表麻及球周麻醉下白内障超声乳化摘出联合人工晶状体植入术的比较

目的 评价表麻下白内障超声乳化摘出及人工晶状体植入术的安全性和效果。方法 ２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摘出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 ２组术后１ｄ、１ｗｋ,３ｍｏ视力无显著差异,并发症：后囊破裂及角膜水肿发生率,２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 表麻下超声乳化     

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。     

表面麻醉下超声乳化术临床观察

目的：观察表面麻醉在白内障超声化及人工晶状体植入术中的效果。方法：采用表面麻醉的方法对263例（292只眼）进行白内障超声乳化人工晶状体植入术。结果：292只眼均在表面麻醉下完成手术。术后1周最佳视力≥0．5者为82％，术后1月最佳视力≥0．5者为93％。主要并发症：后囊破裂12只眼（4％），中度角膜水肿8只眼（2．7％）。结论：白内障超声乳化术中表面麻醉是一种简便、安全、有效的麻醉方法。     

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人工晶状体植入术的安全性及有效性。方法：对90例（102只眼）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：所有患者在表麻下均能很好地配合手术顺利完成。无一例改用其它麻醉方法。平均手术时间为20.04分钟。术后1天及1周视力≥0.5者，分别占67.65％和77.27％。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是安全有效的。     

表面麻醉下透明角膜切口超声乳化白内障摘除术临床观察

目的观察表面麻醉下经透明角膜切口行超声乳化白内障吸除联合折叠式人工晶状体植入术效果。方法各种类型白内障364例(364只眼)在表面麻醉下透明角膜10～12点钟作切口2．8～3．2mm,在3点或9点角膜缘作0．3～0．6 mm辅助切口,超声乳化吸除皮质及核,植入ACRYSOF折叠式人工晶状体。术后观察视力、切口、前房、人工晶状体位置、眼底。结果术后随访1天、7天、1个月和3个月,矫正视力≥0．8者分别为259只眼 (71．20％)、275只眼(75．43％)、279只眼(76．52％)、285只眼(78．34％)。结论表面麻醉下透明角膜切口超声乳化白内障吸除折叠式人工晶状体植入术具有手术时间短、视力恢复快、并发症少等优点。     

门诊白内障患者表面麻醉下行超声乳化摘出术

目的 分析和探讨表面麻醉下行人障超声乳化摘出及人工昌状体植入术的可行性及其效果。方法 门诊非选择性地对１３２例１５７眼各种类型白内障在表面麻醉下进行了超声乳化摘出并人工晶状体植入术。结果 １５２眼（９６．８％）。麻醉满意,５眼（３．２％）增加球后麻醉后完成手术,术后视力及并发症与本科以往球后麻醉下所行白内障超声乳化术的效果相似。结论 表面麻醉下做巩膜隧道切口可满意地完成白内障超声乳化摘出及人工晶状体植入术,为门诊开展本手术提供了便利。     

改良隧道切口非超声乳化白内障摘除联合折叠晶状体植入术临床应用观察

目的:观察改良隧道切口非超声乳化白内障摘除联合折叠人工晶状体植入术的临床效果和特点。方法:118例白内障患者的118只眼,随机分为2组:超声乳化白内障吸除联合折叠人工晶状体植入术手术组58只眼与改良隧道切口非超声乳化白内障摘除联合折叠人工晶状体植入术组60只眼。对比观察两种术式并发症及术后视力。结果:改良隧道切口非超声乳化白内障摘除联合折叠人工晶状体植入术与超声乳化白内障吸除术联合折叠人工晶状体植入术在白内障手术中的并发症、近远期术后视力比较,差异均无统计学意义,而改良隧道切口非超声乳化白内障摘除术的手术成本低于超声乳化白内障吸除术,且学习曲线短。结论:改良隧道切口非超声乳化白内障摘除联合折叠人工晶状体植入术适合在基层医院的白内障治疗中推广。眼科学报2007;23:247-251.     

倍诺喜表面麻醉下小切口非超声乳化白内障术

目的：探讨倍诺喜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364例(402只眼)白内障患者在倍诺喜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： 所有患者在表麻下均能很好地配合手术顺利完成，无一例改用其它麻醉方法。平均手术时间为12．35分钟。术后1天及1周视力≥0．5者，分别占62．44％和78．11％。结论：倍诺喜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是安全有效的。     

表面麻醉下超声乳化白内障人工晶状体植入术

在白内障超声乳化吸出加人工晶状体植入术中,大多数眼科医生采用球后及球周麻醉方法,如何减少手术麻醉时的并发症,在保证手术安全下探讨白内障超声乳化手术表面麻醉的可行性.我们在1999～2001年间,对60例64眼应用0.4%倍诺喜眼液麻醉,施行超声乳化白内障摘除折叠式人工晶状体植入术,效果较好,报告如下.     

Long-term endothelial cell loss after phacoemulsification: peribulbar anesthesia versus intracameral lidocaine 1%: prospective randomized clinical trial

PURPOSE: To evaluate endothelial cell loss after phacoemulsification with posterior chamber intraocular lens implantation using peribulbar anesthesia or topical anesthesia combined with intracameral unpreserved lidocaine 1%. SETTING: Department of Ophthalmology, Charité, Humboldt-University of Berlin, Berlin, Germany. METHODS: Before and 20 months +/- 5.1 (SD) after surgery, specular microscopy was used to evaluate the number and morphology of endothelial cells in 78 eyes having peribulbar anesthesia or topical anesthesia combined with an intracameral injection of 0.15 cc unpreserved lidocaine 1%. RESULTS: The mean endothelial cell loss was 11.11% in the peribulbar group and 12.55% in the topical/lidocaine group. There was no statistically significant difference in the amount of endothelial cell loss or cell morphology between the 2 groups. CONCLUSION: The long-term postoperative endothelial cell course showed that topical anesthesia combined with an intracameral injection of 0.15 cc unpreserved lidocaine 1% is a safe alternative to peribulbar anesthesia.     

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.     

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.     

表面麻醉在短眼轴白内障超声乳化术中的应用

目的：探讨麻醉方法对短眼轴白内障超声乳化术的影响。方法：回顾性分析眼轴长在20．01－22．10mm共80例106只眼白内障超声乳化及人工晶状体植入术,结果：对短眼轴白内障患者,术中组织损伤、后囊破裂、术后角膜水肿发生率,表面麻醉比球周麻醉低,结论：表面麻醉比球周麻醉更适合于短眼轴白内障超声乳化术。     

Clinical and electrophysiologic results after intracameral lidocaine 1% anesthesia: a prospective randomized study.

OBJECTIVE: To evaluate the efficacy and safety of intracameral lidocaine in cataract surgery compared to peribulbar anesthesia. DESIGN: A prospective, randomized, controlled study. PARTICIPANTS: A total of 200 consecutive cataract patients (200 eyes) participated. INTERVENTION: Eyes were randomly assigned to two groups: one group received 0.15 ml intracameral 1% unpreserved lidocaine combined with topical anesthesia (oxybuprocaine); the other group received 6 ml prilocaine peribulbar before phacoemulsification with sclerocorneal tunnel incision. MAIN OUTCOME MEASURES: Duration of surgery was measured; implicit time and amplitudes of the b-waves of the photopic electroretinogram (ERG) potentials (single-flash ERG and the 30-Hz flicker ERG) were recorded; frequencies of intraoperative problems, complications, intraoperative, and postoperative pain were evaluated. RESULTS: After lidocaine anesthesia combined with topical anesthesia, similar complications were found, longer operation time (P < 0.001), and significantly better visual acuity immediately after surgery (P < 0.001). The ERG amplitudes were not significantly reduced after 0.15-ml intracameral lidocaine half an hour after surgery (P > 0.05). CONCLUSION: Intracameral lidocaine 1% combined with topical anesthesia can be recommended as an alternative procedure to peribulbar anesthesia in cataract surgery with corneoscleral tunnel incision.     

四种局麻方式对Phaco患者眼压变化的观察

目的：为对比评价四种方式局部麻醉与眼压变化的关系。方法：连续性选取60全老年性白内障PEA＋IOL住院手术患者,随机分至球后、球周、角膜缘球结膜下及表面麻醉组。分别于麻醉前、麻醉后、麻醉后5分钟及10分钟用非接触式眼压计测量眼压。结果：球后及球周组在麻醉后眼压较麻醉前均升高,结膜下组与表麻组未见显著差异。各种麻醉技术之间对比结果显示,球后组与球周组对麻醉前后眼压影响在麻醉后及5min后差异有显著性,球后组眼压增高较小,降低较快;10min后差异不显著。球后组较结膜下和表麻组眼压在麻醉后升高,10min后降低,球周较结膜下组及表麻组在麻醉后及5min时均高,10min时差异不显著。结膜下组与表麻组始终无显著差异。结论：球后及球周麻醉较结膜下及表面麻醉前后的眼压变化大,且个体眼压反应有很大差异,球外压迫降压后眼和下情况也各异。     

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。     

表面麻醉非超乳小切口手术治疗白内障的临床观察

目的：对表面麻醉小切口白内障囊外摘除术与白内障超声乳化进行临床疗效比较。

方法：患者随机分为两组,A组166例172眼和B组175例180眼分别施行表面麻醉非超乳小切口白内障摘除联合人工晶状体植入术与超乳白内障摘除联合人工晶状体植入术。

结果：两组患者间术后视力和角膜散光比较,差异无统计学差异(P>0.05)。两组术中、术后并发症发生率比较,差异亦无统计学差异(P>0.05)。

结论：小切口白内障囊外摘除是一个安全有效的手术,值得临床中广泛推广。     

上方球周麻醉联合表面麻醉白内障囊外摘除及人工晶状体植入术

目的:探讨上方球周麻醉联合表面麻醉白内障囊外摘除术的安全性及优越性。方法:选取2005-06/2008-12在我科接受白内障手术的患者,将所有患者随机分成3组,分别采用不同麻醉方式,手术方式均为白内障囊外摘除并植入后房型IOL,手术中观察麻醉效果,并术后随访3d观察视力和结膜反应。A组:上方球周麻醉联合表面麻醉(126眼);B组:上方结膜下浸润麻醉联合表面麻醉(89眼);C组:球后麻醉(86眼)。结果:三组全部286例301眼患者,手术全程均获得良好的麻醉效果。后囊破裂,A组和B组明显优于C组;术后结膜反应,A组和C组明显优于B组;术后视力,A组和B组明显优于C组。结论:上方球周麻醉联合表面麻醉白内障囊外摘除术是安全而优越的。