Patients Undergoing Phacoemulsification Surgery Research Articles

Effect of direct oral anticoagulants on bleeding during and after cataract surgery

PurposeTo assess the risk for intraoperative and postoperative ocular bleeding associated with direct oral anticoagulant treatment in patients undergoing phacoemulsification surgery.MethodsConsecutive patients had phacoemulsification and intraocular lens implantation while taking uninterrupted direct oral anticoagulants (dabigatran, rivaroxaban, or apixaban). Gender and age-matched patients without antithrombotic therapy were used as the control group. Patients were examined one week postoperatively. Intraoperative and postoperative hemorrhagic and non-hemorrhagic complications were assessed.ResultsForty patients (56 eyes) on direct oral anticoagulants and 120 patients (172 eyes) without anticoagulation, at a mean age of 77 years, had phacoemulsification. There was no significant difference between the groups in the rate of intraoperative and postoperative bleeding. One eye (1.8%) in the treatment group and 3 eyes (1.7%) in the control group had hyphema (p = 0.72). No patient had thromboembolic event during or after surgery.ConclusionsCataract surgery was safely performed while continuing direct oral anticoagulation.

Effect of Intracameral Moxifloxacin on Endothelial Cell Count and Endophthalmitis Prophylaxis After Cataract Surgery

One of the most feared side effects of contemporary cataract surgery is still endophthalmitis. Prophylactic measures include the use of antibiotics: topical, subconjunctival, and intracameral, to avoid endophthalmitis. Moxifloxacin 0.5% has been used most frequently in preventive late-stage regimens. Objective: To ascertain how well moxifloxacin prevented endophthalmitis in patients having cataract surgery. Methods: This was a descriptive case study and was conducted at Eye Departments of Allama Iqbal Medical College, Jinnah Hospital, Lahore and Ameer-ud-Din Medical College, Lahore General Hospital, Lahore. The study was commenced after approval of the synopsis and completed in 6 months. Results: In this study, 23.75%(n=19) were between 40-50 years, 61.25%(n=49) between 51-60 years and 15%(n=12) had >60 years of age, and their average was calculated as 53.99+6.22 years. 58.76%(n=47) were males and 41.25%(n=33) were females in the study. Mean endothelial cell count before cataract surgery was calculated as 2776 +177 while post-operative the average endothelial count was calculated as 2424 +72.8. while the frequency of effect of moxifloxacin, in the prevention of endophthalmitis in patients undergoing cataract surgery was recorded as 22.5%(n=18) while 77.5%(n=62) had no effect of moxifloxacin while preventing endophthalmitis in patients undergoing cataract surgery. Conclusions: We conclude that the effect of moxifloxacin, in preventing endophthalmitis in patients undergoing phacoemulsification surgery is not significantly higher and may be used in our setup for prevention of endophthalmitis, being a risk factor for blindness. Moxifloxacin does not affect the corneal endothelial cells significantly.

Study of tear film status in patients undergoing phacoemulsification surgery

The present study was undertaken to study the tear film status preoperatively and post-operatively in patients undergoing phacoemulsification surgery. The study was conducted as prospective study on 100 patients undergoing phacoemulsification surgery during the study period of 1 year. Work up for tear film status including Schirmer’s test, staining of cornea and conjunctiva with fluorescein dye, TBUT (tear film break up time) was done preoperatively and postoperatively after phacoemulsification. Mean Schirmer’s value at preoperative assessment was 27.45±4.95 whereas that at post operative day 7, 15 and 30 was 9.09±2.19, 16.73±5.12 and 24.45±4.05 respectively. Similarly, mean TBUT at preoperative level was 11.11±1.16 which reduced to 6.63±1.57 at day 7, 7.37±1.44 at day 15 and 9.77±0.91 at day 30. Test of significance (ANOVA) showed statistically significant difference in mean Schirmer’s and TBUT values at various follow ups post-operatively as compared to baseline (p<0.01). Cataract surgery can lead to dry eye due to incision itself as well as due to intra-operative exposure to the microscope light. Thus, artificial tears must be prescribed to improve the quality of life during immediate post-operative period. However, gradually, tear film status improved. We only followed up patients till one month, a long term follow up is recommended to assess the time taken for the tear film to recover to its preoperative status.

Successful Use of Low-Dose Combination Propofol and Fentanyl in Cataract Surgery Phacoemulsification.

The combination between sedatives and opioids is one of the recommended anesthetic options in ophthalmic procedures and regimens are more advantageous as smaller amounts of each drug can be administered to reduce side effects and have proper outcomes due to the synergistic effects. This study aims to observe the use of low-dose propofol and fentanyl for patients undergoing phacoemulsification surgery. This observational study involves a sample of 125 adult patients who underwent elective cataract procedures using the phacoemulsification technique and had an American Society of Anesthesiologists (ASA) physical status of 1 to 3. Dose amount of fentanyl and propofol, Ramsay score, hemodynamic parameter, side effects, and patient satisfaction were evaluated, recorded, and analyzed using a 5-point Likert scale. The result showed the mean absolute dose of propofol was 12.46±4.376 mg, with a range between 10 and 30 mg, while the mean per body weight was 0.21±0.075 mg. Similarly, the mean absolute dose for fentanyl was 25.04±3.012 mcg within the range of 10-50 mcg, and the per-body weight dose was 0.43±0.080 mcg. About 90.4% and 9.6% of the patients reached Ramsay 2 and 3, respectively. The analysis of systolic, diastolic blood pressure, mean arterial pressure, and pulse rate showed that the combination of low-dose fentanyl and propofol was significantly lower than before therapy administration in all four values (p < 0.05). The combination of low-dose propofol and fentanyl in cataract surgery using phacoemulsification successfully reached the targeted sedation level and a significant decrease in blood pressure, MAP, pulse rate, minimal side effects, and high satisfaction rate.

Effect on determinants of dry eye after phacoemulsification

Quantitative analysis of determinants of dry eye among patients undergoing phacoemulsification surgery. This was a single-centered hospital-based, prospective observational study. Sixty eyes of sixty patients suffering from senile cataract undergoing phacoemulsification surgery were evaluated after randomly selecting them and were followed up postoperatively on day 1 and week 4 to evaluate the dry eye parameters selected for the study.A total of 60 eyes of 60 patients were chosen with a mean age of 63.96 ± 6.95 (mean ± SD) years. The mean baseline Schirmer’s test I, tear break-up time, lissamine test, and OSDI values were 25.45 ± 4.68 mm, 14.15±2.79 s, 1.26 ± 0.44 s, and 7.28 ± 3.13 respectively, whereas post-operatively day 1 the values were 14.75 ± 4.32 mm, 8.91 ± 2.93 s, 3.11 ± 0.78, and 22.85 ± 6.80 respectively. On 4 week follow-up, the value were 22.60 ± 4.54 mm, 13.30 ± 2.79 s, 1.43 ± 0.67, and 12.13 ± 5.45 respectively.Dry eye after cataract surgery is mainly because of tear film stability.The study points to the fact that patients experience increase in dry eye symptoms postoperatively. We also observed a very predictable trend of dry eye in our study, wherein the incidence increases immediately in the early postoperative period, followed by a gradual decrease in dry eye parameters approaching their preoperative baseline value.

A Comparative Study of Various Topical Nonsteroidal Anti-Inflammatory Drugs to Steroid Drops for Control of Post Phacoemulsification Surgery Inflammation

In the past, patients who underwent cataract surgery were prescribed an antibiotic drop and a topical steroid to reduce inflammation in the days following the procedure. However, steroids can have negative consequences, such as slowed wound healing, increased susceptibility to infection, and increased intraocular pressure (IOP) that can cause permanent damage to the optic nerve. Bromfenac is an NSAID that has been demonstrated to reduce post-operative pain and inflammation and is associated with better adherence (since it needs to be taken less frequently) and fewer adverse effects. The purpose of this research was to evaluate the efficacy of a topical steroid against a topical NSAID in the prevention and treatment of inflammation following phacoemulsification surgery. Methods: Eighty eyes from eighty patients who had conventional uncomplicated phaco emulsification with posterior chamber intra ocular lens implantation were used in this prospective randomised study comparing the effect of topical non-steroidal anti-inflammatory drugs versus steroidal drugs in preventing post-operative inflammation following phaco emulsification surgery. Patients were randomly assigned to one of two groups based on whether they received oral or topical medication for the first three weeks after surgery. Twenty patients were assigned to Group A, where they received prednisolone 1% eye drops every two hours for the first week, four times a day for the second week, twice a day for the third week, and gatifloxacin 0.3% six times a day for the entire two weeks. For those in B-Group: For Group B, we divided 60 eyes into three categories: Group B1 received eye drops containing 0.1% diclofenac sodium, while Group B2 received eye drops containing 0.1% nepafenac. The Bromfenac 0.1%.eye drop group B3 treated 20 eyes. While the first week showed statistically significant differences in corneal edoema, anterior chamber cells, and flare, by the third week the results were similar across all four groups. In terms of eyesight, we also discovered a statistically significant difference between Group A and Groups B1, B2, and B3, but this difference had diminished by the third visit. Up to the last visit of the third week, there was no significant difference between the four groups' IOP measurements. Our data demonstrated a marginally different response to steroid or NSAID use, with the steroid group experiencing less corneal edoema than the NSAID group up to the third week visit. Patients undergoing phacoemulsification surgery can benefit from nonsteroidal anti-inflammatory drugs (NSAIDs) like nepafenac 0.1%, bromfenac 0.1%, and Diclofenac sodium 0.1% instead of steroids for postoperative ocular inflammation control. Intraocular inflammation is best treated with prednisolone 1% as it achieved reduced AC cells and flare.

Accuracy of the Goggin Nomogram for 0.50 D Steps in Toric IOL Cylinder Power Calculation.

To examine the accuracy of the cylinder power choice for toric intraocular lenses (IOLs) using the Goggin Nomogram, which adjusts anterior keratometric astigmatic power values for the likely effect of posterior corneal and non-corneal, non-lenticular astigmatism. A consecutive, retrospective case series was based at the Queen Elizabeth Hospital and Ashford Advanced Eye Care in Adelaide, Australia. A total of 586 consecutive eyes of 586 patients underwent phacoemulsification surgery with implantation of a Zeiss AT TORBI 709MP or AT LISA Tri Toric 939 MP toric IOL, calculated using the Goggin Nomogram. The median absolute magnitude of error and geometric mean astigmatic correction index in consecutive eyes with toric IOL cylinder powers of 1.00 to 3.00 diopters (D) were analyzed. Overall, all eyes receiving IOL cylinder powers of 1.00 to 3.00 D inclusive had a median magnitude of error value of 0.19 D (IQR: 0.31) and astigmatic correction index value of 1.03 (IQR: 0.33). For eyes with with-the-rule, against-the-rule, and oblique astigmatism, the median magnitude of error was 0.18 D (interquartile range [IQR]: 0.29), 0.19 D (IQR: 0.31), and 0.17 D (IQR: 0.39), respectively, and the astigmatic correction index was 1.06 (IQR: 0.28), 1.01 (IQR: 0.35) and 1.08 (IQR: 0.32), respectively. Goggin Nomogram adjusted keratometry provided optimal refractive astigmatic outcome in IOL cylinder powers of 1.00 to 3.00 D in eyes with with-the-rule, against-the-rule, and oblique astigmatism. Goggin Nomogram adjusted keratometry compensates for both posterior corneal astigmatism and any other source of ocular astigmatism. [J Refract Surg. 2022;38(5):298-303.].

To compare postoperative astigmatism and visual outcome following phacoemulsification versus Manual Small Incision Cataract Surgery (MSICS) seen at tertiary care center

Purpose: To compare postoperative astigmatism and visual outcome following phacoemulsification versus Manual Small Incision Cataract Surgery (MSICS) seen at a tertiary care center. Method: A total of 100 patients were enrolled in this retrospective study. Group A included 50 patients undergoing phacoemulsification surgery and group B included 50 patients undergoing MSICS. The outcome was evaluated in both techniques in terms of astigmatic profile and visual outcome at post-operative day 1 and 3 months. Results: The mean age was 60 ± 1.84 years in the phacoemulsification group and 61 ± 1.25 years in the MSICS group. In the phacoemulsification group, 60% were male patients as compared with 40% female patients while MSICS group included 62% female patients and 38 % male patients. The initial visual recovery on the first postoperative day was better in the patients who underwent phacoemulsification, with the uncorrected visual acuity better than or equal to 6/18 in 94% of the patients, whereas the percentage was 72% in the MSICS group. At three months, 80% of the patients in the MSICS group had uncorrected visual acuity better than or equal to 6/18 versus 88% of the patients in the phacoemulsification group. The mean astigmatism was 0.808 ± 0.39D in the phaco group and 1.565 ± 0.51D in the MSICS group, p-value significant (0.0001). Conclusion: Both phacoemulsification and MSICS achieved comparable and excellent visual outcomes. However, MSICS appears to be more advantageous than phacoemulsification in terms of speed, cost and independence from technology and appears to be more suitable for mass surgery especially in developing countries.

EVALUATION OF CHOROID THICKNESS CHANGES AFTER UNEVENTFUL PHACOEMULSIFICATION SURGERY USING SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY AT A TERTIARY CARE EYE HOSPITAL

Objective: To analyze the effects of uneventful phacoemulsification surgery on choroidal thickness using spectral domain optical coherence tomography.&#x0D; Study Design: Prospective comparative study.&#x0D; Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jun 2018 to Jun 2019.&#x0D; Methodology: In this prospective study, 300 eyes of 300 patients undergoing phacoemulsification surgery were included. All patients underwent detailed ophthalmologic examination, including measurement with optical biometry, intraocular pressure and choroid thickness. The choroidal thickness was measured perpendicularly at the fovea using spectral domain optical coherence tomography preoperatively and 1 month postoperatively. Changes in intraocular pressure and choroid thickness after surgery were evaluated.&#x0D; Results: There was a statistically significant increase in the choroid thickness in early postoperative period (p-value &lt;0.01). This increment was prominent in sub foveal regions. The intraocular pressure decreased significantly 1 month after surgery (p-value &lt;0.01). The change in intraocular pressure was correlated with the choroid thickness change at sub foveal region.&#x0D; Conclusion: Uncomplicated phacoemulsification induces non-pathologic increase in sub-foveal choroid thickness probably due to the inflammatory insult of the surgery. Long-term follow-up of eyes having phacoemulsification surgery may provide further insight into the effects of cataract surgery on the choroid.

Psödofakik Retina Dekolmanlı Hastaların Demografik ve Klinik Özellikleri ve Bunların Cerrahi Başarıya Etkisi

Aim: In this study, we aimed to determine the demographic and clinical characteristics of patients who underwent surgical treatment for pseudophakic retinal detachment (PRD) and evaluate the effects of these characteristics on the success of the surgery. Materials and Methods: The study included 60 eyes of 60 patients who were diagnosed with PRD at the Retina Section of the 1st Eye Clinic of the Beyoğlu Eye Training and Research Hospital between February 2006 and January 2009. Demographic and pre-, peri- and postoperative clinical data of the patients were recorded. Results: The mean patient age was 58.45±14.91 years. Of the patients, 46 (76.7%) were male and 14 (23.3%) were female. Fifty-two (86.6%) patients underwent phacoemulsification surgery, 1 (1.6%) planned extracapsular cataract extraction, 1 (1.6%) intracapsular cataract extraction, 3 (5%) refractive clear lens extraction, and 3 (5%) lens extraction with irrigation/aspiration for diagnosed pediatric cataract. Twenty-two (36.6%) patients underwent posterior chamber lens implantation in the capsule, 32 (53.3%) posterior chamber lens implantation in the sulcus, 4 (6.6%) anterior chamber lens implantation, and 2 (3.3%) scleral-fixated lens implantation. In 44 (73%) patients, the posterior capsule integrity was impaired. A tear was detected in 27 (45%) patients during the preoperative retinal examination and in 18 (30%) patients during the surgery. No tear was detected in 15 (25%) of the patients. To treat the patients, four different surgical procedures were performed depending on factors including the proliferative vitreoretinopathy (PVR) stage, condition of the lens and posterior capsule, and location of the retinal tear: 360-degree scleral encircling band + local explant (Group I), 360-degree scleral encircling band + pars plana vitrectomy + tamponade (Group 2), 360-degree scleral encircling band + pars plana vitrectomy + intraocular lens removal + tamponade (Group III), and 23G pars plana vitrectomy + tamponade (Group IV). The mean follow-up was 18.3±5.2 (6–32) months. At the last follow-up visits, anatomical success was achieved in 58 (96.6%) of the 60 patients while 17 (32%) showed functional success. The functional success rate was higher in patients in the early stages (up to C1) of PVR (p&amp;lt;0.001). Discussion and Conclusion: According to our findings, PVR stage is directly related to anatomical and functional success in PRD. Surgical treatment is more successful in PRD patients with early-stage PVR.

Development of a reliable preoperative risk stratification system for phacoemulsification.

To present a statistically validated risk classification system for intraoperative complications in cataract surgery. 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece. Prospective observational study. All patients underwent phacoemulsification surgery by experienced, high-volume surgeons for cases with intraoperative complications. The presence of several risk factors was statistically assessed with the help of multiple correspondence analysis to determine the more reliable rank categorization for severity and to calculate a total risk score. This study included 1572 consecutive patients. The proposed system had 3 risk groups and a no-risk group and had high statistical reliability. A comparison of this system against a previously asserted empirical system showed higher internal reliability. Previous efforts to construct a risk classification system for intraoperative complications in cataract surgery have been empirically defined and tested against practice-as-usual. The system in this study quantified risk more accurately and provided an experienced clinician with a reliable means of assessing the preoperational likelihood of intraoperative complications.

Characteristics and Seasonal Variations of Rhegmatogenous Retinal Detachment in the Eastern Black Sea Region of Turkey: 8-Year Results.

Objectives:To assess seasonal variations in the incidence of rhegmatogenous retinal detachment (RRD) in the Eastern Black Sea region of Turkey.Materials and Methods:Patients presenting due to primary RRD to a university hospital operating as a reference clinic in the region between 2011 and 2018 were evaluated retrospectively. Patients’ ages, sex, affected eye, and presentation times were recorded. Years were divided into months, quarters, seasons, and half-year periods, and these periods were analyzed in terms of differences in patient numbers.Results:Two hundred eighty-one eyes of 276 patients meeting the study criteria were included. The patients’ mean age was 60.2 years, and the male:female ratio was 1.35:1. Right and left eye rates were similar. Detachments were most common (49.4%) in the upper temporal quadrant. Eighty-nine patients (31.6%) had undergone uncomplicated phacoemulsification surgery a mean 2.7 years previously. The mean annual case number was 35.13±5.43, and no statistically significant variation was determined in case numbers by year (p=0.558). Analysis of all years revealed a monthly mean case number of 23.42±4.4, with the highest number of cases, 29 (10.3%), being seen in September and the lowest number, 13 (4.7%), in December. No statistically significant monthly variation was determined (p=0.613). Similarly, no statistically significant variation was observed in case numbers analyzed by quarter, season, or half-year (p>0.05).Conclusion:The incidence of cases of uncomplicated RRD does not exhibit seasonal variation in our region. We also think that since 31.6% had a history of cataract surgery, patients undergoing phacoemulsification surgery, even if uncomplicated, should be periodically assessed for detachment.

Steroidal versus non-steroidal eye drops in prevention of cystoid macular edema after cataract extraction in diabetic patients

Background: Cystoid macular edema (CME) is addressed as one of the most important complication responsible for suboptimal visual acuity outcome after cataract surgery. Objective: Comparison between topical steroids versus NSAIDs regarding ability to reduce CME after uneventful cataract surgery of foldable intraocular lens (IOL) implantation in diabetic patients. Patients and methods: In this study, 30 patients underwent phacoemulsification surgery with posterior chamber foldable intraocular lens implantation in Ophthalmology Department, Al-AzharUniversityHospital between December 2017 and November 2018. Patients were randomly categorized into 2 groups. Group 1: Nepafenac eye drops (0.1%) 3 times daily for one month, Group 2: Prednisolone eye drops (1%) 5 times daily for one month. Results: At the end of the follow up, foveal thickness changes in optical coherence tomography (OCT) were found to be slightly less in the no steroidal anti-inflammatory eye drops (NSAIDs) group than in the steroidal group with no significant change in the final visual outcome between the two groups. Conclusion: There was no significant statistical difference between NSAIDs drops and steroids drops in prevention of development of pseudophakic macular edema post cataract surgery.

Safety & efficacy of single subconjunctival triamcinolone 5 mg depot vs topical loteprednol post cataract surgery: less drop cataract surgery.

To do a randomized prospective interventional study for comparing the effects of a single subconjunctival triamcinolone acetonide (SCTA) injection to tapering topical loteprednol in patients undergoing phacoemulsification surgery under topical anesthesia. A total of 400 patients were randomized into 2 groups; Group A (200 patients) received 5 mg SCTA at the end of surgery and topical ketorolac tromethamine (0.5%) with ofloxacin (0.3%) combination for 3wk. Group B (200 patients) received tapering topical loteprednol etabonate (0.5%) along with ofloxacin (0.3%) and ketorolac tromethamine (0.5%) for 3wk. Outcomes evaluated were intraocular pressure (IOP), anterior chamber cells/flare and macular oedema postoperatively at 1, 6 and 12wk. Baseline parameters were almost similar in both the groups. No statistical difference was seen between the preoperative and postoperative IOP values for Group A (P=0.82) and Group B (P=0.61) and postoperative IOP values in between both groups (P=0.14) at 1wk. Incidence of cells/flare postoperative was statistically not significant (P=0.82) in both groups at all follow up visits. Postoperative macular oedema was not observed at any follow up visit. SCTA appears to be an effective alternative to prolong postoperative topical steroid use.

Comparison of SRK/T and Haigis formulae in the prediction of refractive outcome after phacoemulsification

Purpose To compare the accuracy of SRK/T and Haigis formulae used for intraocular lens (IOL) power calculation by a partial coherence interferometer in patients undergoing phacoemulsification surgery. Patients and methods A prospective interventional clinical study included 70 eyes of 60 patients, who underwent uncomplicated phacoemulsification with IOL implantation from October 2015 to December 2017. Preoperative axial length (AL), corneal curvature (keratometry), and preoperative anterior chamber depth (preoperative ACD) were measured using Nidek AL-scan optical biometer and the IOL power was determined using both SRK/T and Haigis formulae. The difference between the predicted value and the postoperative spherical equivalent was calculated for both the formulae by the end of the follow-up (3 months postoperatively). Results The mean errors of the two formulae were SRK/T: −0.225±0.61 D and Haigis: 0.171±0.68 D; the mean absolute errors of the two formulae were 0.534±0.36 and 0.533±0.44 D, respectively. There was no statistically significant difference between the mean error of the two formulas used in the overall performance, but was significant in eyes with an AL of more than 25 mm. The proportion of patients having a prediction error within ±0.50 D of SRK/T formula (54.29%) was comparable to those of Haigis (55.71%) and the prediction errors within ±1.0 D were 87.14 and 85.71%, respectively. There is a weak correlation between the mean AL, keratometry and the Haigis–SRK/T prediction differences (r 2=0.273). Conclusion The calculation of IOL power using SRK/T and Haigis formulae resulted in an accurate postoperative refraction. In long AL subcategory, the mean absolute error of Haigis was less compared with the SRK/T formula.

Comparison of Preoperative Infusion of Magnesium Sulfate and Mannitol on Intraocular Pressure Changes in Patients Undergoing Phacoemulsification Surgery.

Background:The present study has been designed to compare the effect of magnesium sulfate with mannitol on reducing intraocular pressure (IOP).Materials and Methods:During the phacoemulsification surgery, 105 patients randomly divided into three groups receiving 20% mannitol at a dose of 0.3 g/kg, 50% magnesium sulfate at a dose of 20 mg/kg, and placebo (normal saline), with the same volume (100 ml) and infusion time (10 min), were used for the first, second, and third groups, respectively. The IOP was measured before and immediately after the injection and 5 min after the end of the surgery and compared between the groups.Results:The mean IOP immediately after the injection had a significant difference in three groups (mannitol: 15.2 ± 2.5, magnesium sulfate: 14.7 ± 1.9, and normal saline: 13.8 ± 2.8; P = 0.044), and the IOP had a significant difference between normal saline and mannitol groups (0.027) while there was no significant difference between mannitol and magnesium sulfate groups (P = 0.34) and also between magnesium sulfate and normal saline groups (P = 0.2).Conclusion:Using magnesium sulfate had no effect on changes in the IOP and hemodynamic of patients during the surgery. Using mannitol may be effective in reducing IOP while no effect of magnesium sulfate on IOP was found.

Evaluation of small-volume (3 ml) ophthalmic anaesthesia for both subtenon anaesthesia using blunt-tipped curved needle and single medial canthal injection with sharp needle for phacoemulsification surgery

Introduction Medial canthus injection as well as subtenon anaesthesia has been used in anterior segment surgery. In this research, we compared the effectiveness and safety of small volume (3 ml) for either technique. Patients and methods Forty eyes of 40 patients undergoing phacoemulsification surgery at the Research Institute of Ophthalmology, Giza, Egypt, were divided into two groups: group A (20 eyes) included eyes of patients who received subtenon injection with blunt-tipped curved needle and group B (20 eyes) included eyes of patients who received single injection at medial canthus with sharp needle. Following either injection, the akinesia score and surgeon and patient satisfaction scores were reported as well as any related complications. The studied data were subjected to statistical analysis and results emphasized. Results In our study, the akinesia score had a mean value of 6±2.43 for subtenon group and 3.25±2.61 for the single injection medial canthus group, with a highly significant difference (P 0.05). Conclusion For phacoemulsification, subtenon anaesthesia using small volume of 3 ml was more effective regarding better akinesia score compared with a similar volume of medial canthus injection, with lower rate of supplemental injection as well as better patient and comparable surgeon satisfaction. The main disadvantage was a higher rate of pain to injection as well as more need for facial supplementation.

Advanced Subconjunctival Anesthesia for Cataract Surgery.

Ocular regional blocks generally require blind instrumentation to the posterior orbit, leading to rare but serious complications. However, topical anesthesia does not suppress eye or lid movements and may lead to more surgical complications. Advanced subconjunctival anesthesia (ASCAN) is a technique developed to provide reliable akinesia and anesthesia without anterior dissection or blind intrusion into the posterior orbit, while allowing visualization of the needle-tip position. Nonrandomized case series at a rural health service. Advanced subconjunctival anaesthesia was performed on 60 elective adult patients undergoing phacoemulsification surgery. The technique involves piercing the conjunctiva and Tenon's capsule in the superior outer quadrant of the globe with a 25-gauge, 16 mm needle, using either lignocaine 2% plain or in equal mix with bupivicaine 0.5%. Up to 10 mL of anesthetic with hyaluronidase 30 IU/mL is injected in a posterior direction into the sub-Tenon's space. Ocular motor functions were assessed 10 minutes after ASCAN using a Brahma scale. Pain was assessed during surgery and at the end of surgery after subconjunctival injection of antibiotic and steroid using a verbal Numeric Rating Scale. All patients completed surgery without needing supplemental anesthesia. Fifty-eight patients (97%) were pain free, whereas 2 patients experienced transient mild pain. Adequate globe akinesia and reliable lid paralysis was achieved comparable to other studies, with no major surgical or anesthetic complications. Advanced subconjunctival anesthesia is a visually guided, minimally invasive technique, achieving satisfactory analgesia and akinesia for phacoemulsification surgery.

Accuracy of the SRK/T Formula Using Partial Coherence Interferometer, Al-Scan after Phacoemulsification

Purpose: To evaluate the accuracy of SRK/T formula used for IOL power calculation by partial coherence interferometer in patients undergoing phacoemulsification surgery. Patients and methods: A prospective interventional clinical study included 40 eyes of 34 patients who underwent uncomplicated phacoemulsification with IOL implantation from March 2015 to March 2017. Biometries were measured using ultrasound or AL-scan and intraocular lens power was calculated using the SRK-T formula. Patients were divided into 2 groups based on device used for IOL power calculation: AL-scan or ultrasound ; Axial length: >=25 mm or < 25mm; or lens opacity: Cataractous or clear lens. The mean error (ME) was calculated from the difference between the formula predicted refractive error and the actual post operative refractive error by the end of the followup (3 months postoperative). Results: Mean axial length measured preoperatively was 27.47 ± 316mm (21.55-34.05) mm. 60 percent of the patients were within 0.5 D of the predicted refractive error and 90 percent were within 1.0 D. There was no statistically significant difference in the overall performance of the SRK/T formula between the mean error when dividing the patients into 2 groups according to: device used for IOL power calculation (P= 0.274); Axial length (P= 0.46); or lens opacity (P= 0.18) in precision of predicting postoperative refraction. Conclusions : SRK/T formula helps in improvement of the accuracy of IOL power calculation and decreasing the postoperative refractive error. By using SRK/T formula, there was no statistically significant difference between the AL-scan or applanation ultrasound used in biometry.

Ocular lubricant use in medically and surgically treated glaucoma: a retrospective longitudinal analysis.

BackgroundChronic use of intraocular pressure-lowering medications is associated with ocular surface disease (OSD). In this study, we assess the incidence of topical lubricant use as a surrogate marker for underlying OSD, in medically and surgically treated glaucoma patients.MethodsRetrospective chart review was performed for newly diagnosed glaucoma patients who were started on topical medications in 2007 and followed up over a 5-year period. Primary outcome measure was the incidence of topical lubricant use in these patients and a subset of these patients who required glaucoma or cataract surgery during follow-up.ResultsCharts of 505 newly diagnosed glaucoma patients with no prior history of ocular lubricant use were analyzed. Mean age was 63.9 years (SD 11.1), 42.8% were women. One hundred one (20.0%) patients underwent phacoemulsification surgery, 80 underwent mitomycin C (MMC) augmented phacotrabeculectomy, 16 underwent MMC-augmented trabeculectomy and 3 underwent tube surgery during the course of follow-up as their only type of surgery. Five-year incidence of lubricant use was 59% in all glaucoma subjects; 54.1% of patients were on medical treatment and 74.0% of patients who underwent phacotrabeculectomy or trabeculectomy were started on lubricants, respectively (P=0.0011); 60.4% of glaucoma subjects who underwent phacoemulsification surgery were started on lubricants. Incidence of lubricant use increased from 17.7% preoperatively to 74.0% postoperatively in subjects who required trabeculectomy or phacotrabeculectomy. Incidence of lubricant use was similar in patients on one or multiple glaucoma medications, with the mean onset of lubricant use being 10 months after starting glaucoma medication in both groups. Females were more likely to use artificial tears compared with males (P=0.002).ConclusionBoth medical and surgical management of glaucoma have an adverse effect on the ocular surface. Chronic use of glaucoma medications was associated with a high incidence of ocular lubricant use. MMC-augmented trabeculectomy was associated with an even higher incidence of ocular lubricant use.