Visual perception during phacoemulsification cataract surgery under subtenons anaesthesia

Wickremasinghe, Sanj; Tranos, Paris; Sinclair, Neil; Andreou, Petros; Harris, M. L.; Little, Brian

doi:10.1038/sj.eye.6700414

Cited by 45 publications

(34 citation statements)

References 10 publications

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“…Patient preference, however, is more complex than just these component parts. Other factors contribute to a greater or lesser extent, including aspects such as variation from preconceptions of the process, awareness during surgery and intra-operative visual perception [7]. Patient satisfaction is an important marker of quality of care but a difficult outcome to measure.…”

Section: Discussionmentioning

confidence: 99%

A comparison of sub‐Tenon’s with peribulbar anaesthesia in patients undergoing sequential bilateral cataract surgery

Budd

Brown²,

Thomas

et al. 2008

Anaesthesia

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SummaryThe aim of this study was to compare efficacy and particularly patient preference of sub-Tenon's anaesthesia with peribulbar anaesthesia in patients undergoing sequential, bilateral, cataract surgery. Fifty patients were randomised to either sub-Tenon's or peribulbar anaesthesia for their first operation and the alternative technique for their subsequent operation. Intra-ocular pressure was measured, globe and lid akinesia were scored, patients completed a visual rating score of injection and operative pain and their preference for anaesthesia was assessed. Intra-ocular pressure rose significantly following peribulbar injection (p = 0.02) but was comparable at 5 min. There was no significant difference in lid or globe movement. Injection and operative pain scores were low and comparable. Both methods provided similar anaesthesia and akinesia. The majority (86%) chose the method they received first irrespective of whether it was sub-Tenon's or peribulbar, but 10% of patients preferred sub-Tenon's, disliking the facial numbness from peribulbar anaesthesia. With the evolution of small incision phaco-emulsification for cataract surgery, there has been a changing trend in the anaesthesia performed. The anaesthetic technique must produce optimal surgical conditions, providing good anaesthesia for the patient in a safe manner. As a result, sub-Tenon's anaesthesia, using a blunt cannula, has gained increasing popularity. In a survey of current practice in the UK in 2003, it comprised 42.6% of the anaesthetics performed for cataract surgery [1]; peribulbar accounted for 30.6%. Sharp needle techniques are associated with risks such as inadvertent globe perforation, retrobulbar haemorrhage or direct injection into the optic nerve. Sub-Tenon's anaesthesia does not expose patients to these sight threatening consequences. A further possible consequence of sharp needle techniques is injection into the dural sheath leading to unconsciousness and cardiovascular compromise from local anaesthetic effect on the brainstem. These are rare but serious complications. Studies comparing sub-Tenon's with peribulbar anaesthesia in different patient groups have shown it to be at least as effective in terms of anaesthesia and provision of surgical conditions and have demonstrated that it has a more favourable safety profile [2][3][4][5]. There is, however, little available evidence on patients' preferences and perspectives for type of anaesthesia. The aim of this study was to compare the two methods of anaesthesia in patients having bilateral cataract surgery and to ascertain whether patients preferred one method of anaesthesia over the other as the primary outcome. MethodsLocal Research Ethics Committee approval and individual patient consent were obtained. Fifty patients undergoing sequential bilateral cataract surgery were randomly allocated to have either sub-Tenon's anaesthesia for their first operation and peribulbar anaesthesia for their second operation, or the reverse of this. All patients were monitored with pulse oximetry a...

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Section: Discussionmentioning

confidence: 99%

A comparison of sub‐Tenon’s with peribulbar anaesthesia in patients undergoing sequential bilateral cataract surgery

Budd

Brown²,

Thomas

et al. 2008

Anaesthesia

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“…Wickremasinghe SS et al found that although not statistically signifi cant, younger subjects (<65 years) tend to fi nd the visual experience more frightening than those over 80 years (35.7 versus 21.4%) 15 .…”

Section: Discussionmentioning

confidence: 97%

Intraoperative visual experience and preoperative counselling during phacoemulsification under topical anaesthesia

Shakya

Pandey

Pokhrel

et al. 2016

J. Kathmandu Med. Coll.

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Background: Phacoemulsifi cation surgery using topical anaesthesia makes patient experience a multitude of visual sensations. However, it makes cataract surgery safe with the quickest visual recovery. Objective: To fi nd the effect of preoperative counselling about potential intraoperative visual experience during phacoemulsifi cation under topical anaesthesia to alleviate fear in patients having cataract surgery. Methods: This non-randomized and non comparative study was carried out in a tertiary care hospital from February 2015 to April 2015. Forty fi ve adult patients underwent cataract surgery (phacoemulsifi cation with foldable intraocular lens implantation) under topical anaesthesia using Proparacaine hydrochloride 0.5 % eye drops by a single surgeon. All patients received counselling on the potential intraoperative visual experience during phacoemulsifi cation. A structured questionnaire was used to collect data on socio-demographics, pain, intraoperative visual experiences and their fear. Participants were asked if they experienced visual sensations such as light perception, gush of water and movements during surgery. Results: Nineteen (42.2%) of them were men and 26 (57.8%) were women. Sixty nine percent of the patients were above 60 years. All of them reported having experienced visual sensations during surgery, the most common being light perception (100%), movements of instruments or surgeon's hands (91.1%) and gush of water (62.2%). One case (4.4%) felt tolerable pain associated with fear (P=0.000) due to these visual experience. Conclusion: Preoperative counselling about the potential intraoperative visual experience during phacoemulsifi cation under topical anaesthesia alleviates the visual experience fear in patients having cataract surgery.

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“…[10][11][12][13][14][15][16][17] We report that flashing lights and floaters are commonly experienced by patients immediately following an IVT injection, and that flashes are experienced by almost two-thirds of patients within the first 2 weeks following the procedure. Preinjection VA, clinical indication for the IVT injection, and the nature of the pharmacological agent injected did not influence the visual experiences of patients, although the authors concede that subgroups analysis was limited because of its small size.…”

Section: Discussionmentioning

confidence: 99%

“…3 Indeed, some authors are even using IVT therapeutic agents for relatively rare disorders, such as central serous chorioretinopathy. 3 Patients' visual perceptions and experiences induced by frequently performed ophthalmic surgical procedures, such as cataract surgery (under topical [10][11][12][13][14][15] and regional anesthesia [11][12][13][14]16,17 ), glaucoma filtration surgery, 18 and vitreoretinal surgery, [19][20][21][22] are well documented. Indeed, the beneficial effect of preoperative counseling with respect to known and anticipated visual experiences during phacoemulsification cataract surgery, under topical anesthesia, in terms of reducing patients' fear, has been described.…”

Section: Introductionmentioning

confidence: 99%

Visual perceptions induced by intravitreous injections of therapeutic agents

Charalampidou¹,

Nolan

Ormonde³

et al. 2011

Eye

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Purpose The purpose of this study was to conduct a questionnaire-based survey of subjective visual perceptions induced by intravitreous (IVT) injections of therapeutic agents. Patients and methods Patients undergoing an IVT injection of ranibizumab, pegaptanib sodium, or triamcinolone acetonide were administered a questionnaire in the immediate post-injection period and at 2 weeks of follow-up. Results In the immediate post-injection period (75 IVT injections, 75 eyes, 75 patients), lights and floaters were reported after 20 (27%) and 24 (32%) IVT injections, respectively. In comparison, at the 2-week follow-up, the incidence of reported lights (11; 15%) was similar (P40.05), but the incidence of reported floaters was higher (48; 64%; P ¼ 0.00). Subgroup analysis for various injection subgroups (no previous injection vs previous injection(s) in the study eye; injections in study eyes with good VA (logarithm of minimal angle of resolution [logMAR] r0.3) vs moderate VA (0.7 ologMAR40.3) vs poor VA (logMAR Z0.7); injections according to pharmacological agent (ranibizumab vs pegaptanib vs triamcinolone acetonide); injections in study eyes with choroidal neovascularization (of various causes) vs study eyes with macular edema (of various causes); and injections in phakic vs pseudophakic eyes) did not reveal any statistically significant associations. Visual perceptions experienced following 15% of IVT injections gave cause for concern to the patient (mean visual analog scale score ( ± SD): 4.5 ( ± 1.7)), and in 64% of cases, the patients believed that preoperative counseling would have averted the concern. Conclusions Lights and floaters are frequent visual perceptions following IVT injections of therapeutic agents. They can give rise to concern that could be alleviated with preinjection counseling.

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Visual perception during phacoemulsification cataract surgery under subtenons anaesthesia

Cited by 45 publications

References 10 publications

A comparison of sub‐Tenon’s with peribulbar anaesthesia in patients undergoing sequential bilateral cataract surgery

A comparison of sub‐Tenon’s with peribulbar anaesthesia in patients undergoing sequential bilateral cataract surgery

Intraoperative visual experience and preoperative counselling during phacoemulsification under topical anaesthesia

Visual perceptions induced by intravitreous injections of therapeutic agents

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