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。     

白内障冷超声乳化术的临床观察

目的观察白内障超声乳化及人工晶体植入术的效果。方法对70例（72眼）白内障采用新型超声乳化仪，在表面麻醉下行白内障超声乳化人工晶体植入术。观察术中超声乳化能量、超声乳化时间、切口形态、术后视力和手术并发症。结果72眼均在表面麻醉下完成手术。平均超声能量4．56％，平均超声时间56”。术后1天、1周及1个月时，最佳视力≥0．5的术眼分别为40眼（55．56％）、62眼（86.11％）及64眼（88．89％），术后1个月视力≥1．0者57眼（97．17％）。主要并发症：角膜水肿2眼（2．78％），虹膜反应4眼（5．56％），迟发性虹膜睫状体炎1眼（1．39％）。所有患者术中前房稳定，均无切口热损伤。结论新型超声乳化仪行白内障超声乳化人工晶体植入术，具有更好、更精确的能量控制，极大地降低了无效能量的使用和减少热量的产生，提高前房稳定性，平静而有效的超声能量使手术效果更为完善，提高了Phaeo手术的效率。     

白内障冷超声乳化术的临床观察

目的 观察自内障超声乳化及人工晶体植入术的效果。方法 对70例（72眼）自内障采用新型超声乳化仪，在表面麻醉下行白内障超声乳化人工晶体植入术。观察术中超声乳化能量、超声乳化时间、切口形态、术后视力和手术并发症。结果 72眼均在表面麻醉下完成手术。平均超声能量4．56％，平均超声时间56″。术后1天、1周及1个月时，最佳视力≥0．5的术眼分别为40眼（55．56％）、62眼（86．11％）及64眼（88．89％），术后1个月视力≥1．0者57眼（97．17％）。主要并发症：角膜水肿2眼（2．78％），虹膜反应4眼（5．56％），迟发性虹膜睫状体炎1眼（1．39％）。所有患者术中前房稳定，均无切口热损伤。结论 新型超声乳化仪行白内障超声乳化人工晶体植入术，具有更好、更精确的能量控制，极大地降低了无效能量的使用和减少热量的产生，提高前房稳定性，平静而有效的超声能量使手术效果更为完善，提高了Phaco手术的效率。     

双眼表面麻醉在超声乳化手术中的应用

目的:分析115例双眼表面麻醉在超声乳化手术中的应用情况。方法:术中采用4g/LAlcaine滴眼液双眼表面麻醉,经巩膜隧道切口完成常规超声乳化手术,植入单片式PMMA硬质人工晶状体或一片式折叠式人工晶状体。结果:85%手术患者术中没有任何疼痛感,15%患者在手术不同步骤时有疼痛感;术后因角膜上皮脱落导致术眼疼痛的12例,术后35例术眼有异物感、干涩等不适;对侧眼出现不适感15例,其中2例轻微视力下降,均在1wk内恢复。结论:双眼表面麻醉方式行超声乳化手术镇痛效果良好,手术安全、舒适。     

表面麻醉在小切口非超声乳化白内障摘除术中的应用

目的：探讨表面麻醉在小切口非超声乳化白内障除术中应用的安全性和有效性。方法：将各类白内障患共计158例（158眼）采用表面麻醉下经巩膜隧道小切口白内障除，人工晶体植入术。结果：术中完全无痛，配合良好的150例，占95％，术俚稍感疼痛8例，经追加表面麻醉药后缓解；术后2天视力＞0．3的146例，占92．4％，后囊破裂10例，占6％，结论：表面麻醉在小切口非超声乳化白内障除人工晶体植入术中的应用是安全，有效的，但表面麻醉的应用仍有局限性，应根据手术医生的手术经验及病人的配合程度及病情选择应用，以保证手术的最佳效果。     

表面麻醉下白内障超声乳化及人工晶状体植入术临床观察

目的：探讨表面麻醉下巩膜隧道切口超声乳化及人工晶状体植入术的可行性及疗效，方法：表面麻醉下行超声乳化人工晶状体植入共7例（87只眼）。结果：所有术眼均在表面麻醉下顺利完成，其中仅5只眼由于误触虹膜或睫状体，有一过性疼痛感，术后一周视力＞0．5者占78．5％者占78．5％，视力＞1．0者占46．3％，结论表面麻醉下施行超声乳 化术具有安全、有效，并发症少等优点。     

表面麻醉下高度近视眼白内障超声乳化折叠人工晶体植入术临床观察

目的 分析和探讨表面麻醉下高度近视眼白内障超声乳化折叠人工晶体植入术的安全性及疗效。方法 对40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及折叠人工晶体植入术，观察术中疼痛感、并发症及术后效果。结果 46眼无疼痛、2眼有轻微胀痛、2眼感胀痛，术中追加1次表面麻醉，2眼发生后囊膜破裂，1眼发生部分悬韧带离断，无视网膜脱离发生。术后3个月视力≥0．5者占60％，≥1．0者占18％。结论 表面麻醉下高度近视眼白内障超声乳化及折叠人工晶体植入术安全、疗效可靠、并发症少。     

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。     

表面麻醉下隧道切口非超声乳化白内障摘除及人工晶体植入

目的 探讨表面麻醉下行隧道切口非超声乳化白内障摘除及人工晶体植入术的安全性及有效性。方法 对85例（97眼）白内障患者在表面麻醉下行隧道切口非超声乳化白内障摘除及人工晶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。无一例改用其他麻醉方法。平均手术时间为18min。患者配合良好，无一例改为球后或球周麻醉。术后1周视力≥0．2者90眼，占92．8％；视力≥0．5者58眼，占59．8％；视力≥0．8者34眼，占35．1％。结论 表面麻醉隧道切口非超声乳化白内障摘除及人工晶体植入是简便易行的麻醉方法，效果肯定，适合在基层和防盲工作中推广。     

表面麻醉小切口非超声乳化白内障手术的临床效果分析

目的观察表面麻醉小切口非超声乳化白内障手术的临床效果。方法行小切口非超声乳化白内障人工晶体手术治疗白内障的患者98例（109眼），随机分为表面麻醉组49例（54眼）和球后麻醉组49例（55眼）。球后麻醉组给予2％利多卡因球后阻滞麻醉。表面麻醉组给予倍诺喜（盐酸奥布卡因0．4％）表面麻醉。结果采用表面麻醉和球后麻醉的麻醉效果比较差异无统计学意义（P〉0．05），同时手术后1个月视力以及散光度情况比较差异无统计学意义（P〉0．05）。但是表面麻醉组的手术时间要显著短于球后麻醉组，表面麻醉组并发症的发生率显著低于球后麻醉组（P〈0．05）。结论表面麻醉下行小切口非超声乳化白内障摘除联合人工晶体植入术麻醉效果良好，能最大限度减少麻醉所带来的并发症，大大减少了病人的痛苦。     

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。     

Patient pain during different stages of phacoemulsification using topical anesthesia.

PURPOSE: To assess the pain experienced by patients during the different stages of phacoemulsification cataract surgery performed under topical anesthesia. SETTING: Ophthalmic teaching hospital, Dublin, Ireland. METHODS: This prospective study comprised 100 consecutive patients having phacoemulsification under topical anesthesia. Patients were asked to grade the pain they experienced during the different stages of the procedure using a visual analog pain scale from 0 to 10. The pain experienced during the procedure was compared with that experienced after the instillation of a drop of amethocaine. RESULTS: The overall mean pain score was 1.46. The highest mean pain score, which was during the phacoemulsification stage of the procedure, was not significantly more than the score for the administration of the topical anesthetic agent. The duration of surgery was not related to the level of pain during the procedure. CONCLUSIONS: Topical anesthesia was effective in phacoemulsification cataract surgery. Because the highest mean score was not significantly higher than that for the administration of the anesthetic agent, it is possible to counsel patients before surgery that the pain they experience during the procedure will be no worse than that during administration of the anesthetic drops.     

Subjective visual experience and pain level during phacoemulsification and intraocular lens implantation under topical anesthesia

PURPOSE: To investigate the subjective visual experiences and pain during the phacoemulsification and intraocular lens (IOL) implantation under topical anesthesia, and whether these parameters change according to the stage of phacoemulsification cataract surgery. METHODS: Forty eyes of 40 patients with cataract undergoing phacoemulsification and IOL implantation under topical anesthesia were included in this study. The patients were told that they would be asked about their visual experiences and pain level, if any, during every stage of the surgery. As for degree of the pain, a 5-grade scale was used. The surgery was divided into 9 stages, i.e., clear corneal incision, continuous curvilinear capsulorhexis, side-port incisions at 3 and 9 o'clock positions, hydrodissection, nuclear rotation, phacoemulsification, bimanual irrigation and aspiration, IOL implantation, apposition of corneal incisions with stromal hydration. RESULTS: All subjects (100%) reported that they had seen some kind of light during the operation. Thirty-eight patients (95%) said that they had seen one or more colors. In 32 patients (80%), the light intensity decreased, and colors blurred significantly following the hydrodissection. As for the pain level during surgery, the overall pain score was found to be 0.40. The highest mean pain score was noted during IOL implantation stage followed by phacoemulsification and bimanual irrigation-aspiration. CONCLUSION: Topical anesthesia is both a safe and effective method for small-incision clear corneal phacoemulsification cataract surgery. Patients may experience visual sensations, and the pain felt during the operation is low and tolerable. Visual experiences and pain level may change according to the stage of phacoemulsification cataract surgery.     

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.     

Patient's pain feeling and surgeon's comfort--ECCE versus phacoemulsification

PURPOSE: To compare patient's pain and surgeon's comfort during ECCE performed under retrobulbar anesthesia and phacoemulsification under topical anesthesia. MATERIAL AND METHODS: 120 patients scheduled for planned routine cataract extraction were divided in 2 groups: group 1-60 eyes, ECCE under retrobulbar anesthesia and group II-60 eyes, phacoemulsification under topical anesthesia. Immediately after operation patients were asked, to answer questions about their feeling during surgery. Simultaneously, the surgeon filled up the questionnaire, concerning patients behavior during the entire procedure. RESULTS: Statistically significant higher level of pain was reported in group I (ECCE). The most painful moment of the procedure was retrobulbar injection. During surgery pain feeling in both groups was similar. Both types of anesthesia provided very good level of surgeon's comfort. The longer operation, the higher level of pain and lower surgeon's comfort were reported in both groups. CONCLUSIONS: Patients having ECCE performed under retrobulbar anesthesia reported more pain comparing to phacoemulsification under topical anesthesia. Both anesthesia methods provided high level of surgeon's comfort.     

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.     

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 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.