表面麻醉下小切口非超声乳化白内障摘除及人工晶状体植入术

目的:探讨表面麻醉下行小切口非超声乳化白内障摘除及人工晶状体植入术的安全性及有效性。方法:对79例86眼白内障患者在表面麻醉下行小切口非超声乳化白内障摘除及人工晶状体植入术并观察其麻醉效果及术后视力。结果:其中64例71眼无疼痛,15例15眼胀痛,术中追加一次表面麻醉。平均手术时间为18min,术后1d及1wk视力≥0.5者分别占83%和92%。结论:表面麻醉小切口非超声乳化白内障摘除及人工晶状体植入术具有操作简单,手术时间短,术后视力恢复快且稳定,手术成本低,适合我国国情,有利于规模化手术。     

表面麻醉下超声乳化及折叠式人工晶状体植入术

目的 评价表面麻醉在超声乳化并折叠工人晶状体植入术中的优缺点。方法 对168眼白内障患者在表面麻醉下施行超声乳化及折叠式人工晶状体植入术并进行临床观察。结果 术中无疼痛感166眼占98.8%，有疼痛感2眼占1.2%，未追加麻醉完成手术。结论 表面麻醉简单易行，并发症少，视力恢复快。熟练掌握白内障超声乳化及折叠式人工晶状体植入术，能最大限度的缩短手术时间，保证了手术在无痛状态下进行，手术指征得以放宽。值得提倡。     

表面麻醉下超聲乳化及折叠式人工晶狀體植入術

目的 评价表面麻醉在超声乳化并折叠人工晶状体植入术中的优缺点。方法 对168眼白内障患者在表面麻醉下施行超声乳化及折叠式人工晶状体植入术并进行临床观察。结果 术中无疼痛感166眼占98.8％。有疼痛感2眼占1.2％。未追加麻醉完成手术。结论 表面麻醉简单易行、并发症少、视力恢得快。熟练掌握白内障超声乳化及折叠式人工晶状体植入术,能最大限度的缩短手术进间,保证了手术在无痛状态下进行,手术指徵得以放宽。值得提倡。     

利多卡因应用于超声乳化白内障吸除术的临床观察

目的: 评价利多卡因作为表面麻醉剂在超声乳化白内障吸除术中的应用效果。方法: 我院2007-10/2011-09采用20g/L利多卡因注射液滴眼进行表面麻醉,行超声乳化白内障吸除联合人工晶状体植入术1850例2600眼,观察术中的镇痛效果。结果: 所有患者的手术过程顺利,93%的患者镇痛效果良好,术中无疼痛感,患者能很好地配合手术,未发生与麻醉相关的并发症,7%的患者术中诉术眼有胀痛感,均可忍受。术后1mo时,89.4%的术眼裸眼或矫正视力≥0.6。结论: 利多卡因作为表面麻醉剂行超声乳化白内障吸除联合人工晶状体植入术的镇痛效果良好,手术安全、舒适。1674     

超声乳化术中表面麻醉剂的止痛效果

目的：本文报告1200例超声乳化白内障手术中表面麻醉的止痛效果。方法：术中采用0．4％Oxybuprocaine和0.4%Alcaine表面麻醉,经巩膜隧道切口完成常规超声乳化手术,植入单片式PMMA硬质人工晶体和三片式折叠式人工晶体。结果：80％手术病人术中没有任何疼痛感,20％病人（365眼次）在手术不同步骤时有疼痛感,其中有49眼（3．9％）,追加球后麻醉。     

表面麻醉下超声乳化术117例临床分析

目的:评价在表面麻醉下行超声乳化及人工晶状体植入术的安全性及优越性。方法:在爱尔凯因表面麻醉下对117例(121眼)白内障患者行超声乳化及人工晶状体植入术并观察其麻醉效果及视力。结果:在表面麻醉下全部患者均能很好地配合手术完成,无1例更换麻醉方法。平均手术时间13.26min,术后1d视力>0.5者占65.3%,术后1wk>0.5者占87.6%。结论:在表面麻醉下行超声乳化白内障摘除及人工晶状体植入术是安全优越的。     

表面麻醉下小切口白内障超声乳化人工晶状体植入术

目的:探讨表面麻醉下小切口白内障超声乳化人工晶状体植入术的临床效果和优点。方法:70例83眼采用表面麻醉下透明角膜小切口白内障超声乳化术并植入折叠式后房型人工晶状体。结果:术后1mo视力>0.3者77眼。术中1眼出现后囊破裂,但人工晶状体顺利植入;1眼外伤性白内障人工晶状体未能植入;糖尿病患者2眼出现并发症。结论:表面麻醉下小切口白内障超声乳化人工晶状体植入术具有术程短、术后视力恢复快的优点。     

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。     

高度近视白内障表面麻醉下超声乳化手术

目的 探讨高度近患者白内障表面麻醉下超声乳化人工晶状体植入术的安全性及疗效.方法 对59例(71眼)高度近视合并白内障进行表面麻醉下超声乳化人工晶状体植入术,观察术中疼痛感、并发症及手术效果.结果 61眼(85.92％)无疼痛、6眼(8.45％)有轻微胀痛、4眼(5.63％)感胀痛,1眼发生后囊破裂,无视网膜脱离发生.术后3个月视力0.3以上者占67.6％,0.5及以上者占36.6％.结论 表面麻醉下高度近视行白内障超声乳化及人工晶状体植入术疗效可靠、并发症少.     

超声乳化人工晶状体植入术治疗高度近视白内障疗效观察

目的:探讨高度近视白内障表面麻醉下晶状体超声乳化吸除人工晶状体植入术的疗效。方法:回顾性病例系列研究,对60例88眼高度近视白内障采用表面麻醉透明角膜切口晶状体超声乳化折叠人工晶状体植入术后随访1～3mo。结果:患者88眼均顺利完成手术植入丙烯酸酯折叠人工晶状体,植入球面人工晶状体46眼,非球面晶状体39眼,多焦晶状体3眼。度数范围:-6.00～+13.00D。术后视力均有不同程度提高,其中矫正视力≥0.5者54眼(61%),≥0.3者73眼(83%),≥0.05者83眼(94%)。术中术后无严重并发症发生。结论:对高度近视白内障采用表面麻醉下透明角膜切口晶状体超声乳化折叠式人工晶状体植入术是安全有效的,是这一高危人群的理想术式。     

Intracameral lidocaine as supplement to classic topical anesthesia for relieving ocular pain in cataract surgery

AIM: To evaluate safety, efficacy, and patient adherence of intracameral lidocaine as supplement of classic topical anesthetic drops in cataract surgery. METHODS: A prospective and controlled trial including a large cohort of 1650 individuals suffering with bilateral cataract not complicated, in program by phacoemulsification surgery, were randomly assigned to 2 different groups for the type of anesthesia received, 0.4% oxybuprocaine hydrochloride (INN) drops, and INN drops associated to intracameral 1% lidocaine hydrochloride monohydrate. At the end of surgery, tables were assigned to each patient indicating the degree of pain (0-3) felt during the operation. RESULTS: Thirty-two percent of patients in group 1 declared to have not felt any pain against the 77% of patients in group 2. Fifty-nine percent of patients in group 1 complained about only a slight discomfort against 20% of group 2 patients. Only a small percentage of patients in group 1 (5%) admitted severe pain, while no patient in group 2 admitted severe pain. Four patients of group 2 reported an episode of transient amaurosis, lasting several hours after surgery. CONCLUSION: Intracameral administration of lidocaine is a simple and secure method able to increase the analgesia during the cataract surgery, eliminating the discomfort and increasing also the cooperation of the patients during the steps of manipulation.     

Topical versus sub-Tenon's anesthesia without sedation in cataract surgery.

PURPOSE: To compare pain control using topical anesthesia with that using sub-Tenon's anesthesia for clear corneal phacoemulsification cataract surgery and foldable intraocular lens (IOL) implantation. SETTING: Departments of Ophthalmology, General Hospital Asklepeion Voulas and General Hospital of Athens, University of Athens, Athens, Greece. METHODS: One hundred consecutive patients scheduled for bilateral cataract surgery 1 to 2 months apart were prospectively randomized to receive topical anesthesia (100 eyes) or sub-Tenon's anesthesia (100 eyes). The randomization was stratified so that one half of first-eye surgeries and one half of second-eye surgeries were assigned to each anesthesia group, with each patient receiving each type of anesthesia once. All patients had clear corneal phacoemulsification with foldable IOL implantation. Patients were asked to rate their pain level on a 10-point scale for 4 periods: during the administration of the anesthetic agent, during surgery, immediately after surgery, and 24 hours postoperatively. The surgeon recorded his subjective assessment of ease of surgery and surgical complications using a standardized template. RESULTS: Eighty-one percent of patients who received topical anesthesia and 8% of patients who received sub-Tenon's anesthesia reported no pain during delivery of the anesthetic agent. The mean pain score was 0.19 +/- 0.39 (SD) in the topical group and 1.35 +/- 0.63 in the sub-Tenon's group. The difference between groups was statistically significant (P <.001). Seventy-two percent of patients in the topical anesthesia group and 86% in the sub-Tenon's anesthesia group reported no pain or slight discomfort during surgery (mean score 1.13 +/- 1.57 and 0.57 +/- 1.28, respectively) (P <.001). Ninety percent of topical anesthesia patients and 100% of sub-Tenon's anesthesia patients reported no pain or slight discomfort 30 minutes postoperatively (mean score 0.80 +/- 0.93 and 0.12 +/- 036, respectively) (P <.001). All patients in the topical anesthesia group and 77% in the sub-Tenon's group reported no pain 24 hours postoperatively (mean pain 0.00 +/- 0.00 and 0.23 +/- 0.40, respectively) (P <.001). Complications including prolonged akinesia of the globe, chemosis, and conjunctival hemorrhage occurred significantly more frequently in the sub-Tenon's than in the topical group (P <.001). CONCLUSIONS: Patients having cataract surgery under topical anesthesia had more intraoperative and postoperative discomfort than patients receiving sub-Tenon's anesthesia. However, patients having topical anesthesia reported less pain during its administration and had fewer complications. Both anesthesia methods provided high levels of pain control without additional sedation.     

No-anesthesia clear corneal phacoemulsification versus topical and topical plus intracameral anesthesia. Randomized clinical trial.

Purpose: To compare the intraoperative pain scores during clear corneal phacoemulsification under no anesthesia, topical anesthesia, and topical plus intracameral anesthesia.Setting: Dr. Agarwal's Eye Hospital and Eye Research Center, Chennai, India.Methods: Seventy-five patients were randomized to have phacoemulsification under no anesthesia, topical anesthesia, or topical plus intracameral anesthesia. Uncooperative or illiterate patients and those with hard cataract, a shallow anterior chamber, or small pupils were excluded. A protocol was established for supplemental anesthesia in case of breakthrough pain during the surgery. Each patient was asked to grade the overall severity of intraoperative pain immediately after surgery on a 10-point visual analog scale. Also evaluated were the general discomfort during surgery, discomfort from the microscope lights, surgeon stress during surgery, and total surgical time. Comparison among the 3 groups was performed using an analysis of variance.Results: No supplemental anesthesia was required in any group. No significant difference was noted in the mean scores of the subjective sensation of pain with or without topical anesthesia (P =.610). The mean scores of patient discomfort from the microscope lights and surgical time were also statistically insignificant. Patient discomfort and surgeon stress during surgery were significantly greater in the no-anesthesia group than in the topical and topical plus intracameral groups (P =.0235 and P = 0.0206, respectively).Conclusion: No-anesthesia clear corneal phacoemulsification was performed by a highly experienced, skilled surgeon without causing an unacceptable level of pain. However, this technique is not suitable for every cataract surgeon or patient.     

Topical anesthesia for phacoemulsification, intraocular lens implantation, and posterior vitrectomy.

PURPOSE: To evaluate the efficacy of topical anesthesia as an alternative to peribulbar or retrobulbar anesthesia in phacoemulsification and intraocular lens (IOL) implantation combined with pars plana vitrectomy. SETTING: Clinica de Ojos de Maracaibo, Maracaibo, and the Retina and Vitreous Service, Clinica Oftalmologica Centro Caracas, Caracas, Venezuela. METHODS: In this prospective study, phacoemulsification, IOL implantation, and posterior vitrectomy using topical anesthesia (lidocaine 4% drops) were prospectively performed in 45 eyes (45 patients) with varied vitreoretinal pathology including macular holes, epiretinal membranes, subfoveal neovascular membranes, proliferative diabetic retinopathy, and vitreous hemorrhage. Preoperative and intraoperative sedation of varying degrees was necessary. Subjective pain and discomfort were graded from 1 (no pain or discomfort) to 4 (severe pain and discomfort). RESULTS: All patients had grade 1 pain and discomfort during most of the procedure. All patients had grade 2 (mild) pain and discomfort during pars plana sclerotomies, external bipolar cautery, and conjunctival closure. The mean amount of lidocaine 4% drops required during each procedure was 0.5 mL. No patient required additional retrobulbar, peribulbar, or sub-Tenon's anesthesia. CONCLUSIONS: This technique avoids the risks of globe perforation, retrobulbar hemorrhage, and prolonged postoperative akinesia of the eye at a lower cost. With appropriate case selection, topical anesthesia was a safe and effective alternative to peribulbar or retrobulbar anesthesia in phacoemulsification and IOL implantation combined with posterior 3-port pars plana vitrectomy.     

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。     

Combined lidocaine 1% and hydroxypropyl methylcellulose 2.25% as a single anesthetic/ viscoelastic agent in phacoemulsification

PURPOSE: To evaluate the use of a mixture of hydroxypropyl methylcellulose 2.25% (HPMC) and lidocaine 1% (final concentrations) as a single viscoelastic/anesthetic agent to achieve proper anesthesia and viscoelastic properties during phacoemulsification. SETTINGS: Department of Ophthalmology, Cairo University, Cairo, Egypt. METHODS: This prospective randomized study comprised 70 eyes having routine phacoemulsification. Patients had the HPMC-lidocaine mixture (n = 35) or pure HPMC 2.25% (n = 35) injected before capsulorhexis and again before intraocular lens implantation. The results were evaluated by a pain/discomfort score postoperatively. RESULTS: The difference in medians of the overall intraoperative pain/discomfort scores between the 2 groups was not statistically significant. However, mild pain/discomfort was reported by 60.0% in the pure HPMC group and by 31.4% in the HPMC-lidocaine mixture group. Moderate pain/discomfort was reported by 28.6% and 5.7%, respectively. The difference between the 2 groups was statistically significant (P =.001). CONCLUSION: The use of a mixture of HPMC 2.25% and lidocaine 1% rather than a regular viscoelastic agent resulted in clinically and statistically significantly reduced pain/discomfort during phacoemulsification.     

Patient pain during stretching of small pupils in phacoemulsification performed using topical anesthesia

PURPOSE: To assess the pain experienced by patients with small pupils during pupil stretching in phacoemulsification performed using topical anesthesia. SETTING: Royal Victoria Eye & Ear Hospital and Mater Misericordiae University Hospital, Dublin, Ireland. METHODS: This was a prospective study that included 26 eyes with small pupils requiring mechanical pupil stretching during phacoemulsification cataract surgery performed under topical anesthesia without sedation. RESULTS: The mean pain score for the instillation of anesthetic drops (2.02) was higher than the mean pain score for the pupil stretch (1.63), but this difference was not significant (signed rank test = -32; P = .2738). There was no significant correlation between the duration of surgery and the overall pain score (r = 0.345; P = .08). There was no significant correlation between change in pupil size and either the pupil stretch score (r = -0.069; P = .74) or the overall pain score (r = -0.032; P = .8739). CONCLUSIONS: Pupil stretching during phacoemulsification in patients with small pupils was performed with minimal patient-reported pain using topical anesthesia. Stretching small pupils with a mechanical device during phacoemulsification performed under topical anesthesia was a safe procedure and did not result in significant patient discomfort.     

Topical anesthesia with sedation in phacoemulsification and intraocular lens implantation combined with 2-port pars plana vitrectomy in 105 consecutive cases

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of topical anesthesia as an alternative to peribulbar or retrobulbar anesthesia in phacoemulsification and intraocular lens implantation combined with our modified 2-port pars plana vitrectomy technique (phacovitrectomy). PATIENTS AND METHODS: Phacovitrectomy using topical anesthesia (4% lidocaine drops) was prospectively performed in 105 eyes with cataract and varied vitreoretinal pathology. In 75 eyes (71.4%), phacovitrectomy was combined with argon laser photocoagulation (endolaser). Preoperative and intraoperative sedation of varying degrees was necessary. Subjective pain and discomfort were graded from 1 (no pain or discomfort) to 4 (severe pain and discomfort). RESULTS: All patients had grade 1 pain and discomfort during most of the procedure. All patients had grade 2 (mild) pain and discomfort during pars plana sclerotomies, external bipolar cautery, and conjunctival closure. No patient required additional retrobulbar, peribulbar, or sub-Tenon's anesthesia. CONCLUSION: This technique avoids the risk of globe perforation, retrobulbar hemorrhage, and prolonged postoperative akinesia of the eye. With appropriate case selection, topical anesthesia is a safe and effective alternative to peribulbar or retrobulbar anesthesia in phacovitrectomy.