小切口非乳化白内障手术不同麻醉方法的效果

目的比较小切口非超声乳化白内障摘出术中表面麻醉与球后麻醉的麻醉效果。方法 95例（95眼）白内障随机分为A、B两组,A组48例使用0.5%爱尔凯因表面麻醉;B组47例使用传统的球后麻醉。两组均行小切口非超声乳化白内障摘出及人工晶状体植入术,对麻醉效果和并发症进行分析。结果两组麻醉效果均满意,麻醉并发症的发生率A组低于B组（χ^2=4.18,P〈0.05）。结论表面麻醉下小切口非超声乳化白内障摘出术安全有效,并发症少。     

表面麻醉下白内障摘除人工晶状体植入术

目的进一步探讨表面麻醉下小切口非超声乳化白内障摘除人工晶状体植入术的安全性及有效忡。方法随机抽取220例(256眼)行小切口非超声乳化白内障摘除及人工晶状体植入术患者分为2组。表面麻醉组110例(126 眼),球后麻醉组110例(130眼),比较2组的手术效果及并发症。结果表向麻醉组手术时间明显短于球后麻醉组(P<0.01),而且并发症更少,术后1d及1周视力对比无显著性差异(P>0.05)。结论表面麻醉下小切口非超声乳化白内障摘除人工晶状体植入术是安全有效的,而且并发症少,简便易行。     

表面麻醉及球周麻醉下超声乳化白内障吸除联合人工晶状体植入术的比较

目的：评价表面麻醉下超声乳化白内障吸除及人工晶状体植入术的安全性和效果。方法：两组共375例（400只眼）白内障分别在表麻下及球周麻醉下施行超声乳化吸除及人工晶状体植入术,对术后视力,术中及术后并发症进行分析。结果：两组术后1天、1周、3个月视力无显著差异;关发症：后囊破裂及角膜水肿发生率,两组间相差不显著;球周麻醉组发生眶内出血2只眼,暂时性上睑下垂26只眼,暂时性复视9只眼。结论：表面麻醉下超声乳化术是安全有效的。在熟练掌握超声乳化手术的基础上,表面麻醉下手术较球周麻醉下更安全、快捷。     

表面麻醉小切口非超声乳化白内障手术的临床效果分析

目的观察表面麻醉小切口非超声乳化白内障手术的临床效果。方法行小切口非超声乳化白内障人工晶体手术治疗白内障的患者98例（109眼），随机分为表面麻醉组49例（54眼）和球后麻醉组49例（55眼）。球后麻醉组给予2％利多卡因球后阻滞麻醉。表面麻醉组给予倍诺喜（盐酸奥布卡因0．4％）表面麻醉。结果采用表面麻醉和球后麻醉的麻醉效果比较差异无统计学意义（P〉0．05），同时手术后1个月视力以及散光度情况比较差异无统计学意义（P〉0．05）。但是表面麻醉组的手术时间要显著短于球后麻醉组，表面麻醉组并发症的发生率显著低于球后麻醉组（P〈0．05）。结论表面麻醉下行小切口非超声乳化白内障摘除联合人工晶体植入术麻醉效果良好，能最大限度减少麻醉所带来的并发症，大大减少了病人的痛苦。     

小梁切除联合超声乳化IOL植入术中三种麻醉方法的比较

目的:探讨表面麻醉,表面麻醉联合球结膜下麻醉及球后麻醉在小梁切除联合超声乳化人工晶状体(IOL)植入术中的可行性并对其效果进行评价。方法:对90例120眼按入院时间先后分成3组,分别用表面麻醉,表面麻醉结合球结膜下麻醉及球后麻醉行小梁切除联合超声乳化人工晶状体植入术,观察麻醉效果及术中、术后的局部及全身并发症。结果:表面麻醉组有3眼因麻醉不足术中追加结膜下麻醉,有11眼因麻醉不足疼痛不能耐受手术。表面麻醉联合球结膜下麻醉全部30眼麻醉效果理想,均顺利完成手术,且无因麻醉量不足或过量及麻醉手法等问题引起的术中或术后的并发症,球后麻醉30眼有1眼出现一过性黑矇,3眼出现球后出血,1眼术后眼睑青紫,经术中及术后对患者的处理及解释病情,均无大碍,也顺利完成手术。结论:三种麻醉方法中以表面麻醉联合球结膜下麻醉在小梁切除联合超声乳化人工晶状体植入术中最安全且有效,为青光眼白内障联合手术的首选麻醉方式。     

表麻下的白内障小切口非超声乳化术

目的 探讨表面麻醉下小切口白内障非超声乳化手术的安全性和有效性.方法 研究组109例（109眼）,使用0.4%倍诺喜表面麻醉;对照组79例（79眼）,使用传统的球周麻醉.两组均行小切口白内障非超声乳化手术及人工晶状体植人手术.对麻醉的有效性、并发症和手术时间进行分析.结果 所有患者均能耐受手术,研究组的麻醉并发症的发生率低于对照组,手术时间也大大缩短.结论 表面麻醉下小切口白内障非超声乳化手术是安全有效的,并发症少,简便易行.     

表面麻醉下晶状体超声乳化临床观察

目的观察表面麻醉在晶状体超声乳化白内障摘出及人工晶状体植入术中的麻醉效果。方法采用表面麻醉对198例(212眼)进行晶状体超声乳化白内障摘出及人工晶状体植入术。结果212眼均在表面麻醉下完成手术,术后1周最佳视力≥0.5者176眼(83.02%),术后1月最佳视力者≥0.5者200眼(94.34%)。主要并发症:后囊破裂6眼(2.83%),中度角膜水肿4眼(1.89%)。结论表面麻醉下行晶状体超声乳化白内障摘出人工晶状体植入术是安全、有效的。     

表面麻醉下行白内障超声乳化术

目的：探讨表面麻醉下行白内障超声乳化术的安全及有效性。方法：观察102例单纯表面麻醉下实施白内障超声乳化术的麻醉效果和术后视力,结果：所有患者都能很好配合表面麻醉下施行该手术,无1例追加球后或球周麻醉,手术时间一般为8－15分钟,术后3月矫正视力＞0．5者占96．08％。无1例发生球后麻醉的诸多并发症。结论：表面麻醉对于白内障超声乳化手术是一种有效,安全的选择。     

表面麻醉下的白内障超声乳化术

为评估采用表面麻醉进行白内障超声乳化术的可靠性、有效性及安全性,对１７３例白内障患者经表面麻醉进行白内障超声乳化术。随机选取同期手术的另外１７３例患者采用标准的球后麻醉做为对照组。比较两组患者不同麻醉方法的并发症,以及两组患者术中的配合程度及疼痛感。结果：球后麻醉组中,结膜水肿、结膜下出血及眼睑出血的发生率显著高于表现麻醉组（Ｐ〈０．００１）,另有２例发生球后出血。表面麻醉组中未见类似并发症。表面     

表面麻醉下高度近视眼白内障超声乳化术初步探讨

目的：分析和探讨表面麻醉下行高度近视眼合并白内障超声乳化术的安全性及其疗效。方法：对45例50只高度近视眼合并白内障患者进行表面麻醉下超声乳化术并植入人工晶状体，观察手术中疼痛感、并发症、术后疗效及与疗效相关问题。结果：40例45只眼无疼痛，3例3只眼有轻微胀感，2例2只眼胀痛，术中追加一次表面麻醉，1例1只眼发生部分悬韧带离断，无视网膜脱离发生。结论：表面麻醉下高度近视眼合并白内障超声乳化术安全、疗效确切、并发症少。     

表面麻醉用于人工晶状体植入联合小梁切除术

目的 评价表面麻醉在白内障超声乳化及人工晶状体植入联合小梁切除术中的麻醉效果。方法 采用表面麻醉的方法超声乳化白内障摘除联合小梁切除术26例（26眼）。记录患者在接受表麻、作巩膜隧道、超声乳化术中、虹膜周切、术后这5个阶段的患者感觉,同时记录术中是否有眼睑挤压、眼球转动及其配合程度。结果 26例患者中麻醉时无痛和轻微疼痛者为26例（100％）;中等程度疼痛者于超声乳化术中占1例,虹膜周切时占2例,术后占1例,且都能忍受;重度疼痛者无,88．5％患者能很好地配合手术,术中无麻醉引起的并发症发生。结论 该麻醉方法适用于白内障超声乳化及人工晶状体植入联合小梁切除术,不仅避免了球后或球周麻醉的诸多并发症而且使手术变得更加简单、安全。     

筋膜下麻醉小梁切除术

目的:探讨筋膜下麻醉行小梁切除术的有效性及安全性。方法:在连续58例(60眼)青光眼小梁切除术中分别应用表面麻醉、球后麻醉、筋膜下麻醉各20眼,观察麻醉效果、并发症情况。结果:表面麻醉组患者术中在上直肌牵引缝线、巩膜电凝、周边虹膜切除、结膜缝合时有不同程度痛感,筋膜下麻醉、球后麻醉组患者术中无明显痛感,筋膜下麻醉组1眼、球后麻醉组2眼术中出现一过性黑矇,球后麻醉组术中出现球后出血1眼,术后短暂性上睑下垂2眼。结论:小梁切除术采用筋膜下麻醉具有麻醉效果好、并发症少的优点,是理想麻醉方法。     

筋膜下麻醉小梁切除术

目的：探讨筋膜下麻醉行小梁切除术的有效性及安全性。方法：在连续58例（60眼）青光眼小梁切除术中分别应用表面麻醉、球后麻醉、筋膜下麻醉各20眼,观察麻醉效果、并发症情况。结果：表面麻醉组患者术中在上直肌牵引缝线、巩膜电凝、周边虹膜切除、结膜缝合时有不同程度痛感,筋膜下麻醉、球后麻醉组患者术中无明显痛感,筋膜下麻醉组1眼、球后麻醉组2眼术中出现一过性黑矇,球后麻醉组术中出现球后出血1眼,术后短暂性上睑下垂2眼。结论：小梁切除术采用筋膜下麻醉具有麻醉效果好、并发症少的优点,是理想麻醉方法。     

Topical plus intracameral lidocaine versus retrobulbar anesthesia in phacotrabeculectomy: prospective randomized study

PURPOSE: To compare the efficacy and safety of topical and retrobulbar anesthesia for phacotrabeculectomy. SETTING: Hospital Ramón y Cajal, Madrid, Spain. METHODS: This prospective study comprised 60 patients (60 eyes) having phacotrabeculectomy surgery. Patients were randomly assigned to 1 of 2 groups receiving topical anesthesia plus intracameral lidocaine 1% or retrobulbar anesthesia. Patients were asked to document the discomfort they experienced during the administration of the anesthetic agent, during surgery, and postoperatively using a numeric pain scale. Complications and surgical conditions were also evaluated. RESULTS: The retrobulbar group reported significantly more discomfort during administration of the anesthetic agent than the topical group (P < .001). The topical group reported significantly more discomfort intraoperatively (P < .01). Eyelid squeezing and eyeball movement were more common in the topical group; however, neither was a problem to the surgeon. There was no difference in surgical conditions (P = .38) or the postoperative pain scores between the 2 groups (P = .06). One patient receiving topical anesthesia developed a suprachoroidal hemorrhage intraoperatively. CONCLUSIONS: Topical anesthesia supplemented with intracameral lidocaine was an effective alternative to retrobulbar anesthesia for phacotrabeculectomy. Although the degree of patient discomfort was significantly higher during surgery under topical anesthesia, the method avoids the pain and complications associated with a retrobulbar injection.     

Phacoemulsification with topical anesthesia performed by resident surgeons

PURPOSE: To evaluate and compare the outcomes in phacoemulsification cases performed by resident surgeons using topical anesthesia or retrobulbar anesthesia. SETTING: Department of Ophthalmology, Emory University, Atlanta, and Department of Veterans Affairs Medical Center, Decatur, Georgia, USA. METHODS: This was a retrospective review of phacoemulsification cases performed by resident surgeons during 1 academic year. Variables analyzed included patient age and sex, preexisting conditions limiting final acuity, and type of anesthesia used. Outcomes measured included intraoperative and postoperative complications and final visual acuity. RESULTS: Of the 291 cases analyzed, 119 (40.9%) were retrobulbar and 172 (59.1%) were topical. Residents began using topical anesthesia after a brief introductory period with retrobulbar anesthesia. Vitreous loss occurred in 15 cases (5.1%), 8 retrobulbar (6.7%) and 7 topical (4.1%) (P =.42). Postoperative complications occurred in 30 cases (10.3%), 17 topical (9.9%) and 13 retrobulbar (10.9%) (P =.85). Overall, 245 cases (84.2%) achieved a final best corrected visual acuity (BCVA) of 20/40 or better. When cases with preexisting conditions limiting final acuity were eliminated, 92.1% achieved a final BCVA of 20/40 or better. More topical cases (112, 65.1%) than retrobulbar cases (64, 53.8%) achieved a final BCVA of 20/25 or better (P =.06), and more topical cases (149, 86.6%) than retrobulbar cases (96, 80.7%) achieved a final BCVA of 20/40 or better (P =.19). CONCLUSION: Topical anesthesia is safe and efficacious for phacoemulsification performed by resident surgeons early in training after a brief introduction to phacoemulsification using retrobulbar anesthesia.     

Clorazepate dipotassium versus midazolam for premedication in clear corneal cataract surgery

PURPOSE: To evaluate and compare the efficacy of oral clorazepate dipotassium (Tranxilium) and intravenous midazolam (Dormicum) as premedication agents in retrobulbar anesthesia and clear corneal phacoemulsification with intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, University of Essen, Essen, Germany. METHODS: In a prospective clinical trial, 97 consecutive patients (97 eyes) having phacoemulsification with implantation of a foldable IOL were randomized to 2 groups. The first group received 10 mg oral clorazepate dipotassium and the second group, 1 mg intravenous midazolam. The surgeon's subjective experience of patients' cooperation during retrobulbar anesthesia and after surgery was measured on a 5-point Likert scale. The duration of surgery and rate of complications were documented. One day after surgery, the patients' subjective comfort during cataract surgery was evaluated using a 5-point Likert scale and the best corrected visual acuity was determined. RESULTS: The level of anterograde amnesia tended to be higher in the midazolam group than in the clorazepate dipotassium group (4% versus 0% for anesthesia administration; 14% versus 4% for surgery), but the difference between groups was not significant. There were no significant differences in patient cooperation or complications during surgery. Patient satisfaction scores were not significantly different between the groups (P<.14); however, patients in the midazolam group expected to have significantly less pain during surgery (P<.04). The rate of potential visual acuity recovery was similar between groups. CONCLUSIONS: Anterograde amnesia occurred more frequently and patients expected less pain before surgery with midazolam. Both anesthetic agents provided safe and effective premedication for retrobulbar anesthesia in clear corneal cataract surgery.     

Phacoemulsification with topical anesthesia: Resident experience

PURPOSE: To compare the intraoperative and postoperative complications and outcomes of phacoemulsification performed by residents using topical and retrobulbar anesthesia. SETTING: Two university ophthalmology departments. METHODS: One hundred fifty phacoemulsification procedures were performed by 3 residents who used retrobulbar anesthesia (retrobulbar group), and 146 phacoemulsification procedures were performed by another 3 residents who used topical anesthesia and who had no experience with retrobulbar or peribulbar anesthesia (topical group). Case notes were prospectively compared. The data analyzed included the ocular history, intraoperative and postoperative complications, and final best spectacle-corrected visual acuity (BSCVA). RESULTS: There were no differences between the 2 groups in complication rates. Anterior capsule tears occurred in 8 eyes (5.3%) in the retrobulbar group and 7 eyes (4.7%) in topical group. Capsulorhexis was continuous but not curvilinear in 14 eyes (9.3%) and 12 eyes (8.2%), respectively. Capsulorhexis tear or posterior capsule rupture that necessitated conversion to extracapsular cataract extraction occurred in 3 eyes (2.0%) in the retrobulbar group and in 1 eye (0.6%) in the topical group. Posterior capsule rupture with vitreous loss occurred in 10 eyes (6.6%) and 9 eyes (6.1%), respectively. Loss of lens fragments in the vitreous cavity occurred in 3 eyes (2.0%) and 4 eyes (2.7%), respectively. The 63 postoperative complications (41 eyes [27.3%], retrobulbar group; 22 eyes [15.0%], topical group) included cystoid macular edema, intraocular lens decentration, endophthalmitis, bullous keratopathy, transient intraocular pressure elevation, temporary corneal edema, and vitreous hemorrhage. Some cases had more than 1 complication. The BSCVA, including in eyes with preexisting ocular pathology, was 20/40 or better in 86.7% in the retrobulbar group and 84.9% in the topical group. CONCLUSION: When supervised and in selected patients, residents who have no retrobulbar or peribulbar anesthesia experience can safely perform phacoemulsification using topical anesthesia.     

Patient's pain feeling and surgeon's comfort--ECCE versus phacoemulsification

PURPOSE: To compare patient's pain and surgeon's comfort during ECCE performed under retrobulbar anesthesia and phacoemulsification under topical anesthesia. MATERIAL AND METHODS: 120 patients scheduled for planned routine cataract extraction were divided in 2 groups: group 1-60 eyes, ECCE under retrobulbar anesthesia and group II-60 eyes, phacoemulsification under topical anesthesia. Immediately after operation patients were asked, to answer questions about their feeling during surgery. Simultaneously, the surgeon filled up the questionnaire, concerning patients behavior during the entire procedure. RESULTS: Statistically significant higher level of pain was reported in group I (ECCE). The most painful moment of the procedure was retrobulbar injection. During surgery pain feeling in both groups was similar. Both types of anesthesia provided very good level of surgeon's comfort. The longer operation, the higher level of pain and lower surgeon's comfort were reported in both groups. CONCLUSIONS: Patients having ECCE performed under retrobulbar anesthesia reported more pain comparing to phacoemulsification under topical anesthesia. Both anesthesia methods provided high level of surgeon's comfort.     

Topical anesthesia with or without propofol sedation versus retrobulbar/peribulbar anesthesia for cataract extraction: prospective randomized trial

PURPOSE: To evaluate the feasibility of intravenous sedation in addition to topical anesthesia during cataract extraction. SETTING: Helsinki University Eye Hospital, Helsinki, Finland. METHODS: Three hundred seventeen eyes of 291 consecutive patients having cataract surgery were prospectively randomized to receive topical (oxybuprocaine 0.4%, n = 96), combined (topical anesthesia and propofol sedation, n = 107), or retrobulbar/peribulbar (prilocaine 1.5%, n = 114) anesthesia. The intraoperative conditions were judged by the surgeon. A numerical scale (0 to 10) was used to assess the degree of pain during surgery. Outcome measures were the number of complications and adverse events registered perioperatively and 1 week postoperatively as well as Snellen visual acuity. RESULTS: The success of posterior chamber intraocular lens (IOL) implantation through a self-sealing clear corneal incision was 97.9%, 96.3%, and 98.2% in the topical, combined, and retrobulbar/peribulbar groups, respectively. There was no difference among the groups in pain during surgery, frequency of complications, or outcome measures. One week postoperatively, visual acuity was 20/40 or better in 81.7%, 78.5%, and 77.5% of eyes in the topical, combined, and retrobulbar/peribulbar groups, respectively. The surgeon reported significantly fewer difficulties in the retrobulbar/peribulbar group (9.8%) than in the topical (26.0%) (P =.004) or combined (21.0%) (P =.036) groups. Additional sedative/analgesic medication given intraoperatively was required significantly more often in the topical (15.6%) than in the retrobulbar/peribulbar group (2.6%) (P =.002). Patients with bilateral surgery preferred combined anesthesia over retrobulbar/peribulbar anesthesia; however, there was no significant difference in patient acceptance among groups in patients having unilateral surgery. CONCLUSION: Intravenous propofol sedation added to topical anesthesia did not improve the operative conditions or surgical outcome. Retrobulbar/peribulbar anesthesia ensured the best surgical conditions. Patients in all anesthesia groups reported high satisfaction. However, patients having bilateral surgery seemed to prefer combined anesthesia over retrobulbar/peribulbar anesthesia.     

Combined topical and intracameral anesthesia for Descemet’s stripping automated endothelial keratoplasty

To evaluate the use of combined topical and intracameral anesthesia for Descemet’s stripping automated keratoplasty (DSAEK). This was a retrospective comparative cohort analysis consisting of 10 eyes in 10 consecutive patients undergoing DSAEK surgery with combined topical and intracameral anesthesia. These cases were compared with 21 randomly selected controls during the same time period undergoing DSAEK surgery performed under retrobulbar anesthesia. Incidence of intraoperative and postoperative complications, and endothelial cell counts were compared. In all cases, DSAEK was completed without intraoperative complications. All patients tolerated the procedure well. There were 6 cases of postoperative graft dislocation requiring rebubbling, and no cases of primary failure or endophthalmitis. No significant difference in endothelial cell counts was found at final follow-up. Short-term results suggest that combined topical and intracameral anesthesia is as safe and effective for DSAEK in cooperative patients when compared to retrobulbar anesthesia. It may thereby be an alternative anesthetic modality for patients in whom retrobulbar or peribulbar anesthesia may be risky or contraindicated.