Topical-intracameral anesthesia in manual small incision cataract surgery: A pilot study in a Tertiary Eye Care Center in Africa

Uche, NJ; Okoye, Obiekwe; Arinze, Obinna C; Okoloagu, NN

doi:10.4103/1119-3077.175972

Cited by 4 publications

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“… 4 Since MSICS involves increased handling of tissues such as conjunctiva and sclera, and potentially increased iris touch in comparison to phacoemulsification, peribulbar anesthesia has remained the most common mode of anesthesia for the procedure. 5 9 10 This is even though multiple authors and reviews have shown the effectiveness and relative painlessness of STA. 9 14 15 16 27 This could be because STA is still not commonly performed in many training centers and involves the learning of a slightly different and newer method of administering anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Topical anesthesia is the most common method of anesthesia for phacoemulsification cataract surgery. 1 2 3 For manual small incision cataract surgery (MSICS), which is a worthy alternative to phacoemulsification and has been endorsed not just as the most appropriate technique in developing countries 4 5 6 7 but also advocated for inclusion in the surgical curriculum in the Western world, 8 peribulbar anesthesia remains the norm in the majority of cases. 5 9 10 Peribulbar anesthesia is a relatively blind and invasive technique with potentially dangerous side effects such as globe perforation, orbital hemorrhage, and brainstem anesthesia.…”

Section: Introductionmentioning

confidence: 99%

“… 1 2 3 For manual small incision cataract surgery (MSICS), which is a worthy alternative to phacoemulsification and has been endorsed not just as the most appropriate technique in developing countries 4 5 6 7 but also advocated for inclusion in the surgical curriculum in the Western world, 8 peribulbar anesthesia remains the norm in the majority of cases. 5 9 10 Peribulbar anesthesia is a relatively blind and invasive technique with potentially dangerous side effects such as globe perforation, orbital hemorrhage, and brainstem anesthesia. 11 12 13 Sub-tenon's anesthesia (STA), less invasive than peribulbar, has been found to be as safe and effective as peribulbar anesthesia and is more comfortable to the patient at the time of administration.…”

Section: Introductionmentioning

confidence: 99%

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Anterior Subconjunctival Anesthesia for Manual Small Incision Cataract Surgery

Ajay¹,

Subhasree

Poka

2021

Journal of Current Ophthalmology

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Purpose: To compare the effectiveness of anterior subconjunctival anesthesia (ASCA) with sub-tenon's anesthesia (STA) for manual small incision cataract surgery (MSICS), regarding pain, akinesia, surgeon comfort, and complications. Methods: This trial randomized 164 patients into two groups. Group 1 received ASCA, and Group 2 received STA. MSICS was performed on all patients. Any complications of anesthesia were noted before starting surgery. Patient ocular motility during surgery was scored between 0 and 4 based on the number of directions of gaze in which movement persisted. Following surgery, patients scored pain felt during surgery on a visual pain-score analog, and the surgeon graded for “discomfort” felt during surgery from 0 (Nil) to 4 (additional anesthesia needed). Results: Chemosis due to anesthesia and persistence of ocular motility in all four gaze directions were seen in all 82 patients of Group 1, but these did not prevent the surgeon from performing MSICS. Seventy-seven patients (94%) in Group 1 and 79 (96.4%) in Group 2 had no or mild pain during surgery. The surgeon had moderate-to-severe discomfort in 14 (17.2%) Group 1 patients and 3 (3.6%) Group 2 patients, most of whom had deep-set eyes or exhibited excessive eye movements. Two patients in Group 1 and one patient in Group 2 were converted to peribulbar block. Conclusion: ASCA is a safe and effective alternative for performing MSICS. It does not induce akinesia but provides adequate anesthesia for the surgery in most patients, except those with deep-set eyes, especially if displaying increased anxiety.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anterior Subconjunctival Anesthesia for Manual Small Incision Cataract Surgery

Ajay¹,

Subhasree

Poka

2021

Journal of Current Ophthalmology

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“…Subtenon was superior to intravenous Fentanyl for perioperative anaesthesia in infants undergoing cataract surgery measured by cries pain score [33] . In a hospital based case series study to evaluate the efficacy and safety profile of the use of aqueous topical/intracameral anesthesia in manual small incision cataract surgery, Uche et al [34] reported that the mean pain score in this study was low, there was no correlation between perception of pain with gender or age and surgeons experience was excellent in most of the cases.…”

Section: Comparison Of Pain Scorementioning

confidence: 99%

Local Anaesthesia in Cataract Surgery

Reddy

Thevi

2017

International Journal of Ophthalmic Research

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nerves of the cornea and the conjunctiva (long and short ciliary nerves, nasociliary nerves). This technique eliminates the possible complications of injectable anesthesia. However, it does not eliminate pain sensitivity of the iris, the zonule, and the ciliary body which is achieved by intracameral technique of anesthesia with preservative free 1% lidocaine. In a constantly evolving arena, the sub-Tenon's block has gained popularity while the deep angulated intraconal (retrobulbar) block has been largely superseded by the shallower extraconal (peribulbar) approach. Hyaluronidase is a useful adjuvant because it promotes local anesthetic diffusion and hastens block onset time but there is a possibility of getting an allergic reaction. Ultrasound-guided eye blocks afford real-time visualization of needle position and local anesthetic spread. An advantage of sonic guidance is that it may eliminate the hazard of globe perforation by identifying abnormal anatomy, such as staphyloma. INTRODUCTIONThe ideal anaesthesia would be one that provides adequate pain relief during surgery and postoepratively, be easy to administer and have minimal complications. For doing cataract surgery, the anaesthesia could be local or general. Majority of cataract patients are operated under local anaesthesia (infiltration, topical, intracameral). The infiltration anaesthesia is given as retrobulbar or peribulbar or subTenon's block. Carl Koller first used cocaine as a topical anaesthetic for eye surgery in 1884 [1] . The general anaesthesia has its own complications in elderly cataract patients and most of them may have diabetes or hypertension or heart diseases or combination of them. No need of fasting before or after surgery, no need of intubation, no need of using any systemic medications are the advantages of local anaesthesia. However, cataract in children, patients with parkinsonism, deaf mute patients, mental retardation patients, patients ABSTRACTThere has been a significant evolution in surgical technique of cataract extraction. The technical advances in phaco machines, phacotips, and availability of ophthalmic viscoelastic devices have played a great role in cataract surgery to be faster and more controlled now than before. Similarly, local anesthesia techniques in cataract surgery have also advanced significantly from retrobulbar, peribulbar, sub-Tenon's, to topical anaesthesia. Even though, the sub-Tenon's anesthesia technique reduced the risk of complications of peribulbar/ retrobulbar anesthesia but the technique is still associated with a possibility of damage to optic nerve, retrobulbar hemorrhage, and ocular muscle injury. Topical anesthesia is used to block the afferent EDITORIAL

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Complications of manual small-incision cataract surgery

Goel

Shah

Malik

et al. 2022

Indian Journal of Ophthalmology

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The manual small-incision cataract surgery (MSICS) is instrumental in tackling cataract-induced blindness in developing countries, especially with a sizeable proportion being hard brunescent cataracts. MSICS has a unique set of complications related to wound construction, the creation of the capsular opening, and the technique of nuclear delivery. A poorly constructed sclero-corneal tunnel or a small capsulorhexis hampers the nuclear extraction, and the extensive intracameral maneuvers increase the chances of postoperative corneal edema and iritis. Though MSICS has been shown to have universal applicability, producing replicable visual outcomes requires a significant learning curve. This article reviews the relevant published literature on complications of MSICS utilizing the databases of PubMed, Medline, Cochrane, and Google Scholar.

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Topical-intracameral anesthesia in manual small incision cataract surgery: A pilot study in a Tertiary Eye Care Center in Africa

Abstract: The mean pain score in this study is low. There is no correlation between perception of pain with gender or age. Surgeons experience is excellent in most of the cases. This method of anesthesia in MSCIS is adequate for patient's comfort and safe cataract surgery.

Cited by 4 publications

References 30 publications

Anterior Subconjunctival Anesthesia for Manual Small Incision Cataract Surgery

Anterior Subconjunctival Anesthesia for Manual Small Incision Cataract Surgery

Local Anaesthesia in Cataract Surgery

Complications of manual small-incision cataract surgery

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