Simultaneous Bilateral Cataract Research Articles

Evaluation of local anesthesia techniques for small incision cataract surgery

Purpose: To evaluate the surgical experiences and patient preference with 3 local anesthesia techniques for small incision cataract surgery.Setting: Department of Ophthalmology, Hjørring Hospital, Denmark.Methods: This prospective, randomized study included 66 patients having simultaneous bilateral cataract surgery. There were 3 test groups, each containing 2 of the following local anesthesia techniques: retro/peribubar (RBA), sub-Tenon's (STA), or topical (TA). Each patient served as his or her own control. No medical sedation was used. Patient response to each anesthesia technique was evaluated by the surgeon based on surgical difficulties, a nurse using hand-holding tension and verbal interaction, and a visual analog pain score. Patients were also asked which of the 2 techniques they preferred and their reasons.Results: No local anesthesia techniques interfered with surgery. The order of a positive pain/discomfort response during surgery was TA > STA > RBA. Significantly more pain occurred with application of RBA than with STA or TA. No postoperative pain was recorded with any method. Fifty-six percent of patients said they preferred 1 technique over the other; 16% of patients having STA would not do so again, 19% would not have TA again, and 40% would not have RBA again. The main reasons for preferring STA and TA were fear of or pain from a retrobulbar injection. The main reasons for preferring RBA were less awareness, anxiety, and surgical pain. Immediate visual recovery seemed to be of minor importance in patients' choice of an anesthesia technique.Conclusion: Although less discomfort/pain occurred during surgery with RBA, patients preferred STA and TA primarily because of the inconvenience or pain of the retrobulbar injection. Although medical sedation was not used in this study, the pain/discomfort ratio from surgery was not greater than in studies using intravenous sedation, indicating that the use of medical sedation should be re-evaluated.

Evolving trends in cataract surgery techniques and timing

Evolution in cataract surgery developed along two fronts: technique and timing. New cannulae with very wide aspiration ports permit nucleosuction; a manual small incision method that fractionates and aspirates the nucleus. Phacoemulsification is made easier and safer with phaco sweep. Posterior capsule polishing is gentle if the only vacuum is generated by the infusion passing through the system and the aspiration tubing is not used. Fibrin glue may make long corneal incisions as stable as short ones. Several studies challenge our conventional thoughts simultaneous bilateral cataract surgery and whether patients need to be examined on the first postoperative day.

Simultaneous bilateral cataract extraction in the UK.

AIMS/BACKGROUND--Simultaneous bilateral extracapsular cataract extraction (SBCE) is not routinely performed in the developed world. This study investigated the safety and efficacy of this procedure as performed in the UK. METHODS--A review of 319 consecutive patients (638 eyes) who underwent SBCE with posterior chamber intraocular lens implantation is presented. RESULTS--The incidence of intraoperative complications was 7.7%. These included posterior capsule rupture (0.8%) and vitreous loss (0.3%). Postoperative complications were seen in 8.7% of operated eyes and included iris prolapse (0.3%) and raised intraocular pressure (3.0%). Endophthalmitis occurred in one eye (0.15%). There were no major bilateral complications, and, in particular, no cases of bilateral endophthalmitis. Final visual acuities compared favourably with reports for unilateral surgery. Eighty two per cent achieved a final visual acuity of 6/12 or better, and 41% tested 6/6 or better. CONCLUSION--This study illustrates that SBCE is not associated with an increased incidence of complications and that the visual results are good. Where indicated, and under strict surgical protocol, this procedure is safe.

Simultaneous bilateral cataract extraction in the UK.

Simultaneous bilateral extracapsular cataract extraction (SBCE) is not routinely performed in the developed world. This study investigated the safety and efficacy of this procedure as performed in the UK. A review of 319 consecutive patients (638 eyes) who underwent SBCE with posterior chamber intraocular lens implantation is presented. The incidence of intraoperative complications was 7.7%. These included posterior capsule rupture (0.8%) and vitreous loss (0.3%). Postoperative complications were seen in 8.7% of operated eyes and included iris prolapse (0.3%) and raised intraocular pressure (3.0%). Endophthalmitis occurred in one eye (0.15%). There were no major bilateral complications, and, in particular, no cases of bilateral endophthalmitis. Final visual acuities compared favourably with reports for unilateral surgery. Eighty two per cent achieved a final visual acuity of 6/12 or better, and 41% tested 6/6 or better. This study illustrates that SBCE is not associated with an increased incidence of complications and that the visual results are good. Where indicated, and under strict surgical protocol, this procedure is safe.

Is Simultaneous Bilateral Extracapsular Cataract Extraction with Lens Implantation Justified?

We present the results of 40 cases of simultaneous bilateral extracapsular cataract extraction and lens implantation carried out under general anaesthesia by one surgeon over a 4-year period. We report the outcome of surgery and record that there were no complications attributable to carrying out surgery on both eyes at the same sitting. We discuss the advantages and possible disadvantages of simultaneous bilateral surgery and conclude that the procedure should be considered in certain cases.

Simultaneous Bilateral Cataract Extraction: ECCE versus ICCE

OBJECTIVE: To evaluate the differences in visual rehabilitation between intracapsular (ICCE) and extracapsular (ECCE) cataract surgery as well as the significance for visual performance of the position of an intraocular lens in the eye. STUDY DESIGN: Prospective study of simultaneously performed cataract extraction in both eyes, with evaluation at 3 days, 6 weeks, 3 and 6 months after surgery. PATIENTS: Ten adult patients severely visually handicapped from equally advanced cataract in both eyes had simultaneous cataract surgery performed under general anaesthesia with an ECCE with a posterior chamber lens (PCL) in one eye and an ICCE with an anterior chamber lens (ACL) in the other eye. MAIN OUTCOME MEASURES: Refraction and visual acuity (VA) were obtained unbiased by a trained nurse with an autorefractor and with the same instrument a value for contrast (CS) and glare (GS) sensitivity were obtained, expressed as the numerical drop in Snellen lines from the best visual acuity obtained at the same time. RESULTS: After 6 months all patients seemed to have benefited almost equally in both eyes (mean VA/ECCE 0.72 ± 0.15); and mean VA (ICCE 0.80 ± 0.16). No subjective differences in visual performance was noticed between the eyes except in one of the ECCE patients, who experienced the beginnings of opacification in the posterior capsule. There were no significant differences in either CS (ECCE: 2.7 ± 1.8 and ICCE: 3.4 ± 1.3; P = 0.37) or GS (ECCE): 4.4 ± 1.6 and ICCE: 5.2 ± 1.9; P = 0.21) after 6 months. There was no significant difference in intraocular pressure, and no corneal or retinal complication occurred in either group. CONCLUSION: When ICCE and ECCE have been compared, it has always been by retrospective study of different patients operated on by different surgeons, using different microsurgical techniques and with different observation periods. This study is a unique attempt to evaluate the two surgical techniques in a prospective manner. During an observation period of 6 months no differences occurred in visual rehabilitation between ECCE/PCL and ICCE/ACL, when these procedures were performed at the same time in a small number of patients having simultaneous bilateral cataract surgery.

Simultaneous Bilateral Intraocular Lens Implantation

A retrospective survey of 76 patients who had simultaneous bilateral cataract extraction with intraocular lens implantation between January 1987 and June 1990 is reported. Of these 76 patients six case notes were untraceable. Of the remaining 70 patients 49 were female and 21 were male with ages ranging from 50 to 93 (mean age 77; 63% over 80 years old). The indications, perioperative care and immediate postoperative care up to 6/52 are discussed.