Use of Simultaneous Bilateral Cataract Surgery (SBCS) to Optimize Parameters Affecting the Subjective Perception of the Procedure

Abstract

Introduction. Simultaneous Bilateral Cataract Surgery (SBCS) is still a relatively controversial procedure. The main objection is the risk of bilateral endophthalmitis or bilateral refractive error. However, SBCS has also some advantages (faster visual rehabilitation, lower risk of nosocomial infection, and lower cost). Performing surgery on both eyes in one session has one additional advantage which has not yet been described in the literature (according to the information available to authors). It allows surgeons to distinguish the effect of minor differences in the surgical protocol on the subjective perception of the procedure more accurately, which is a more suitable method than comparing two independent groups of patients. Purpose. To compare the effect of minor changes in the surgical protocol during SBCS on intraindividual subjective perception of surgery (pain, pressure, glare, and perception of the duration of the surgery). Methods. During the surgery of the right and left eyes of one patient, we randomly changed one surgical parameter (use of intracameral anesthesia, light intensity of the operating microscope, type of eyelid speculum, creation of the posterior circular capsulorhexis, and communication with the patient during surgery). Patients immediately after both surgeries subjectively evaluated the perception of pain (on the scale 0–10), pressure, and glare (on the scale 0–5) and estimated the duration of the surgery, separately for each eye. Each change was evaluated in a group of 50 patients. Results. In the control group with no parameters changed, we noted no difference in subjective perception of the first and second surgery. In subgroups, where we changed the protocol, we detected only minor differences in subjective perception of pain, pressure, glare, and duration of the surgery. Only one statistically significant difference in subjective pain perception was in the subgroup where we used eye intracameral anesthesia (0.34 eyes with intracameral anesthesia, 0.44 eyes with only topical anesthesia). We did not note any statistically significant differences in the perception of the time of surgery. Conclusion. SBCS can be used to optimize the parameters of cataract surgery. In our study, we noted a positive effect of intracameral anesthesia on subjective perception of surgery.

Contemporary Practices in Cataract Surgery- Subjective Preferences of Czech Cataract Surgeons

“…V rámci operačního dne 5 chirurgů standardně operuje více než 20 katarakt, 16 operuje 15-20 katarakt, 17 uvedlo 10-15 katarakt, 8 operuje 5-10 katarakt a 5 pak 1-5 katarakt. Řada kataraktových chirurgů běžně provádí také další typy očních operací -antiglaukomové (16 chirurgů), vitreoretinální (10), transplantace rohovky (11) refrakční laserové zákroky (15), refrakční nitrooční zákroky (23). Pouze 16 chirurgů uvedlo, že jiné operace neprovádějí.…”

“…Pravděpodobnou příčinou je relativní jednoduchost těchto postupů a nízké riziko komplikací. Práce, které srovnávají efektivitu topické a intrakamerální anestezie, nacházejí rozdíly jen relativně malé, ve prospěch intrakamerální, respektive kombinované anestezie [9,10].…”

Cytokines in aqueous humor of patients with congenital cataract during delayed sequential bilateral cataract surgery

“…Another advantage of ISBCS for children is the rapid visual rehabilitation [ 11 ] for both eyes to reduce amblyopia in the second eye. Bilateral cataract surgery needing general anesthesia is an indication of ISBCS [ 9 , 12 , 13 ]. However, due to the concern about the potential risk of severe bilateral endophthalmitis, ISBCS for cataract surgery in children is still needs to be treated with caution [ 10 ].…”