8/25/2023 0 Comments Pinpoint pupilAccommodation is the adaptative faculty that enables clear vision with subjective variation in the linear distance of visual targets. Schematically, the cornea and crystalline lens provide the requisite total dioptric power (about +60 diopters the cornea makes up about + 40 to + 48 diopters). Visual clarity depends on the ability to bring incident light rays to a point focus at the fovea centralis. This review highlights the risk factors for small pupils during surgery and current management strategies.Īs an optical system, the eyes function in line with the basic principles of refraction. Hence, achieving and maintaining adequate mydriasis throughout surgery is essential. When dealing with challenging cases like lens subluxation, pseudo-exfoliation, and zonular dehiscence, a small pupil further increases the risk and adversely affects the surgical outcome. Intra-ocular lens implantation in the bag also requires adequate dilation. Removal of cataract and the cortical matter becomes increasingly difficult. Repeated touching of the iris increases the risk of fibrinous complications. Making a good capsulorhexis with a small pupil can be a challenge, even for an experienced surgeon. For example, if the pupil size decreases from 7 mm to 6 mm, this 1 mm change in pupil diameter will lead to a decrease of 10.2 mm2 in the area of surgical field. Intra-operative miosis limits the field of surgery and increases the risk of complications. Despite good pre-operative dilation, the pupil can be quite unpredictable during surgery. Various topical and intra-cameral drugs are used in combination to achieve mydriasis. As cataract surgical techniques continue to improvise and get faster, an adequate pupil size is of paramount importance. Our review discusses the simple and quick options available to a cataract surgeon when faced with this dilemma. There are now pharmacological interventions that help tackle this unforeseen happening. This problem is more pronounced in children. Unexpected pupillary constriction during surgery increases the risk of complication. HS is a rare complication of anterior cervical spine fixation, and it is essential to have a thorough understanding of intraoperative and postoperative ACDF-related complications to avoid them whenever possible and manage them successfully and safely when they occur.Ĭataract surgery requires a well-dilated and stable pupil for a good outcome. Even one year after surgery, the symptoms persisted. Her NLI was C4, and her ASIA Impairment Scale score was C. During rehabilitation admission, her neurological findings were that her motor level of injury was C4 on the right and C5 on the left, and her sensory level of injury was C4 and C5, respectively, on the right and left sides. She developed ptosis, miosis, and anhidrosis on the side immediately after surgery. She underwent a C5 and C6 central corpectomy and mesh cage fusion by an anterior longitudinal incision via right-sided exposure. The cervical spine MRI suggested compression fractures of the C5 and C6 vertebral bodies with cord compression. Her neurological injury level (NLI) was C4, and her ASIA Impairment Scale score was A. Her pre-operative findings were that her motor level of injury was C4 on the right and C5 on the left, and her sensory level of injury was C4 and C5, respectively, on the right and left sides. A 42-year-old female presented with sudden-onset weakness in both upper and lower limbs secondary to trauma and was diagnosed with a spinal cord injury with tetraplegia. Horner syndrome (HS) is a rare complication of anterior cervical decompression and fusion procedures (ACDF). In addition to conventional mushroom identification methods, this report also highlights the use of toxicology tests on different biological and non-biological specimens for diagnosis, prognosis and surveillance purposes. Key issues in the management of these cases were presented. In this report, the variable clinical presentation of cholinergic mushroom poisoning is discussed. Muscarine, a cholinergic toxin found in mushrooms such as Inocybe and Clitocybe species, was subsequently extracted from and identified in the urine specimens of both patients, using a liquid-chromatography tandem mass spectrometry method. Mushroom specimens were sent to a mycologist for identification using morphological analysis. Mildly elevated liver transaminase was noted in one female patient. The patients volunteered a history of taking two tablespoons of cooked wild mushrooms collected in a country park. Two middle-aged patients presented to the emergency unit with acute gastrointestinal symptoms including epigastric pain, vomiting and diarrhea, followed by miosis, palpitations and diaphoresis which were compatible with a cholinergic toxidrome. We report an uncommon case of cholinergic poisoning following an ingestion of wild mushrooms.
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