3.2%) of hypotension and 1 case (3.2%) of bradycardia occurred in group D. CONCLUSIONS: Compared with the combined use of propofol and alfentanil, dexmedetomidine could be used appropriately for MAC in cataract surgery with better satisfaction from the patients and a more stable cardiovascular state.
Alfentanil ; Anesthesia ; Blood Pressure ; Bradycardia ; Cataract ; Dexmedetomidine ; Eye ; Heart Rate ; Humans ; Hypertension ; Hypotension ; Iowa ; Outpatients ; Oxygen ; Propofol ; Respiratory Insufficiency ; Respiratory Rate

We report here the records of 10 consecutive Korean patients (10 eyes) with ocular toxoplasmosis which showed the typical clinical manifestations with seropositivity for Toxoplasma gondii specific IgG antibodies by micro-ELISA between 2006 and 2010. Nine patients were males and 1 was female; their age was 50.5+/-13.8 years. The most common accompanying signs were vitritis (100%), anterior uveitis (70%), and scattered white deposit (80%). Pre-existing retinochoroidal scar was found in 1 (10%) patient. All patients received antiparasitic chemotherapy and systemic corticosteroid treatment, which resolved the presenting attack and recovered the visual acuity better than initial one in 9 patients and worse in 1. Optic atrophy, cataract, and retinal neovascularization were observed during the follow-up period and recurrence was detected in 3 eyes (30%) 6 to 20 months after the initial attack. In Korea, although rarely detected and reported, ocular toxoplasmosis needs more attention in clinical field of retinal diseases.
Adrenal Cortex Hormones/administration & dosage ; Adult ; Age Distribution ; Aged ; Anti-Inflammatory Agents/administration & dosage ; Antibodies, Protozoan/*blood ; Antiprotozoal Agents/administration & dosage ; Cataract/pathology ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunoglobulin G/blood ; Korea ; Male ; Middle Aged ; Optic Atrophy/pathology ; Retinal Neovascularization/pathology ; Sex Distribution ; Toxoplasma/immunology/*isolation & purification ; Toxoplasmosis, Ocular/complications/*diagnosis/drug therapy/*pathology ; Uveitis, Anterior/complications/drug therapy/parasitology/pathology

PURPOSE: To analyze the risk factors of Korean patients with anterior ischemic optic neuropathy (AION). METHODS: Medical records of 48 Korean patients (24 men, 24 women) who were diagnosed as having AION were retrospectively reviewed and the risk factors of AION including age, sex, associated systemic disease, past medical history, social history, hematologic findings, 24-hour blood pressure monitoring, and optic disc of the clinically normal fellow eye, were analyzed. RESULTS: The mean age of the 48 patients was 59.4 years (range, 36~80 years). There were 6 patients (12.5%) less than 45 years of age, 18 patients (37.5%) of 45 to 65 years of age, and 24 patients (50.0%) more than 65 years of age. There were 29 patients (60.4%) with associated systemic diseases such as hypertension (65.5%), diabetes mellitus, cerebrovascular disease, migraine, and heart disease with a decreasing order. Nine patients (18.8%) with a mean age of 50.6 years were smoker. Four patients developed AION after a cataract operation. There were 17 (68.0%) out of 25 patients with an increased level of cholesterol. Four patients whose 24-hour blood pressure was monitored showed that their blood pressure in night was lower than that in the day time. A cup disc ratio less than 0.2 was observed in 28 contralateral eyes (68.3%) of 41 patients with unilateral AION. CONCLUSIONS: Hypertension, high cholesterol and decreased cup-to-disc ratio were observed in more than 60% of the Korean patients with AION, thereby composed the major risk factors.
Blood Pressure ; Blood Pressure Monitors ; Cataract ; Cholesterol ; Diabetes Mellitus ; Heart Diseases ; Humans ; Hypertension ; Male ; Medical Records ; Migraine Disorders ; Optic Neuropathy, Ischemic* ; Retrospective Studies ; Risk Factors*