systematic use of topical anaesthesia in cataract surgery: dream or reality? A study about 300 consecutive cases.

Abstract

Abstract: : Purpose: To evaluate patients intraoperative pain and management of the surgery. 300 consecutive cataract cases eligible for cataract surgery were operated by the same surgeon during a period of 3 months. Methods: All patients underwent clear corneal phacoemulsification and implantation of a foldable intraocular lens. Topical anesthesia consisted in the administration of: 2 oxybuprocaine hydrochloride 0.4% preserved eyedrops 10 mn before surgery, and 2 tetracaine 1% unpreserved eyedrops a few seconds before corneal incision. A 3/0 silk was passed through the superior rectus muscle and fixed to the operatory field so as to adjust eye position and limit its movements. The intraoperative conditions were judged by the surgeon and a visual analog scale was used before and immediately after surgery to assess patients severity of intraoperative pain. Their discomfort was reassess the same day, about 3 hours after surgery, just before their leaving of the hospital. Results: The mean age of the patients was 75.3 years old (from 45 to 91 years), the sex ratio was 0.46 with 68% of women, and the comorbidity rate was 21% for diabete and 62% for high blood pressure. Topical anesthesia only, could be used in 97% of the cases, and only 9 patients needed an additional peribulbar anaesthesia. Intravenous sedation was administrated in 10.5% of thr cases (31 patients). Cataract surgery was performed in approximately 12.4 mn, and complications rate was only 2 %. 204 patients (68%) reported minimal discomfort (a maximum score of 2/10) or no pain at all. The mean pain score was 0.17+/–0.88, 1.82+/–1.87 and 0.16+/–0.68 respectively before, during and after the surgery. Conclusions: Topical anaesthesia can be proposed for nearly all the patients undergoing cataract surgery apart from the ones suffering from diseases limiting their cooperation. It appeared to be an inexpensive, safety and simply mean to manage cataract surgery with minimallizing discomfort for the patient in experimented hands.

Keywords: cataract • small incision cataract surgery • clinical (human) or epidemiologic studies: systems/equipment/techniques