Aphakic patient

Anesthesia Discontinue use prior to general anesthesia with anesthetics that sensitize the myocardium to sympathomimetics (eg, cyclopropane, halothane). Aphakic patients Maculopathy with associated decrease in visual acuity may occur in the aphakic eye if this occurs, promptly discontinue use. 

Adverse reactions may include transient stinging and burning eye pain/ache browache headache allergic lid reaction conjunctival hyperemia conjunctival or corneal pigmentation ocular irritation (hypersensitivity) localized adrenochrome deposits in conjunctiva and cornea (prolonged use) reversible cystoid macular edema (may result from use in aphakic patients) palpitations tachycardia extrasystoles cardiac arrhythmia hypertension faintness. 

Aphakic patients Macular edema occurs in up to 30% of aphakic patients treated with epinephrine. Discontinuation generally results in reversal of the maculopathy. 

Although, Rhodonine(l 1) is not normally associated with human vision, some aphakic patients have been found to respond to irradiation in the 310-360 nm region131, the very same region to which many UV sensitive animals respond (and far beyond the skirt of the Rhodonine(9) spectra). See Section 17.3.3.2.2,... 

Figure 5.5.10-2 compares the typical putative spectrums based on such a linear analysis, (3, y, p compared to the actual chromophores, Rhodonines 5, 7 9 [with Rhodonine(l 1) shown for completeness. It is not significant in human vision except for aphakic patients.] Hunt describes the (3,y p spectrums as probable sensitivity curves of the three types of cones. He did not discuss any rod spectrum in his figure. The probable sensitivity curves appear to have been normalized individually. The peak in the p spectrum appears to be at a longer wavelength than frequently suggested. However, it is still at too short a wavelength to support the known spectral response of the human eye as illustrated by the Photopic Luminosity Function. 

Amos JF, Semes Lfi Swanson MW, et al. Pupillary dilation for aphakic patients, pseudophakic patients, and patients with cataract. Optom CUn 1991 1 188-194. 

Patients who have had cataract extraction with implantation of an intraocular lens (lOL) often have pupils that dilate less well than they did preoperatively.The poorer pupillary response probably relates to the amount of iris trauma occurring at surgery. The difference in mydriatic response may affect evaluating and treating peripheral retinal abnormalities in aphakic and pseudophakic eyes. However, even with maximally dilated pupils often the capsulotomy is the limiting fector. 

Intermediate uveitis may not warrant any therapeutic intervention in mild cases where the visual acuity is 20/40 or better. However, medical therapy is required for most patients. Macular edema is a frequent complication and requires prompt management to prevent permanent vision loss. In general, topical steroids are minimally effective in intermediate uveitis, except in those patients who are aphakic. Periocular and systemic steroids are substantially more efficacious. Periocular steroid injections are preferable in unilateral presentations and in children, whereas oral or other systemic routes are required for bilateral cases. For steroid-resistant intermediate uveitis, immunosuppressive therapy or surgery (cryotherapy and vitrectomy) may be necessary. Complications associated with intermediate uveitis include persistent CME,... 

These devices are generally helpful to elderly patients, especially those wearing aphakic lenses. They consist usually of a rubber bulb with a suction cup. They can cause severe corneal damage if used improperly as well as ocular infection if they are not properly cleaned and disinfected. 

Cystoid macular edema has been reported to occur in 2.8% of the patients receiving adrenaline especially in aphakic or pseudophakic eyes (13). Cystoid macular edema has also been seen after the use of dipivefrine, but in the classic case described in 1982 pretreatment with timolol maleate may have predisposed the eye to this complication (14). 

Silicone oil injection has been used to treat retinal detachment. Six patients who had had previous silicone oil injection had the oil extracted, partial introduction of perfluorocarbon liquids, extraction of epiretinal membranes, endodiathermy, retinotomy, retinectomy, complete filling of the intraocular cavity with perfluorocarbon, endophotocoagulation, and silicone oil injection (10). All maintained the reattached retina. One developed a macular epiretinal membrane. Another developed a macular epiretinal membrane with subfoveal perfluorocarbon and a relapse of the retinal re-detachment when the silicone oil was extracted and it had to be re-introduced. Four of the patients developed different degrees of cataracts the other two were aphakic. 

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