Abstract
Purpose: :
To quantitatively evaluate and compare the effect of oral propanolol 10mg and sublingual timolol maleate 0.5% on hand tremor and its effect on surgical performance assessed while performing the anti-tremor level 3 training module of the EYESi surgical simulator (Mannheim,Germany,VRmagic)
Methods: :
A randomized, single masked study was performed at Hospital Nuestra Senora de la Luz, Mexico. 19 ophthalmology residents (PGY2 to 4) volunteered for the study. Residents were tested on 4 separate days. On each day subjects injested 10 mg of propranolol, 1 sublingual drop of timolol maleate 0.5%, placebo or 1 sublingual drop of sodium hyaluronate 30 minutes prior to performing the anti-tremor level 3 training modules. Scores were recorded with the standarized software of the simulator. Two variables were evaluate: avarage tremor and out of tolerance percentage.The means of both variables were calculated for the two groups. A T-test was used to compare each group against placebo.
Results: :
There was a significant effect of propranolol in reducing surgical tremor (p=0.02). Statistically significant difference was not observed with timolol (p=0.9). Comparing the two beta-adrenergic receptor blocking agents, propranolol achieved significantly better tremor scores (p=0.004). The out of tolerance percentage was also lower with propranolol however the difference was not statistically significant (p=0.35)
Conclusions: :
Oral propanolol taken 30 min before surgery may reduce hand tremor of the surgeon. Further investigation of this possible beneficial effect on surgical performance is warranted.
Keywords: training/teaching cataract surgery • cataract • vision and action