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.