Underwent Phacoemulsification Surgery Research Articles

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.

Efficacy of Laryngeal Mask Airway Impregnation with Diltiazem Gel on Hemodynamic Changes in Patients with Hypertension Undergoing Phacoemulsification Surgery: A Randomized Clinical Trial

Background: Airway control problems are among the most prevalent causes of anesthesia-related mortality and morbidity. Some devices provide patients with adequate oxygen supply and ventilation during surgery by creating a safe airway in anesthetized patients. One of these devices is the laryngeal mask airway (LMA). The compression and painful stimuli following the LMA cuff inflation can lead to hemodynamic changes. Diltiazem gel is used in the control and treatment of hypertension (HTN) and heart arrhythmia and is absorbed through the tracheal mucosa. Objectives: By assuming that diltiazem gel is superior to other drugs used to prevent arrhythmias and hemodynamic changes during surgery, this study aimed to evaluate the effect of LMA impregnation with diltiazem gel, compared to lubricant gel. Methods: This study was conducted as a double-blind, randomized clinical trial on 80 participants with HTN who were candidates for phacoemulsification (phaco) surgery in Imam Khomeini Hospital, Kermanshah, Iran. The participants were assigned to an intervention (LMA impregnated with diltiazem gel) and a control group (LMA impregnated with lubricant gel) through the block random method in the form of 40 blocks of 2 using a random-numbers table. Hemodynamic changes (systolic and diastolic blood pressure and heart rate) were measured before, immediately after, 5 min, and 15 min after intubation, during surgery every 15 min, upon entering the recovery unit, and 15 and 30 min after entering the recovery unit. Results: The mean systolic and diastolic blood pressure in the intervention group showed a significant decrease, compared to that in the control group. A significant difference was also observed in the mean heart rate difference between the two study groups, but only at the beginning of the study (P&lt;0.05). Additionally, according to the results of repeated measures analysis of variance, the mean of the measured variables showed a significant difference at different measurement times in the intervention group (P&lt;0.05). Conclusion: The findings supported the effectiveness of diltiazem gel in reducing blood pressure, especially in the final stages of surgery, decreasing the number of premature ventricular contractions, and controlling normal breathing. Therefore, specialists and surgeons can use diltiazem gel to control the hemodynamic status of patients.

Hubungan Antara Tekanan Intraokular, Diabetes Mellitus, dan Hipertensi dengan Visus Setelah Operasi Fakoemulsifikasi

Introduction: The objective of this study is to determine whether there is a relationship between intraocular pressure (IOP), diabetes mellitus, and hypertension with visual acuity in senile cataract patients after phacoemulsification surgery. Methods: A retrospective cross-sectional study of senile cataract patients who underwent phacoemulsification surgery from 2019-2020 at Christian University of Indonesia General Hospital. Data were taken from medical records using purposive sampling, consist of visual acuity before and after phacoemulsification, visual acuity during 3 months of follow up, IOP before and after phacoemulsification, and the presence of systemic comorbidities such as hypertension and diabetes mellitus. Data were analyzed statistically with SPSS. Result: 122 eyes from 83 patients mostly had severe visual impairment before and a day after phacoemulsification, and improved to normal vision after a month and 3 months following phacoemulsification. The mean IOP was 18,36 mmHg and 21,33 mmHg before and after phacoemulsification. There were 78 patients who had systemic comorbidities such as hypertension and diabetes mellitus. There was no significant correlation between IOP and hypertension with visual acuity after phacoemulsification (p&gt;0,005). Meanwhile, significant correlation was found between diabetes mellitus with visual acuity a day and a month after phacoemulsification (p&lt;0,005). Conclusion: Diabetes mellitus has a significant relationship with visual acuity a day and a month after phacoemulsification surgery.

Visual Outcome and Complications in White Mature Cataracts after Phacoemulsification.

To identify risk factors and perioperative complications and assess postoperative visual outcome in patients of white mature cataracts undergoing phacoemulsification surgery. This cross-sectional study was conducted on 46 patients of white mature cataract undergoing phacoemulsification. Preoperatively, a detailed ocular examination was done, and anterior chamber depth (ACD) and lens thickness (LT) were measured on ultrasound biomicroscopy. Intraoperative and postoperative complications (on days 1, 7, and 30) and best-corrected visual acuity on postoperative day 30 were noted. The mean age of patients was 60.78 ± 9.001 years. The study group consisted of 41.3% of males and 58.7% of females. 8 (19.56%) cases encountered complications during phacoemulsification surgery. The intraoperative complications were capsulorhexis-related in 5 (10.86%) patients, posterior capsular rent in 2 (4.3%) patients, and 1 (2.17%) case had zonular dialysis. There was no difference in mean ACD and LT in cases who developed complications and those who underwent uneventful surgery (P > 0.05). The commonly observed postoperative complications on day 1 were corneal edema (41.3%), anterior chamber flare (45.65%), and cells (39.13%) which resolved with routine topical medications. All patients showed a significant reduction in postoperative intraocular pressure (P < 0.001). A total of 37 (80.43%) eyes regained vision between 6/6 and 6/9 postoperatively (P < 0.001). Phacoemulsification surgery is safe in white mature cataract that results in significant visual improvement. Common intraoperative complications are capsule related, while frequently encountered postoperative complications are corneal edema and anterior chamber reaction. Preoperative ACD and LT have no role in predicting intraoperative complications.

The Pattern of Intraocular Pressure After Phacoemulsification Surgery In Senile Cataract

Phacoemulsification is a surgical procedure for cataracts, which can increase intraocular pressure (IOP) and cause blindness due to glaucoma. It was known that the pattern of IOP changes after phacoemulsification surgery in senile cataracts. This study was an observational analytic study without a control group design. The study population was male and female senile cataract patients over 40 years of age who underwent phacoemulsification surgery at Kebumen Eye Centre Clinic in 2020. Intraocular pressure measurements using a Noncontact Tonometry by a nurse were carried out before surgery (D-0) and postoperatively on day 2 (D-2), day 9 (D-9), day 16 (D-16), and day- 23 (D-23). The data were analyzed using the Friedman test followed by the Post Hoc LSD test. The Friedman test results showed significant differences (p 0.05) in the IOP measurement at D-0, D-2, D-9, D-16, and D-23. Wilcoxon post hoc test showed IOP measurements on D-2 increased and then decreased normally. There was a change in the IOP pattern after phacoemulsification surgery, in which the IOP increased significantly on D-2 and then decreased normally.

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.

Factors Influencing Visual Improvement after Phacoemulsification Surgery among Malaysian Cataract Patients.

Blindness and visual impairment are part of the global burden of eye disease, with cataract being one of the leading causes of blindness. This study aimed to determine the factors affecting visual acuity (VA) improvement among cataract patients after phacoemulsification surgery in Malaysia. Cataract patients aged over 18 who underwent phacoemulsification surgery between January 2014 and December 2018 were included in this retrospective cohort study. Patients’ sociodemographic, comorbidities, surgical, and related complication factors were extracted from the National Eye Database. The outcome was measured by the difference in visual acuity before and after the operation and was categorized as “improved”, “no change”, and “worse”. A total of 180,776 patients were included in the final analysis. Multinomial logistic regression analysis showed “no changes in VA” was significantly higher in patients aged less than 40 years old (OR: 1.66; 95% CI: 1.22, 2.26), patients with ocular comorbidities (OR: 1.65; 95% CI: 1.53, 1.77), patients who had undergone surgery lasting more than 60 min (OR: 1.39; 95% CI: 1.14, 1.69), patients who had surgery without an intraocular lens (IOL) (OR: 1.64; 95% CI: 1.20, 2.26), and patients with postoperative complications (OR: 8.76; 95% CI: 8.13, 9.45). Worsening VA was significantly higher among male patients (OR: 1.11; 95% CI: 1.01, 1.22), patients who had ocular comorbidities (OR: 1.76; 95% CI: 1.59, 1.96), patients who had undergone surgery lasting more than 60 min (OR: 1.94; 95% CI: 1.57, 2.41), patients who had surgery without an IOL (OR: 2.03; 95% CI: 1.48, 2.80), and patients with postoperative complications (OR: 21.46; 95% CI: 19.35, 23.80). The factors impacting “no changes” in and “worsening” of VA after cataract surgery were the following: older age, male gender, ethnicity, ocular comorbidities, surgeon grade, absence of IOL, intraoperative complication, and postoperative problems.

Changes in Corneal Astigmatism after Closing Clear Corneal Incision by Simple Hydration Undergoing Phacoemulsification at the Department of Ophthalmology JPMC

Purpose: To determine the mean changes of corneal astigmatism after closing clear corneal incision by simple hydration undergoing phacoemulsification in the eye department of a tertiary care hospital. Methodology: This was a Quasi experimental study conducted at the department of Ophthalmology, Jinnah Postgraduate Medical Center, Karachi, from 30th October 2020 to 29th April 2021. Total 100 patients who underwent phacoemulsification surgery for cataract were included. Changes of astigmatism were measured with Auto-refractometer. Fundus examination was done using +90D lens with a slit lamp. Mean changes in corneal astigmatism were calculated. Pre and post operatively change in astigmatism was compared using paired t-test. Stratification was done. P value ≤0.05 was considered as statistically significant. Results: Mean age was 43.47±11.13 years. There were 54% male and 46% female patients. Mean change of corneal astigmatism was 0.23±0.44 diopter. Mean corneal astigmatism, preoperatively, after 1 week and after 1 month were 1.05±0.05 diopter, 0.69±0.34 diopter and 1.28±0.44 diopter respectively. Highly significant mean difference of corneal astigmatism was observed between preoperatively and after 1 week, preoperatively and after 1 month and also observed between 1 week and 1 month. Conclusion: Closing clear corneal incision by simple hydration undergoing phacoemulsification was found an effective technique for treatment of corneal astigmatism. Keywords: Mean Changes, Corneal Astigmatism, Closing Clear Corneal Incision, Simple Hydration, Phacoemulsification

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.].

Eye-Related Factors That Can Be Associated With the Plane of Phacoemulsification.

Purpose: To evaluate the effect of eye-related factors such as biometric and surgical parameters, nuclear sclerosis (NS) grade, and pupil and capsulorhexis diameters on the plane of phacoemulsification (PP).Material and Methods: This prospective study included 328 eyes of 328 patients who underwent phacoemulsification surgery. The phaco-chop technique was performed in all patients and changes in PP that occurred during surgery were recorded. Patients were grouped as follows: Group 1, > 75% of lens nucleus emulsified in the capsular bag; Group 2, > 75% of lens nucleus emulsified at the pupillary plane; and Group 3, > 50% of lens nucleus emulsified in the anterior chamber. The association between PP and eye-related factors was evaluated.Results: There were 153 patients (46.7 %) in Group 1, 104 patients (31.7 %) in Group 2 and 71 patients (21.6 %) in Group 3. The factors associated with PP were anterior chamber depth (ACD) (p = 0.020) and NS grade (p = 0.028). No significant relationship was detected between PP and age, surgical parameters or other biometric values. Moreover, PP was found to be more anterior in patients with soft cataracts and deeper ACD values (p values were 0.002 and 0.036, respectively).Conclusion: The present study has reported that PP may move to more anterior, as softer cataracts may increase the fear of posterior capsule rent. Moreover, PP may move to more posterior due to shallow anterior chambers or high-grade cataracts that could potentially increase the fear of endothelial injury.

Effect of surgical abstinence on the risk for posterior capsule rupture during cataract surgery

To evaluate the impact of surgery restrictions on cataract surgery performance. Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom. Retrospective, observational cross-sectional study. A single-center, retrospective review of all patients who underwent phacoemulsification surgery at Moorfields Eye Hospital between September 2019 and January 2021 was conducted. The main outcome measure was posterior capsule rupture (PCR) rate before and after COVID-19-imposed restrictions to elective cataract surgery. A total of 15 688 surgeries were performed by 256 different surgeons in the study period. In the prerestriction period (September 2019 to March 2020), the PCR rate was 0.99%, whereas in the 19-week postrestriction period, the PCR rate spiked to 1.62% (odds ratio 1.65; P = .001; CI 1.24 to 2.20; relative risk: 1.64). The COVID-19 pandemic provided a unique opportunity to assess a large group of surgeons' performances after prolonged surgical abstinence. A 19-week restriction period in surgical activity showed an increased incidence of PCR complications. This is relevant because it can concern any surgeon on the extended time off from work such as sick, sabbatical, research, and parental leave. Supporting strategies should be implemented by associated regulators to minimize this negative impact.

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.

The impact of phacoemulsification surgery on vision-related quality of life in senile cataract patients.

Background:Phacoemulsification surgery may have beneficial effects on the quality of life of patients with senile cataract. These effects can be evaluated with the help of questionnaires and tests.Purpose:To evaluate the effect of the phacoemulsification surgery on the vision-related quality of life (VR-QOL) in patients with senile cataract using the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and functional independence measure (FIM) tests.Methods:The data collection was prospective. NEI-VFQ-25 and FIM tests were measured by a masked ergo-therapist. The patients who underwent phacoemulsification surgery were included in this study. Mean best-corrected visual acuity (BCVA), NEI-VFQ-25 and FIM scores were compared in the preoperative period and at least 3 months after the surgery according to demographic properties including gender, age, education status, as well as the BCVA level and laterality.Results:Preoperative mean BCVA and NEI-VFQ-25 composite scores improved significantly (p < 0.001 and p = 0.001, respectively). All NEI-VFQ-25 subscale scores except the general health (p = 0.235) and driving (p = 0.226) showed a significant postoperative increase. The postoperative NEI-VFQ-25 composite scores showed a significant increase in all subgroup analyses (p < 0.05 for all). Patients with poorer BCVA, bilateral surgery, and low education status had lower preoperative NEI-VFQ-25 composite scores than the patients with better BCVA, unilateral surgery, and high education status (p = 0.026, p = 0.016, and p = 0.032, respectively). All FIM scores were similar in the preoperative and postoperative periods regardless of subgroup analyses (p > 0.05 for all).Conclusion:Phacoemulsification surgery can provide a satisfying improvement in VR-QOL in patients with cataracts. As a valid and reliable test, the NEI-VFQ-25 scale can be used to measure the visual function after the ocular surgeries.

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.

Clinical profile, visual outcome and root cause analysis of post-operative cluster endophthalmitis due to Burkholderia cepacia complex.

Purpose:To present varied clinical presentations, surveillance reports, and final visual outcomes of a rare outbreak of cluster endophthalmitis caused by gram-negative, opportunistic bacilli, Burkholderia cepacia complex (Bcc).Methods:Details of five patients who developed postoperative cluster endophthalmitis were collected. For each patient, an undiluted vitreous sample was collected during vitreous tap. Bacterial culture from the vitreous sample in each case had grown Bcc. Surveillance investigations for root cause analysis (RCA) were performed in the operating room (OR), admission, and day-care wards to localize the source.Results:Four patients had undergone phacoemulsification surgery, and one patient had undergone penetrating keratoplasty. Each patient received an initial dose of empiric intravitreal ceftazidime and vancomycin. The organism isolated in each case was sensitive to ceftazidime, cotrimoxazole, and meropenem and resistant to other antibiotics. Core vitrectomy was done after 48–60 hours in four patients along with intravitreal imipenem injection. One patient did not provide consent for core vitrectomy and subsequently developed phthisis bulbi. Three patients had subsequent recurrences. Two patients had a final BCVA of 20/60, two had BCVA better than 20/200, while one patient had no perception of light. None of the surveillance samples from the OR complex could isolate Burkholderia.Conclusion:Extensive OR surveillance should be done to identify the potential source of infection. However, the source may not be identifiable in few instances like in our case. Longer follow-up is recommended in cases of Bcc endophthalmitis due to the persistent nature of the infection.

A double-blinded randomized clinical trial for pain perception: The efficacy and safety of topical cold saline solution anesthesia in phacoemulsification.

Purpose:To compare the efficacy and safety of cold saline solution (0.9% NaCl) with topical ophthalmic proparacaine for maintaining topical anesthesia of patients undergoing phacoemulsification surgery.Methods:The prospective, double-blinded, and randomized clinical study was randomly assigned to two groups that underwent phacoemulsification surgery due to cataracts. The cold saline group included 86 eyes of 86 patients with topical anesthesia of cold saline solution alone. The proparacaine group included 84 eyes of 84 patients with topical ophthalmic proparacaine (room temperature) anesthesia alone. The patients were scored according to a pain survey questionnaire of Visual Analog Scale (VAS) ranked between 0 and 10. The surgeon scored surgical experience by a Surgeon Questionnaire Scale (SQS) in three parameters, each of which was ranked from 1 to 3 based on questions regarding ease and comfort during the surgery.Results:The mean VAS scores were 1.29 ± 0.65 and 1.22 ± 0.66 for the cold saline and proparacaine groups, respectively (P = 0.182). The mean scores of SQS (lower values represented favorable results) were 4.11 ± 0.76 and 3.97 ± 0.74 in the cold saline and proparacaine groups, respectively (P = 0.163). Ten patients in the proparacaine group experienced corneal epitheliopathy in the postoperative period.Conclusion:As an easily accessible and cost-effective method, cold saline solution alone might be an alternative to topical ophthalmic proparacaine alone with comparable safe and effective results. The absence of allergic or toxic effects also provided a significant advantage in the cold saline application.

Do Consecutive Phacoemulsification Surgeries Under Topical Anesthesia Differ in Terms of Pain Perception and Cooperation?

BackgroundAlthough intraoperative ocular pain has been investigated extensively in the literature, few studies have evaluated the pain perception between consecutive surgeries. Determining the facts about pain perception during phacoemulsification will allow surgeons to decide the type of anesthesia that best fits the patient when planning the contralateral cataract surgery. The aim of this study was to determine the level of pain perception, factors affecting pain perception, level of patient cooperation, and perception of operation time during consecutive phacoemulsification surgeries.MethodologyThis study included 314 eyes of 157 patients with bilateral senile cataracts who underwent phacoemulsification surgery under topical anesthesia with an interval of no more than six months. All patients underwent complete ophthalmic examination. Operation time, phaco time, surgeon’s comfort, and patient’s cooperation were recorded. Immediately after the operation, the patients graded the pain they experienced via the Visual Analogue Scale (VAS) from 0 to 10 and estimated the operation time.ResultsThe mean VAS score was 0.88 ± 0.97 for the first eye and 1.50 ± 1.27 for the second eye (p < 0.011) surgery. The perception of the mean operation time was significantly lower in the first eye surgery (p < 0.001), even though the real objective operation time and phaco time were lower in the second eye surgery. The surgeon reported significantly more comfort during the first eye surgery. VAS was found to be positively correlated with nonsteroidal anti-inflammatory drug use, intraocular pressure, axial length, anterior chamber depth, central corneal thickness, phaco time, and operation time perception, and inversely correlated with best-corrected visual acuity and mature cataract morphology.ConclusionsConsecutive phacoemulsification surgeries appear to differ not only in terms of pain perception but also operation time perception, patient cooperation, and surgeons’ comfort. Determining and controlling the factors that can influence patients’ pain perception and comfort will increase the safety of the contralateral surgery.

Impact of Music on the Vitals in Patients Undergoing Cataract Extraction Surgery

Background: Music is an inexpensive, easily available anxietolytic known to mankind since ages. Cataract extraction surgery is one of the widely performed surgeries under local anesthesia. India is a developing country where limited resources are spent over health infrastructure which has to cater to a large population. In our study, we have tried to utilize the anxietolytic effect of music in combating the anxiety and stress patients suffer from during surgery to essentially better the postoperative prognosis of the patients in the most inexpensive way possible. Materials and Methods: The sample size was decided taking into consideration various prevalence studies. The patients were consequently recruited for the study considering the inclusion and exclusion criteria. Patients were divided into two groups – both undergoing phacoemulsification surgery under local anesthesia by the same surgeon in the same operating room where one group was made to listen to "Classical Sitar Music," whereas the other group was not made to listen to music. Blood pressure and heart rates were measured before and after surgery and compared in all patients. Results: Blood pressure and heart rates were statistically significantly normalized (lowered) postoperatively as compared to their preoperative values in the group which were made to listen to music. Conclusion: Music can be used widely used in decreasing anxiety levels in patients undergoing cataract extraction surgery, thereby improving the postoperative prognosis in patients in a cost-effective way.

Correlation between keratometry and corneal incision before and after phaco surgery.

Cataract is a common cause of vision loss and blindness in humans. After surgical management of cataract, all efforts should be focused on reducing postoperative astigmatism thus providing an excellent vision to patients. To determine the relationship between corneal incision and refraction changes before and after phacoemulsification surgery in 300 patients undergoing cataract surgery in Khatam hospital in Mashhad, Iran from January 2017 to April 2018. Three hundred patients (144 women and 156 men) with cataract undergoing phacoemulsification surgery were recruited in this cross-sectional study. Refraction, keratometry and visual acuity measurement were performed before surgery. Then, a steep-based incision in the cornea was made without stitches. A 3.2 mm corneal incision was made at two supratemporal and temporal sites. The patients were followed-up for one and six months, and one year after surgery monitoring their vision and refraction, and performing keratometric measurements. The mean age of the patients was 65.7±9.54 years (age range, 42-84 years). No major complications were observed. The greatest mean of changes in corneal power was in the supratemporal incision (1.28±0.6). Keratometry had a significant relation with the incision (p.