Comparison of surgeon comfort assessment during phacoemulsification using bilateral topical anesthesia versus ipsilateral topical anesthesia: a randomized controlled study.

Abstract

To evaluate the effectiveness of bilateral use of topical anesthetic eye drops during phacoemulsification procedure as compared to use in one eye only. This is a prospective double-blind randomized case study of 180 cases undergoing phacoemulsification under topical anesthesia using 0.5% proparacaine: Group 1 consisting of patients who had topical anesthetic eye drop instilled into the operating eye only and Group 2 consisting of patients who had both their eyes anesthetized using topical anesthetic eye drops. Phacoemulsification was done using standard surgical technique. Main parameters evaluated included number of intra-operative patient counseling score (IPCS), surgical comfort score (SCS), total phacoemulsification procedure time (TPPT) and total operation time (TOPT). A comparison of mean value of various variables between Group 1 (60; 33.3% cases) and Group 2 (120; 66.7% cases) using "t" test revealed that there was a statistically significant difference for mean SCS (78.38±10.31 vs. 85.05±8.70; p=0.00), mean IPCS (12.60±3.11 vs. 6.63±1.74; p=0.00) and mean TOPT (418.88±89.59 vs. 341.64±79.51; p=0.00), respectively. However, no statistically significant difference existed for mean TPPT (143.57±87.96 vs. 152.96±78.99; p=0.48). Simultaneous instillation of topical anesthetic eye drops in both the eyes, i.e., operating eye and the fellow eye as against practice of instilling topical anesthetic eye drop in the operating eye only, helps in decreasing the total surgical time by primarily shortening the durations of pre- and post-ultrasonic periods of surgery where effective globe stabilization is wanted. This is achieved by better patient compliance, which in turn enhances surgeon's comfort during phacoemulsification surgery.