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.     

Combined topical and intracameral anesthesia in penetrating keratoplasty

BACKGROUND: The standard of care for penetrating keratoplasty (PKP) is either retrobulbar or peribulbar anesthesia combined with seventh cranial nerve akinesia or general anesthesia. These methods are known to be associated with rare but potentially serious adverse ocular and systemic events. PURPOSE: To determine the safety and efficacy of combined topical and intracameral anesthesia in addition to intravenous sedation for repeat penetrating keratoplasty (PKP). SETTING: Tertiary-care university hospital. METHODS: In this prospective study, combined topical tetracaine 0.5% and 0.2 cc intracameral 1% lidocaine along with i.v. sedation with midazolam and fentanyl were used for patients undergoing repeat PKP in 15 eyes of 15 selected patients. The indication for surgery was failed corneal graft. Verbal pain scale (VPS, 0-3) was recorded preoperatively, intraoperatively at 3 time-points (after trephination, after placing 8 interrupted sutures, and after placing the running suture), and postoperatively (1 hour postoperatively, overnight pain, and 1 day postoperatively). Patient and surgeon satisfaction were assessed postoperatively using a scale (1-5). After surgery patients were asked for their preferences comparing the current use of topical anesthesia compared with retrobulbar anesthesia used for their initial PKP. RESULTS: The mean intraoperative VPS score was 0.51 +/- 0.32 (range 0-1.33), and the mean postoperative VPS score was 0.47 +/- 0.50 (range 0-1.67). There were no serious intraoperative or postoperative complications. All patients reported high mean satisfaction score of 4.67 +/- 0.49 (range 4-5). The mean satisfaction score reported by the surgeon was 4.47 +/- 0.63 (range 3-5). All patients but 1 (93.3%) preferred combined topical over retrobulbar anesthesia, which they had in their previous surgery. CONCLUSIONS: We found combined topical and intracameral anesthesia to be safe and effective in our selected group of patients undergoing repeat PKP, and it may provide a satisfactory alternative anesthetic modality for patients in whom general, retrobulbar, or peribulbar anesthesia may be contraindicated.     

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.     

Topical anesthesia in posterior vitrectomy

PURPOSE: To evaluate the efficacy of topical anesthesia as an alternative to peribulbar or retrobulbar anesthesia in posterior vitrectomy procedures. METHODS: Posterior vitrectomy using topical anesthesia (4% lidocaine drops) was performed prospectively in 134 eyes (134 patients) with various vitreoretinal diseases, including severe proliferative diabetic retinopathy (n = 69), vitreous hemorrhage (n = 12), rhegmatogenous retinal detachments (n = 11), epiretinal membranes (n = 10), macular holes (n = 7), dislocated crystalline lens or intraocular lens (n = 6), giant retinal tears (n = 5), intraocular foreign bodies (n = 3), trauma (n = 3), endophthalmitis (n = 3), subfoveal choroidal neovascular membrane (n = 3), and neovascular glaucoma (n = 2). In 26 (19.4%) eyes, posterior vitrectomy was combined with a scleral buckling procedure, and in 84 (62.6%) eyes, argon laser photocoagulation was performed. 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 average amount of 4% lidocaine drops needed during each procedure was 0.5 mL. No patient required additional retrobulbar, peribulbar, or sub-Tenon anesthesia. CONCLUSIONS: 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 three-port pars plana vitrectomy procedures.     

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.     

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.     

Topical anesthesia for penetrating trabeculectomy

PURPOSE: To evaluate the efficacy and clinical practicability of topical anesthesia in comparison with retrobulbar anesthesia for penetrating trabeculectomy. METHODS: The prospective single-surgeon clinical interventional trial included 20 consecutive patients, who were randomly distributed into a topical anesthesia group ( n=10) and a retrobulbar anesthesia group ( n=10). In the topical anesthesia group, patients received preoperatively oxybuprocaine 0.4% eye drops and cocaine hydrochloride eye drops 10%. The patients of the retrobulbar group received 5 ml mepivacaine 2% injected into the retrobulbar space. To assess intraoperative pain, each patient was asked immediately after surgery to quantitate his/her pain using a 10-point pain rating scale. RESULTS: The topical anesthesia group and the retrobulbar anesthesia study group did not vary significantly in duration of surgery (21.5+/-3.37 min vs 20.2+/-4.46 min, P=0.31), preoperative intraocular pressure (32.2+/-14.62 mmHg vs 30.6+/-12.33 mmHg, P=0.22), postoperative intraocular pressure (8.0+/-4.47 mmHg vs 9.12+/-3.13 mmHg, P=0.64), subjective pain score by the patient (2.25+/-1.23 relative units vs 2.33+/-1.08 relative units ( P= 0.71), and practicability score by the surgeon (2.24+/-1.76 vs 2.56+/-1.58, P=0.82). CONCLUSIONS: In view of its clinical feasibility and its minimally invasive character, topical anesthesia may be an option for penetrating trabeculectomy.     

Nausea and vomiting after phacoemulsification using topical or retrobulbar anesthesia

PURPOSE: To determine and compare the incidence of postoperative nausea and vomiting in patients having phacoemulsification under topical or retrobulbar anesthesia. SETTING: Department of Ophthalmology, United Christian Hospital, Hong Kong, China. METHODS: In this prospective randomized clinical trial, patients scheduled for routine phacoemulsification with posterior chamber intraocular lens implantation under local anesthesia without sedation were randomized to receive topical anesthesia or retrobulbar anesthesia. One hundred seven eyes of 107 Chinese patients were included. There were 49 patients and 58 patients of similar age and sex distribution in the retrobulbar group and topical group, respectively. Postoperative nausea and vomiting (PONV), the need for an antiemetic, and intraocular pressure (IOP) were recorded 1 day after surgery. Also recorded were the patient's preexisting risk factors for PONV (if any), fasting time, duration of surgery, and intraoperative complications or need for supplementary anesthesia or analgesia. RESULTS: The overall incidence of PONV in the entire study group was 3.7% (4 patients). No statistically significant differences in PONV were found between the 2 anesthesia techniques, although 6.1% (3 of 49) in the topical group had nausea compared with 1.7% (1 of 58) in the retrobulbar group. No significant differences were found in the fasting time, duration of surgery, or postoperative IOP between patients who had PONV and those who did not. CONCLUSIONS: Topical and retrobulbar anesthesia were associated with a low incidence of PONV in routine phacoemulsification. There were no statistically significant differences in PONV between the 2 anesthesia techniques. No significant correlation was found between the incidence of PONV and the duration of surgery, presence of complications, fasting time, postoperative IOP, or history of PONV or motion sickness.     

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。     

表面麻醉下穿透性角膜移植术治疗角膜穿孔伤的研究

目的探讨表面麻醉下行穿透性角膜移植手术（PKP）治疗角膜穿孔伤的可行性。方法回顾性分析10例（10眼）在表面麻醉下行PKP治疗角膜穿孔伤的临床资料。结果所有患者均能耐受和配合手术,8例术后视力均得到不同程度的提高。术后植片透明7例,透明率为70．00％,其中1例甘油冷冻保存的角膜术后植片浑浊,1例因排斥反应导致植片浑浊,另1例因继发性青光眼后角膜失代偿导致植片浑浊。结论表面麻醉下行PKP是治疗角膜穿孔伤的一种安全有效的方法。     

Local parabulbar anesthesia with Greenbaum cannula for most common ophthalmic operations

PURPOSE: To compare two methods of local anesthesia in ophthalmic surgery: classic retrobulbar and new--parabulbar made with Greenbaum cannula and to try to assess new method. MATERIAL AND METHODS: 300 patients underwent most common ophthalmic operations: ECCE + PCLI and glaucoma surgery. 150 of them were anesthetised by retrobulbar and 150 by parabulbar (flush) with Greenbaum cannula methods. We compared the presumed influence of these two types of anesthesia on the operations assessing the following: the occurrence "vis a tergo" and posterior capsule rupture. We compared also efficacy of both methods (analgesia and akinesia) and complications (retrobulbar hematoma, globe perforation). We minimalized the volume of anesthetic mixture used in retrobulbar method to 1.5 ml (0.5 ml 0.5% bupivacaine + 1 ml 2% xylocaine). RESULTS: The number of complications was lower in the group anesthetised by parabulbar method. The complications of local anesthesia were bigger in retrobulbar method (retrobulbar hematoma, globe perforation). Anesthesia in parabulbar method in spite of little volume of anesthetic mixture was very good but akinesia--slightly weaker comparing to retrobulbar injection. CONCLUSIONS: Parabulbar anesthesia made with Greenbaum cannula is a very good, safe method giving very good anesthesia no possibility of globe perforation or retrobulbar hematoma, but the method is for skilled surgeons because of weaker akinesia.     

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.     

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。     

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.     

A comparison of blood pressure changes in phacoemulsification cataract surgery with topical and retrobulbar block local anesthesia

Background: Changes are observed in blood pressure (BP) levels during cataract surgery, although BPs are considered to remain stable under local anesthesia. We evaluated the daily, pre- and postoperative BPs of 2270 patients after cataract surgery performed under either topical anesthesia or retrobulbar block. Methods: All operations were performed by the same surgeon using the same method of phacoemulsification and aspiration with posterior chamber intraocular lens implantation under local anesthesia. Results: The mean daily BP was 99.3±14.2 mm Hg; the mean preoperative BPs increased and then the postoperative BPs decreased. The postoperative BPs of the retrobulbar injection group decreased significantly more than those of the topical application group. In 833 cases, the systolic BP changed by more than 20 mm Hg. Even when the patients were hypertensive, the preoperative and postoperative BPs decreased in the same manner. Conclusion: The present study shows that, following surgery with retrobulbar block anesthesia, BP decreases to a greater extent than with topical anesthesia. Physicians should be aware of the high proportion of cases in which the systolic BP changes by more than 20 mm Hg.     

Persistent vertical binocular diplopia after cataract surgery

PURPOSE: To report the incidence of, and factors associated with, persistent vertical diplopia after cataract surgery. DESIGN: Consecutive interventional case series. METHODS: Retrospectively, all adult patients examined during a five year, five month period because of new onset persistent (>3 months) vertical binocular diplopia after cataract surgery were analyzed. All patients had their cataract surgery at the same outpatient ophthalmic surgery center, and were referred to the author, enabling calculation of incidence. Trends in anesthesia type and strabismus complications therefrom were also assessed. Comparison was made between ophthalmologist-administered retrobulbar anesthesia versus anesthesia staff-administered retrobulbar anesthesia. Incidence during a period in which hyaluronidase was not incorporated in the retrobulbar anesthetic was calculated. RESULTS: Persistent vertical diplopia occurred after cataract surgery in 32 (0.18%) of 17,531 eyes that had cataract surgery. No patient whose cataract surgery was conducted with topical anesthesia (3817 eyes) had persistent vertical diplopia, whereas 32 (0.23%) of the 13714 eyes whose cataract surgery was done after retrobulbar anesthesia were affected. No cases of persistent postoperative diplopia were found among 7410 cataract surgery eyes after retrobulbar injection given by one cataract surgeon. There was a threefold greater number of left eyes involved than right eyes (P <.005). No significant (P >.20) increase in cases of persistent vertical diplopia was noted during a period of hyaluronidase shortage. CONCLUSIONS: In this study, persistent binocular vertical diplopia after cataract surgery occurred in 0.23% of cases in which retrobulbar anesthesia was performed. No cases were found after topical anesthesia. Occurrence may be technique-related.     

Iatrogenic eye perforation in para- and retrobulbar injections

The authors report on 5 cases of inadvertent iatrogenic perforation of the globe in the course of retrobulbar and parabulbar injections. Perforation occurred twice by injection of the drug into the eyeball itself (subretinally or intravitreally), while in 3 cases a double perforation occurred, as a result of which the drug penetrated behind the eye. The prognosis is better in the latter case. Even though perforation of the globe during parabulbar and retrobulbar injections is extremely rare, it must always be considered if there is a sudden deterioration in vision and/or severe pain immediately after the injection; depending on the situation, retinal and/or vitreous surgery must then be performed at once.     

表面麻醉白内障摘除术的临床研究

目的 :评估表面麻醉下行白内障手术的安全性、可靠性及有效性。方法 :收集 940例经表面麻醉行白内障手术的病例 (研究组 ) ,其中 65 8例行白内障超声乳化术 ,2 82例行小切口白内障摘除术 ;随机选取 981例同期经常规球后麻醉行白内障手术的病例作为对照组。对两种不同麻醉方法下行白内障手术的两组病例的麻醉效果及并发症进行比较 ,作回顾性分析。结果 :研究组中有 6例牵拉上直肌或电凝止血时感到轻微疼痛 ,3例术中手术器械接触虹膜时有挤眼动作 ,其余 93 1例均无疼痛感。与对照组比较差异无显著性 (P >0 2 5 )。对照组中 ,球结膜水肿、眼睑皮下瘀血、睑裂变小、球后出血的发生率明显高于研究组 (P <0 0 0 1)。结论 :表面麻醉行白内障手术是一种安全、有效、并发症少的麻醉方法。     

Topical anesthesia: possible risk factor for endophthalmitis after cataract extraction

PURPOSE: To assess the relationship between the risk for acute endophthalmitis after cataract extraction and whether certain factors, such as surgeon qualification, numerical order, duration of surgery, operating theater, and type of anesthesia (topical or retrobulbar), could be modified to decrease the risk. SETTING: Single-center academic practice. METHODS: Two epidemiological studies were performed: a case-control study and a retrospective cohort study. The surgical records of all patients with clinically diagnosed endophthalmitis within 30 days after cataract surgery performed between February 2002 and September 2003 were reviewed. The endophthalmitis cases were compared with 108 randomly selected controls (4 controls per case). The global incidence of endophthalmitis and the incidence according to type of anesthesia were calculated. RESULTS: Of 5011 cataract extractions performed, 27 cases of endophthalmitis occurred. The incidence was 5.39 per 1000 procedures. An independent statistically significant relationship was found between endophthalmitis and the use of topical anesthesia (odds ratio [OR], 11.8; 95% confidence interval [CI], 2.4-58.7) and surgery longer than 45 minutes (OR, 7.2; 95% CI, 1.7-29.7) but not between the other variables. The incidence of endophthalmitis was 1.8 per 1000 cataract extractions with retrobulbar anesthesia and 6.76 per 1000 with topical anesthesia (relative risk [RR], 3.76; 95% CI, 0.89-15.85). After the start of the study period was extended to May 2001, the incidence of endophthalmitis was 1.3 per 1000 cataract extractions with retrobulbar anesthesia and 8.7 per 1000 with topical anesthesia (RR, 6.72; 95% CI, 1.63-27.63). CONCLUSION: Results suggest that there may be an association between topical anesthesia and endophthalmitis after cataract extraction.     

儿童全麻术中高眼压的预防

目的探讨儿童全麻术中高眼压的预防。方法观察43例儿童白内障摘出术,随机分为两组。观察组23例,应用氯胺酮麻醉联合利多卡因球后麻醉;对照组20例只应用氯胺酮麻醉。观察麻醉达成5min后的术眼眼压及术中有无后囊前突、虹膜膨出等高眼压征象。结果观察组麻醉达成5min后术眼平均眼压（17．34±4．26）mmHg,后囊前突3例、虹膜膨出1例;对照组术眼平均眼压（21．23±4．35）mmHg,后囊前突9例、虹膜膨出3例。结论氯胺酮可使眼外肌张力增加,眼压升高;球后麻醉可使眼外肌松弛,眼压降低,从而减少氯胺酮用量,使麻醉更加安全可靠。