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.     

Perilimbal topical anesthesia for clear corneal phacoemulsification

PURPOSE: To evaluate the efficacy of perilimbal topical anesthesia for clear corneal cataract surgery. SETTING: Department of Ophthalmology, University of Udine, Udine, Italy. METHODS: Seventy-five consecutive patients were studied for perioperative pain, visual outcome, and intraoperative complications. Topical anesthesia was administered with a cellulose sponge soaked in preservative-free lidocaine 2%. The perilimbal area was touched 360 degrees for 30 seconds with the sponge tip under the operating microscope just before surgery. No sedation or adjunctive anesthetic drops were given. Surgery was performed through a temporal corneal tunnel with the easy-chop technique. Pain was scored on a subjective scale from 0 (no pain) to 3 (severe pain). Visual acuity was measured 1 day and 1 week after surgery. Mean operating time was recorded. RESULTS: Sixty-nine patients (92%) tolerated the procedure well, giving a pain score of 0 or 1. Six (8%) of the 40 patients who had a single stitch at the end of surgery scored 2. No patient reported pain during iris touch, intraocular lens implantation, or conjunctiva manipulation. No intraoperative complications were recorded. Mean operating time was 12.7 minutes +/- 3.7 (SD) (range 7 to 34 minutes). Mean preoperative visual acuity was 0.4 +/- 0.2 (range 0.01 to 0.80). Visual acuity of 0.5 or better was attained in 93.6% of eyes 1 day and in 96% 1 week postoperatively. CONCLUSIONS: Perilimbal topical anesthesia was an effective and easy-to-administer anesthetic procedure for phacoemulsification, providing good perioperative pain tolerance by patients and rapid visual recovery.     

Limbal anaesthesia versus topical anaesthesia for clear corneal phacoemulsification

PURPOSE: To compare the safety and clinical efficacy provided by limbal anaesthesia with topical anaesthesia in cataract surgery. METHODS: A total of 117 consecutive patients undergoing routine cataract surgery were randomly assigned to receive limbal or topical anaesthesia. Limbal anaesthesia was administered with a cellulose ophthalmic sponge soaked in preservative-free lidocaine hydrochloride 4% applied to the temporal perilimbal area for 45 seconds immediately before surgery. For topical anaesthesia lidocaine 4% was instilled in each patient at 10-min intervals four times before surgery. We studied phaco time, perioperative pain, visual outcome and intraoperative complications. The level of intraoperative pain was scored on a scale of 1-10, where 1 = no pain and 10 = severe pain. RESULTS: 55 patients (91.6%) in the topical group and 54 patients (94.7%) in the limbal group tolerated the procedure well, giving pain scores of 1-3, with no statistical difference. No patients in either group required supplemental anaesthesia and no intraoperative complications were recorded. No eyes had epithelial defects at the end of surgery or at postoperative check-ups. CONCLUSION: Limbal anaesthesia in cataract surgery is safe and the two anaesthesia techniques do not present differences in the degree of analgesia achieved.     

Acute suprachoroidal hemorrhage during clear corneal phacoemulsification using topical and intracameral anesthesia

Shallowing of the anterior chamber and hardening of the eye occurred just before commencement of irrigation/aspiration of cortex in an 80-year-old man having temporal clear corneal cataract surgery under topical and intracameral anesthesia. Nucleus removal had been completed and was uneventful. Intraoperative fundus examination with the indirect ophthalmoscope disclosed a choroidal hemorrhage. The wound was immediately closed with sutures, and intravenous mannitol was administered. The hemorrhage remained localized. The red reflex remained unchanged at all times, and there was no prolapse of intraocular contents. A high index of suspicion is critical to the early diagnosis and management of choroidal hemorrhage.     

Surgeon experience and patient comfort during clear corneal phacoemulsification under topical local anesthesia

PURPOSE: To evaluate patient comfort during topical anesthesia clear corneal phacoemulsification surgery performed by a surgeon in the learning curve or by an experienced surgeon. SETTING: Royal Alexandra Hospital, Paisley, Scotland, United Kingdom. METHODS: This study comprised 46 consecutive patients having phacoemulsification under topical anesthesia of proparacaine 0.5% (Proxymetacaine. Surgery was performed by a surgeon during his learning curve (n = 20) or by an experienced surgeon (n = 26). No sedation or intracameral anesthesia was used in either group. All patients had clear corneal phacoemulsification with foldable acrylic posterior chamber intraocular lens implantation. Each patient's subjective experience of overall pain perioperatively (period immediately surrounding and during surgery) and worst pain perceived during surgery was measured immediately after surgery using a 10-point visual analog scale. RESULTS: There was no significant difference in patient-reported pain scores for overall pain perioperatively (P =.47, Wilcoxon rank sum test) and the worst pain perceived during surgery (P =.32, Wilcoxon rank sum test). CONCLUSIONS: Topical anesthesia with proparacaine provided similar and reasonable analgesic effects in patients having surgery by a surgeon in the learning curve and those having surgery by an experienced surgeon. The discomfort perceived during surgery performed by an experienced surgeon was less, although not statistically significantly different.     

Inflammation after sclerocorneal versus clear corneal tunnel phacoemulsification

OBJECTIVE: To compare the postoperative inflammation after phacoemulsification followed by intraocular lens (IOL) implantation by means of sclerocorneal versus clear corneal tunnel incision. DESIGN: Randomized controlled clinical trial. PARTICIPANTS: One hundred eyes of 100 patients were examined at a German University eye hospital. INTERVENTION: One hundred eyes with cataract necessitating phacoemulsification with posterior chamber IOL implantation were randomly assigned to receive a temporal sclerocorneal or clear corneal tunnel incision by a single surgeon. MAIN OUTCOME MEASURES: Preoperative and postoperative inflammation was evaluated by measurement of flare using laser flare photometry. Statistical inference was mainly based on nonparametric group comparisons by use of two sample Wilcoxon tests. RESULTS: Mean anterior chamber flare in the group with sclerocorneal tunnel increased from 7.5 photon counts/ms preoperatively to 19.6 at 6 hours postoperatively and decreased to 11.1 (day 1), 11.7 (day 2), 11.6 (day 3), and 9.2 (5 months) during the postoperative course. The mean flare in the clear corneal tunnel incision group increased from 7.7 preoperatively to 12.9 at 6 hours postoperatively and then decreased to 9.2 (day 1), 9.8 (day 2), 9.1 (day 3), and 9.2 (5 months). Individual postoperative flare changes were significantly lower in the clear corneal tunnel group at the day of surgery (P<0.0001), as well as at day 1 (P = 0.0011), day 2 (P = 0.0079), and day 3 (P = 0.0020). After 5 months, no statistically significant difference was found. CONCLUSIONS: After phacoemulsification and foldable IOL implantation, postoperative alteration in the blood-aqueous barrier was statistically significantly lower with the clear corneal tunnel incision group compared with the sclerocorneal incision group, in the first 3 days postoperatively.     

Patient comfort during clear corneal phacoemulsification with sub-Tenon's local anesthesia

PURPOSE: To assess patient comfort with and without intravenous (i.v.) cannulation during 1-quadrant sub-Tenon's anesthesia during phacoemulsification. SETTING: Royal Alexandra Hospital, Paisley, Scotland, United Kingdom. METHODS: This prospective masked controlled clinical trial comprised 119 patients having elective clear corneal phacoemulsification. Fifty had sub-Tenon's anesthesia with an i.v. cannula; 23, sub-Tenon's anesthesia without an i.v. cannula; and 46, topical anesthesia of proparacaine 0.5% without an i.v. cannula. No patient received sedation. All patients had clear corneal phacoemulsification with foldable posterior chamber intraocular lens implantation. The patients' subjective pain experience was measured immediately after surgery by a single independent observer using a 10-point visual analog scale. RESULTS: The mean patient-reported pain was low in all 3 groups. The mean i.v. cannula-related pain score in the sub-Tenon's group with an i.v. cannula (1.00; range 0 to 8) was higher than the mean general pain score (0.46; range 0 to 5) and worst pain experienced during surgery score (0.64; range 0 to 3). In the topical anesthesia group, 8 patients (17%) reported greater discomfort directly or indirectly related to the subconjunctival antibiotic injection at the end of surgery. CONCLUSION: Patient-reported pain caused by placing an i.v. cannula in the sub-Tenon's group significantly altered overall patient comfort during the surgical experience. Thus, the routine use of i.v. access during clear corneal phacoemulsification under sub-Tenon's anesthesia should be avoided to improve patient satisfaction.     

透明角膜切口白内障超声乳化术后的屈光观察

目的分析4mm透明角膜切口超声乳化联合折叠式人工晶状体植入术后的屈光状态和屈光改变稳定时间。设计前瞻性病例非对照研究。研究对象96例白内障患者。方法对96例(111眼)白内障患者行4mm透明角膜切口白内障超声乳化吸除术联合折叠式人工晶状体植入术。对全部术眼分别应用显然验光法和角膜曲率法观察术后1周、1、2、3个月球镜和散光度数的变化。主要指标屈光度。结果术后1周、1、2、3个月全部术眼球镜分别为(-1．02±0．95)D,(-0．92±0．98)D,(-0．89±0．96)D．(- 0．87±0．93)D；眼轴＜25mm者球镜分别为(-0．80±0．74)D,(-0．70±0．79)D,(-0．67±0．76)D,(-0．64±0．71)D；眼轴≥25mm者球镜分别为(-1．84±1．20)D,(-1．72±1．19)D,(-1．73±1．15)D,(-1．72±1．15)D。全部术眼和眼轴＜25mm者术后1周与1个月比较屈光度数间差异无统计学意义(P=0．61．P=0．89),眼轴25mm者术后1个月与2个月比较屈光度数间差异无统计学意义(P=0．90)。各时段全部术眼手术性散光为(1．64±1．25)D,(1．61±1．31)D,(1．58±1．29)D,(1．57±1．25)D。全部术眼、眼轴＜25mm者、眼轴≥25mm者术后1周与术前相比散光差异无统计学意义(P均＞0．05)。结论4mm透明角膜切口白内障超声乳化联合人工晶状体植入手术,不论眼轴＜25mm还是≥25mm,术后1个月屈光达到稳定,可以配镜矫正。(眼科,2006,15：338-340)     

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。     

Combined phacoemulsification and pars plana vitrectomy: clear corneal versus scleral incisions: prospective randomized multicenter study

PURPOSE: To compare the complications and outcomes of implantation of a foldable intraocular lens (IOL) through a clear corneal incision and implantation of a poly(methyl methacrylate) (PMMA) IOL through a scleral incision in combined phacoemulsification and pars plana vitrectomy. SETTING: Departments of Ophthalmology, St. Franziskus Hospital, Muenster, Eye Hospital, Muelheim, and University of Essen, Essen, Germany. METHODS: This prospective randomized study included 62 eyes having implantation of a PMMA IOL (811B, Pharmacia) through a scleral incision and 61 eyes having implantation of a polyacrylic (AcrySof, Alcon) IOL through a clear corneal incision. The preoperative visual acuity, underlying retinal disease, and vitreoretinal surgical maneuvers did not differ between groups. The surgical methods and intraoperative complications were noted. Examinations 2 days and 3 months after surgery included visual acuity, refractive error, keratometry, slitlamp evaluation, tonometry, and ophthalmoscopy. RESULTS: Intraoperatively, both incisions were stable and no serious complications occurred. Two days after surgery, the incidence and quantity of cells and fibrin in the anterior chamber were lower in the clear corneal incision group than in the scleral incision group (P<.05). Corneal endothelial dysfunction was more common in the clear corneal group than in the scleral group (P<.05). Three months after surgery, the astigmatic changes did not differ significantly between groups and the incidence of posterior capsule opacification (PCO) was lower in the clear corneal group (P<.05). Postoperative visual acuity improved significantly in 63% of eyes and 61% of eyes in the scleral group and clear corneal group, respectively. Visual acuity was limited by macular pathology. CONCLUSIONS: Both clear corneal and scleral incisions were safe in combined phacoemulsification and vitrectomy. Eyes with smaller clear corneal incisions and foldable IOLs had less postoperative inflammation and PCO.     

Torsional mode versus conventional ultrasound mode phacoemulsification: randomized comparative clinical study

PURPOSE: To compare the intraoperative and short-term postoperative outcomes of cataract surgery performed with torsional mode and conventional ultrasound mode using the Infiniti Vision System (Alcon Laboratories). SETTING: Cataract Service, Zhongshan Ophthalmic Center, Sun-Yat-Sen University, Guangzhou, China. METHODS: In this randomized comparative study, 525 eyes were assigned to phacoemulsification by torsional mode or conventional ultrasound (US) mode. The surgery was performed by an experienced surgeon, and the outcomes were evaluated by an examiner who was masked to treatment assignments. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), and surgical complications. Patients were seen 1, 7, and 30 days after surgery. Postoperative outcome measures were the final best corrected visual acuity (BCVA) and the change in corneal clarity, central corneal thickness (CCT), and endothelial cell count. RESULTS: The US group had 262 eyes and the torsional group, 263 eyes. All patients completed the follow-up visits. In the eyes with nucleus density grades of 1, 2, 3, and 4, the mean UST was 10.25 seconds +/- 7.4 (SD), 25.14 +/- 5.5 seconds, 36.45 +/- 8.3 seconds, and 61.44 +/- 17.8, respectively, in the US group and 8.32 +/- 6.8 seconds, 18.45 +/- 7.2 seconds, 29.48 +/- 12.4 seconds, and 48.39 +/- 20.3 seconds, respectively, in the torsional group (P<.001); the mean CDE was 1.25 +/- 0.5, 4.18 +/- 1.2, 8.59 +/- 6.5, and 16.51 +/- 9.6, respectively, in the US group and 0.94 +/- 0.3, 3.13 +/- 2.7, 7.47 +/- 12.6, and 14.08 +/- 8.3, respectively, in the torsional group (P<.001). At 1 day and 7 days, the mean BCVA was 0.23 +/- 0.12 logMAR and 0.00 +/- 0.10 logMAR, respectively, in the US group and 0.18 +/- 0.11 logMAR and -0.08 +/- 0.05 logMAR, respectively, in the torsional group (P<.001). At 30 days, the mean BCVA was -0.10 +/- 0.07 logMAR and -0.12 +/- 0.06 logMAR in the US group and the torsional group, respectively (P>.01). At 1 day and 7 days, the mean CCT was 625 +/- 80 microm and 568 +/- 37 microm, respectively, in the US group and 601 +/- 35 microm and 559 +/- 40 microm, respectively, in the torsional group (P<.001). At 30 days, the mean CCT was 531 +/- 30 microm in the US group and 529 +/- 39 microm in the torsional group (P>.01). At 7 days and 30 days, the mean central corneal endothelial cell count was 2135 +/- 858 cells/mm(2) and 2084 +/- 527 cells/mm(2), respectively, in the US group and 2004 +/- 656 cells/mm(2) and 1953 +/- 615 cells/mm(2), respectively, in the torsional group (P<.001). CONCLUSION: The torsional mode may provide more effective lens removal with a lower level of phacoemulsification time and energy.     

白内障手術中表面麻醉的臨床觀察

目的探討表面麻醉下白内障摘出及人工晶體植入術的臨床效果.方法本組300例白内障患者使用0.4%鹽酸丁氧普魯卡因表面麻醉后行鞏膜隧道切口或透明角膜切口摘除白内障并植入人工晶體.結果對300例患者觀察總結,80%的病人術中無任何痛感,20%的病人在術中不同階段有輕微痛感.結論通過以上病例觀察表明,表麻下白内障摘出及人工晶體植入術是可行的,臨床上可酌情選用.     

角膜切口对白内障手术后散光的影响

目的:观察沿角膜散光陡峭轴方向做透明角膜切口行白内障超声乳化联合人工晶状体植入术后散光和视力的变化。方法:根据IOL-Master检测结果选择角膜最大屈光力轴行3.0mm透明角膜切口做白内障超声乳化术42眼作为观察组(A组),常规颞上(右眼)、鼻上(左眼)3.0mm透明角膜切口白内障超声乳化术68眼作为对照组(B组)。检测术前、术后1d;1wk;1,3mo角膜散光和视力变化。结果:A组术前、术后1d;1wk;1,3mo视力分别为0.2±0.24,0.73±0.37,0.78±0.38,0.94±0.36,0.76±0.13;B组为0.17±0.2,0.82±0.3,0.84±0.2,0.77±0.26,0.8±0.36;差异无统计学意义(P>0.05)。A组术前、术后1d;1wk;1,3mo角膜散光度分别为1.01±0.10D,1.33±0.13D,1.15±0.14D,0.90±0.13D,0.89±0.12D;B组为0.95±0.13D,1.25±0.15D,1.07±0.13D,0.87±0.12D,0.82±0.11D。术后1d;1wk;1mo与术前相比散光度均无统计学意义(P>0.05)。两组术后3mo散光度与术前相比差异有统计学意义(P<0.05)。两组术后3mo裸眼视力≥0.8者分别为21眼(50%)和32眼(47%),两者相比有统计学意义(P<0.05)。结论:沿陡轴透明角膜切口白内障超声乳化联合人工晶状体植入术有助于患者视力提高及减少术后角膜散光。     

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。     

白内障手术中表面麻醉的临床观察

目的 探讨表面麻醉下白内障摘出及人工晶体植入术的临床效果。方法 本组300例白内障患者使用0.4％盐酸丁氧普鲁卡因表面麻醉后行巩膜隧道切口或透明角膜切口摘除白内障并植入人工晶体。结果 对300例患者观察总结,80％的病人术中无任何痛感,20％的病人在术中不同阶段有轻微痛感。结论 通过以上病例观察表明,表麻下白内障摘出及人工晶体植入术是可行的,临床上可酌情选用。     

隧道巩膜切口与透明角膜切口超声乳化白内障手术的临床效果分析

目的探讨老年性白内障摘除人工晶状体植入术两种不同术式的临床疗效;评价隧道巩膜切口与透明角膜切口的疗效差异。方法对年龄60～80岁,平均(68.4±9.1)岁的老年性白内障患者按前后阶段分成两组,A组98例(109只眼),行隧道巩膜切口白内障超声乳化摘除联合人工晶状体植入术;B组216例(258只眼)行透明角膜切口白内障超声乳化摘除联合折叠式人工晶状体植入术。分析两种不同切口及相应不同类型人工晶状体植入方式的优缺点。结果术后视力：两组术后1周、1个月、3个月的裸眼视力及最佳矫正视力存在显著性差异。术后并发症有轻度角膜内皮水肿、重度角膜内皮水肿、重度前段葡萄膜反应、人工晶状体夹持等。结论角膜透明切口白内障超声乳化摘除联合折叠式人工晶状体植入术术后散光小,并发症少,视力恢复好。     

Reduction in IOP after clear corneal phacoemulsification in normal patients

A prospective study was performed to evaluate the changes in intraocular pressure (IOP) after clear corneal phacoemulsification in normal patients. The mean preoperative IOP of 30 patients was compared with the IOP at 1, 2, 3, and 5 months postoperatively. Lens extraction was associated with a reduction of IOP of 3.36 mmHg (SD +/- 2.33--p = 0.005) after 5 months.