New technological progress in robotics has brought many beneficial clinical applications. Currently, computer integrated robotic surgery has gained clinical acceptance for several surgical procedures. Robotically assisted eye surgery is envisaged as a promising solution to overcome the shortcomings inherent to conventional surgical procedures as in vitreoretinal surgeries. Robotics by its high precision and fine mechanical control can improve dexterity, cancel tremor, and allow highly precise remote surgical capability, delicate vitreoretinal manipulation capabilities. Combined with magnified three‑dimensional imaging of the surgical site, it can enhance surgical precision. Tele‑manipulation can provide the ability for tele‑surgery or haptic feedback of forces generated by the manipulation of intraocular tissues. It presents new solutions for some sight‑threatening conditions such as retinal vein cannulation where, due to physiological limitations of the surgeon’s hand, the procedure cannot be adequately performed. In this paper, we provide an overview of the research and advances in robotically assisted vitreoretinal eye surgery. Additionally the barriers to the integration of this method in the field of ocular surgery are summarized. Finally, we discuss the possible applications of the method in the area of vitreoretinal surgery.

The vitreoretinal interface is involved in a wide range of vitreoretinal disorders and separation of the posterior vitreous face from the retinal surface is an essential part of vitrectomy surgeries. A diverse range of enzymatic and non-enzymatic agents are being studied as an adjunct before or during vitrectomy to facilitate the induction of posterior vitreous detachment. There is a significant body of knowledge in the literature about different vitreolytic agents under investigation for a variety of pathologies involving the vitreoretinal interface which will be summarized in this review.

The vitreoretinal interface is involved in a wide range of vitreoretinal disorders and separation of the posterior vitreous face from the retinal surface is an essential part of vitrectomy surgeries. A diverse range of enzymatic and non-enzymatic agents are being studied as an adjunct before or during vitrectomy to facilitate the induction of posterior vitreous detachment. There is a significant body of knowledge in the literature about different vitreolytic agents under investigation for a variety of pathologies involving the vitreoretinal interface which will be summarized in this review. Method s: Articles retrieved by Pubmed search using keywords “Vitreolysis”, pharmacologic Vitreolysis, plasmin and vitrectomy, and microplasmin and vitrectomy, were used in this review. recent reports have raised strong hopes that pharmacologic vitreolysis may eventually find its way to clinical practice. Further investigations will demonstrate whether enzymatic vitreolysis could be used as an adjunct and/or alternative treatment for treatment of vitreoretinal disorders.

To define the characteristics of vitreoretinal surgeries amid coronavirus disease 2019 (COVID‑19) pandemic restrictions in Turkey.

This descriptive, cross-sectional study was conducted for vitreoretinal surgeries during the 10-week period (during this period, all elective surgeries were postponed across the country by the order of the Republic of Turkey Ministry of Health) in a single tertiary referral hospital in Ankara, Turkey. The number of surgeries, surgical indications, risk factors, etiological factors, and associated conditions were investigated and compared with the clinical features of the patients who underwent vitreoretinal surgery in the same period of the recent year.

During this period, vitreoretinal surgery was performed more commonly for the male population (P < 0.001). The number of vitreoretinal surgeries was statistically significantly correlated with the number of COVID‑19 cases (P = 0.006 and r = −0.791 for weekly numbers of new surgeries and cases, and P < 0.001 and r = 0.929 for cumulative numbers of surgeries and cases). Diabetes mellitus in 26 patients (32.9%) was the most common systemic comorbidity. The most common indication for vitreoretinal surgery was rhegmatogenous retinal detachment in 44 patients (55.7%) followed by diabetic retinopathy complications in 21 patients (26.6%). No one was operated on for vitreoretinal interface disorders during this period, and the rate of rhegmatogenous retinal detachment was higher than the same period of the recent year (P = 0.003).

Amid COVID-19 pandemic restrictions in Turkey, the number of vitreoretinal surgeries was inversely associated with the number of confirmed COVID‑19 cases. The male population needed more vitreoretinal surgery, and rhegmatogenous retinal detachment was the most common indication for all patients.

The popularization of ophthalmic endoscopy has been promoted by recent technological advancements that increase the number of indications for endoscopy. These advancements have improved the endoscope’s capabilities in its two fundamental surgical advantages: (1) bypassing anterior segment opacities, and (2) visualizing anteriorly positioned structures such as the ciliary bodies and sub-iris space. In this article, the current state of the ophthalmic endoscope is reviewed alongside its growing number of applications in glaucoma, vitreoretinal, and ocular trauma surgery. We describe the role of endoscopy in endocyclophotocoagulation for glaucoma, cyclitic membrane peeling in hypotony, retinal detachment surgery, intraocular foreign body removal, severe endophthalmitis, and pediatric traumatic vitreoretinal surgery. This review examines both the pearls and limitations of the ophthalmic application of endoscopy. In doing so, we hope to provide guidelines for using the endoscope and also to highlight applications of endoscopy that merit further study.

Adequate visualization and identification of the posterior hyaloid, epiretinal membranes and the internal limiting membrane are of paramount importance in modern vitreoretinal surgery. “Chromovitrectomy” is a term used for describing the vital dyes use in order to stain these transparent tissues and facilitate their manipulation during vitreous surgery. This article reviews the indications, applications and characteristics of vital dyes in vitreoretinal surgery. Various dyes are currently being used in routine clinical procedures, however the ideal staining agent has not yet been found. Any dye which is injected intravitreally has the potential to become toxic. Triamcinolone acetonide is used to highlight the vitreous and is particularly beneficial in determining the attachment of the posterior hyaloid to the underlying retina. Trypan blue stains epiretinal membranes and facilitates their complete removal. Both indocyanine green and brilliant blue G stain the internal limiting membrane properly, however concerns over indocyanine green toxicity have made surgeons switch to brillliant blue G as a safer alternative.

Postoperative cognitive impairment is common in the elderly. Multiple factors such as anesthetic drugs are effective on postoperative cognitive function. Lidocaine is a drug used for different therapeutic targets in anesthesia. One of its indications is reducing airway irritations before extubation. This study is designed to evaluate the effect of bollous intravenous lidocaine at the end of surgery on postoperative cognitive function in the elderly undergoing urologic and orthopedic surgery with general anesthesia. In this double blinded clinical trial, after permission from research committee and having obtained written consent, patients older than 65yr were devided in two equal groups (each group comparising of 35 patients). In case group, we used intravenous lidocaine 1.5mg/kg before extubation and in control group, normal saline was used. Cognitive state was evaluated by MMSE questionnaire at four stages: preoperative, at discharge time from recovery, 6hours and 24hours after surgery. Finally, data were analysed with ANOVA, T-test and Mann-Whiteny test. Two groups had no significant differences in demographic factors, surgery status, past history of HTN, DM and smoking. Mean of MMSE at the time of discharge from recovery was 22.4±4.5(SD) and 22.1±4.4(SD) in lidocaine and normal saline group respectively. It showed significant differences with MMSE at the time of before surgery and 24 hours after surgery within two groups, but there was no significant differences in MMSE before surgery, at discharge time from recovery,6hours and 24hours after surgery between two groups. Frequency of severe cognition impairments in lidocaine group before surgery, at discharge from recovery room, 6hours and 24 hours after surgery was 8%, 17%, 9%, 6% respecttively. This frequency was 0%, 20%, 17%, 3% respectively in normal saline group. Two groups showed no significant differences in cognitive impairments at before and after surgery.Conclusion and Administration of bolous intravenous lidocaine before extubation didnot improve cognition state in elderly undergoing noncardiac surgeries under general anesthesia. The effect of lidocaine on cognitive function following cardiac surgeries in which the brain is at potential risk is clear, but in noncardiac surgeries where the brain is not at risk of ischemic events, lidocaine showed no clinical effects. Thus further studies with different doses of lidocaine and different assessment methods are recommended.

Brugada syndrome (BrS), a type of sudden arrhythmic unexpected death syndrome (SADS), is characterized by specific electrocardiogram (ECG) changes, a structurally normal heart, and susceptibility to life-threatening ventricular arrhythmias. General anesthesia (GA) is usually used for major surgery in patients with BrS due to concerns that some local anesthetic agents may precipitate critical arrhythmias. The majority of ophthalmic surgeries are successfully carried out under regional anesthesia (RA). The literature does not address the use of ophthalmic RA in patients with BrS except one report of peribulbar block for glaucoma surgery. This clinical case report and the liertature review suggests that for BrS patients presenting for vitreoretinal surgery, a sub-tenon block, with or without sedation may safely be used as a primary anaethestic technique.

Induction of anaesthesia and its associated spikes in blood pressure can cause rupture of an aneurysm during intracranial surgery. Lidocaine can reportedly provide hemodynamic stability when applied before endotracheal intubation. Rapid injection of large doses of lidocaine can cause unconsciousness.. Lidocaine was applied as the sole anaesthetic for induction and maintenance during aneurysm surgery in four patients undergoing intracranial aneurysm surgery. Blood pressure alteration after induction and during surgery, bleeding, brain laxity, intracranial pressure and extubation time were acceptable.. Although propofol remains a standard agent for such types of surgeries, lidocaine proved equally effective and coupled with its low cost, minimal side effects and omission of other hypnotic agents was a plausible induction agent and a maintenance drug in the selected cases..

Post operative pain has been one of the problems in surgical procedures under intravenous regional anesthesia (IVRA). This study evaluates the effect of addition of paracetamol and dexamethasone to lidocaine for IVRA on post operative pain. In this clinical trial double blind study sixty patients (ASA1, 2), aged 20-60 years undergoing upper limb surgery under IVRA were assigned to four groups: Groupe 1: lidocaine, Groupe 2: lidocaine plus dexamethasone, Groupe 3: lidocaine plus paracetamol and Groupe 4: lidocaine plus paracetamol. In all of the groups, Lidocaine was diluted with normal saline to a total volume of 40 ml. Sensory and motor block onset time and severity of post operative pain and amount of meperidine consumption in 24h after surgery were assessed. Sensory and motor block onset time in the fourth group in comparsion to other groups was shorter (p< 0/01). Post operative pain and analgesic consumption were reduced in fourth group when compared with other groups (p<0/05). The addition of paracetamol and dexamethasone to Lidocaine in IVRA shortens the onset time of sensory and motor block and reduces post operative pain and analgesic consumption.