表面麻醉下超声乳化白内障摘除及人工晶体植入术的临床观察

目的 察应用利多卡因行表面麻醉在超声乳化白内障摘除及人工晶体植入术中的临床效果。方法 应用利多卡因作单纯角结膜表面麻醉，实施白内障超声乳化及人工晶体植入术456例（495眼），并观察其麻醉效果。结果 456眼（92．12％）术中完全不感疼痛或偶感轻微疼痛，手术配合良好。34眼（6．87％）术中疼痛，需加点利多卡因1～2次后才顺利完成手术；5眼（1．01％）术中疼痛，需加用球后或球周麻醉方可完成手术。结论 利多卡因表面麻醉是实施超声乳化白内障摘除及人工晶体植入术的有效麻醉方法。     

白内障青光眼联合手术表面麻醉的效果评价

目的评价白内障超声乳化吸出人工晶状体植入联合小梁切除术表面麻醉的临床效果.方法对34例(40眼)青光眼合并白内障在2%利多卡因表面麻醉下行白内障超声乳化吸出人工晶状体植入联合小梁切除术,观察术中反应及术后效果.结果所有患者术中均能很好配合;术后24眼(60%)视力≥0.5,影响术后视力的原因主要是眼底病变.随访3～24月,31眼术后眼压在正常范围,平均(15.89±3.02)mmHg,8眼加用β-本阻滞剂后眼压控制,视野无进行性损害.结论表面麻醉下行白内障超声乳化吸出人工晶状体植入联合小梁切除术安全、快速、经济、有效.     

高度近视伴核性白内障表面麻醉下超声乳化治疗观察

目的 探讨高度近视伴核性白内障表面麻醉下超声乳化吸出及人工晶状体植入术的效果.方法 对78例(78跟)高度近视伴核性白内障在表面麻醉下行超声乳化吸出及人工晶状体植入术,观察麻醉满意度,术中及术后并发症.结果 所有患者均在表麻下无痛苦完成手术,术中术后无严重并发症发生.术后1d视力≥0.5者46例(46眼),占58.97％;术后1周视力≥0.5者58例(58眼),占74.35％.结论 表面麻醉下超声乳化白内障吸出术人工晶状体植入是高度近视伴核性白内障较理想的手术方式.     

采用表面麻醉进行晶状体超声乳化术的可行性

目的探讨采用表面麻醉进行白内障晶状体超声乳化术的可行性。方法对440例（616眼）在表面麻醉下施行了晶状体超声乳化白内障吸出联合人工晶状体植入术。结果术中轻微疼痛者36眼（5．84％），余均无痛。后囊破裂14眼（2．27％）。结论表面麻醉用于晶状体超声乳化白内障吸出联合人工晶状体植入麻醉效果良好。并发症少。     

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     

利多卡因表面麻醉行白内障超声乳化术临床观察

我们在经典式的术前麻醉基础上,采用国产2%利多卡因表面麻醉,行不同切口白内障超声乳化摘出术,取得满意效果. 1资料与方法 1.1资料 收集2000年在我院行白内障超声乳化摘出术的各类白内障患者350例(350眼).其中男性169例(169眼),女性181例(181眼),年龄最小10岁,最大92岁.根据little晶状体硬度分级方法分类:Ⅱ级核85眼,Ⅲ级核232眼,Ⅳ级核33眼.     

糖尿病患者白内障表麻下超声乳化吸出术

目的探讨糖尿病患者的白内障在表面麻醉下行超声乳化吸出及人工晶状体植入术的安全性手术效果。方法对39例（41眼）糖尿病患者白内障在表面麻醉下行超声乳化吸出及人工晶状体植入术,观察其术后视力、不良反应及并发症。结果所有患者均在表麻下很好地配合完成了手术,无感染、出血等严重并发症发生。平均手术时间7 m in,术后第1 d视力≥0.5者23眼,占56.10%;术后1周视力≥0.5者37眼,占90.24%,最佳视力1.2。结论糖尿病患者白内障在表麻下行超声乳化吸出及人工晶状体植入术是可行的。     

合并全身病的白内障表面麻醉超声乳化术分析

目的 探讨合并全身病的白内障表麻下超声乳化吸出人工晶状体植入术的可行性及安全性。方法 对197例(199眼)合并全身病的白内障均在表麻下完成巩膜隧道切口超声乳化吸出，植入人工晶状体。手术时间13-25分钟，平均20分钟。观察麻醉效果、并发症及术前术后视力等。结果 全部病例未加球后、球周麻醉或结膜下麻醉，手术成功率97．49％，表麻成功率100％，术后视力恢复快、反应轻、结膜充血不明显。结论 表麻对合并全身病的白内障患者是安全可行的。     

表面麻醉下白内障超声乳化人工晶状体植入

目的：探讨表面麻醉白内障超声乳化及人工晶状体植入术的安全性及有效性。方法：观察128例（148眼）单用表面麻醉白内障超声乳化及人工晶状体植入术的麻醉和手术效果及并发症.结果：患者均能很好地配合手术顺利完成，仅2眼因结膜瘢痕，出现较明显的疼痛。术后1天及1周视力≥0．5者分别为81．97％及92．62％，无严重的并发症。结论：表面麻醉白内障超声乳化是安全有效的，二者结合使手术更快捷、安全、术后恢复更快。     

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。     

A randomized controlled trial of intracameral lidocaine during phacoemulsification under topical anesthesia

OBJECTIVE: To test the hypothesis that adjunctive intracameral 1% lidocaine reduces intraoperative pain during phacoemulsification using topical anesthesia. DESIGN: Prospective, double-masked, randomized, controlled trial. PARTICIPANTS: A total of 200 patients undergoing routine phacoemulsification under topical 1% tetracaine were studied. INTERVENTION: Randomization to 0.5 ml intracameral, unpreserved, epinephrine-free 1% lidocaine or placebo was conducted. MAIN OUTCOME MEASURE: Intraoperative pain was quantified by the patients using a 0-10 visual analog pain scale. RESULTS: Intraoperative pain scores (+/- standard deviation) for the lidocaine and control groups were 1.29 +/-1.24 and 1.44 +/- 1.33, respectively (P > 0.35). CONCLUSIONS: In a rigorously double-masked, prospective, randomized, controlled trial there was no significant reduction in intraoperative pain when intracameral 1% lidocaine was used during phacoemulsification under topical anesthesia.     

表面麻醉下经球结膜手术治疗原发性结膜下眶脂肪脱垂

目的：评价表面麻醉下经球结膜手术治疗原发性结膜下眶脂肪脱垂的临床疗效。
　　方法：选择2011-01/2015-06在我院眼科进行原发性结膜下眶脂肪脱垂手术治疗的患者11例22眼,记录主观和客观手术时长、术中配合情况、术后恢复及复发情况及并发症。
　　结果：患者17眼的麻醉效果明显,5眼(均为第二术眼)在补点1次表面麻醉药后疼痛消失,22眼均能顺利完成手术操作。术中配合程度Ⅰ级组和Ⅱ级组的客观手术时长相比,差异具有统计学意义(t=-3.123,P<0.01),提示手术中配合程度越差的患者其客观手术时间比较长。术后1、3、9 mo复诊,眼部伤口均愈合良好,眼球运动正常,未见肿物复发。
　　结论：表面麻醉下经球结膜手术治疗原发性结膜下眶脂肪脱垂,麻醉效果满意,手术效果好,是一种简单易行、安全有效的麻醉方法。     

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.     

Comparison of topical and subconjunctival anesthesia in intravitreal injection administrations

PURPOSE: To compare the effectiveness of topical and subconjunctival anesthesia in intravitreal injection administrations. METHODS: Twenty-eight patients from a university clinic with bilateral diabetic macular edema were prospectively randomized to receive intravitreal injection of 4 mg triamcinolone under topical anesthesia for one eye and subconjunctival anesthesia for the other eye by using lidocaine 4%. Patients were asked to grade the pain they experienced during administration of both anesthesia and intravitreal injection by using a 4-point pain scale: from 0=no pain to 3=severe pain. Complications that developed during both procedures were recorded. RESULTS: The mean pain score experienced during subconjunctival injections was 0.78+/-0.62, whereas no anesthesia-related pain was reported in the topical group. The mean pain score experienced during intravitreal injection was 1.64+/-0.67 in the topical and 0.85+/-0.52 in the subconjunctival group (p<0.001). The mean total pain scores of both procedures were 0.82+/-0.34 in the topical and 0.82+/-0.51 in the subconjunctival group (p>0.05). Nine eyes (32%) developed subconjunctival haemorrhage after subconjunctival injection, whereas no anesthesia-related complication developed in the topical group. Subconjunctival haemorrhage was also observed in 5 eyes (18%) in the topical group and in 11 eyes (40%) in the subconjunctival group (p>0.05) after intravitreal injection. CONCLUSIONS: Although subconjunctival anesthesia provides better pain control during intravitreal injections, its application is more painful and leads to subconjunctival haemorrhage. Moreover, the mean total pain scores are similar in both methods. Therefore, topical anesthesia may be more suitable for daily practice.     

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.     

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.     

利多卡因注射液滴眼用于激光角膜原位磨镶术表面麻醉的效果研究

目的探讨2％利多卡因注射液滴眼用于准分子激光角膜原位磨镶术（LASIK）表面麻醉的效果。方法100例（200眼）随机分成利多卡因组和奥布卡因组,每组50例（100眼）。两组分别在两种药物的表面麻醉下进行LASIK,根据术中患者对疼痛和触觉的感受评价麻醉效果。结果利多卡因组中98眼能顺利完成手术,2眼稍感疼痛,追加滴利多卡因1滴后顺利完成手术。奥布卡因组99眼顺利完成手术,1眼稍感不适,未做处理,也顺利完成手术。结论2％利多卡因注射液滴眼用于LASIK表面麻醉效果良好。     

Lidocaine 2% gel versus lidocaine 4% unpreserved drops for topical anesthesia in cataract surgery: a randomized controlled trial

OBJECTIVE: To compare intracameral levels and clinical efficacy of lidocaine 2% gel with lidocaine 4% unpreserved drops. DESIGN: Double-blind, randomized, one-surgeon, controlled trial. PARTICIPANTS: One hundred seven consecutive cataract cases eligible for topical anesthesia. INTERVENTION: Patients were randomly assigned to receive 20 mg of lidocaine either as lidocaine 2% gel (1 ml) or as lidocaine 4% unpreserved eyedrops (0.5 ml) before clear corneal phacoemulsification. MAIN OUTCOME MEASURES: Aqueous samples were taken to measure lidocaine intraocular levels. Intraoperative pain was quantified a few minutes after surgery using a 0 to 10 visual analog scale. SECONDARY OUTCOME MEASURES: Patients were asked to grade the degree to which they were bothered by tissue manipulation. The surgeon graded patients' cooperation. The anesthesiologist recorded any increase in pulse or blood pressure and the need for supplemental topical anesthesia or intravenous sedation. Duration of surgery and intraoperative complications were also recorded. RESULTS: In the gel group intracameral lidocaine levels were significantly higher (P < 0.001) and patient-reported intraoperative pain scores were significantly lower (P = 0.026). Patients in the gel group were bothered by tissue manipulation to a lesser extent (P = 0.028), and their cooperation was better (P = 0.002). Increases in blood pressure were more frequent in the eyedrops group. Supplemental anesthesia was required in two cases (3.70%) in the gel group versus eight cases in the eyedrops group (15.09%). No correlation between intracameral lidocaine levels and intraoperative pain scores was found (r = -0.026, P = 0.789). CONCLUSIONS: If administered by means of gel, the same amount of lidocaine gives significantly higher intracameral levels of lidocaine, better analgesia, better patient cooperation, and less need for intraoperative supplemental anesthesia. Lower pain scores do not correlate with intracameral lidocaine levels.     

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.     

表麻下行斜视矫正术的临床观察

目的观察盐酸奥布卡因滴眼液联合2%利多卡因表面麻醉下行斜视矫正术的临床麻醉效果。方法对90例（175眼）斜视术前滴盐酸奥布卡因滴眼液6次,常规行斜视矫正术且术中滴2%利多卡因3次。结果麻醉效果良好,术中剪切分离时无疼痛感,仅在牵位肌肉时有酸胀不适,经解释后手术配合良好。结论斜视矫正术用盐酸奥布卡因联合2%利多卡因表面麻醉有效、并发症少。