Randomized comparative clinical study of cryoanalgesia versus topical anesthesia in clear corneal phacoemulsification

Effect of cryotherapy on pain scores and satisfaction levels of patients in cataract surgery under topical anesthesia: a prospective randomized double-blind trial

Objective

To evaluate the effects of cryotherapy on pain scores and satisfaction levels of patients during cataract surgery under topical anesthesia. Eighty patients aged between 55 and 75 years scheduled for cataract surgery were randomly allocated to two study groups to receive topical anesthesia with cryotherapy (TC) or topical anesthesia alone (T) groups. Visual analog pain scores, patient satisfaction level, hemodynamic parameters, and quality of operating conditions were recorded.

Results

Cryotherapy significantly reduced VAS pain scores during surgery (P = 0.014). Although no significant difference in postoperative pain scores, opioid consumption, heart rate, and mean arterial blood pressure was seen in the postoperative period. The surgeon reported better quality of operating conditions in the TC group (P = 0.018). Cryotherapy as a complementary method with topical anesthesia reduced pain scores of patients during surgery. It also produced a better quality of operating conditions for surgeons. There was no significant difference in either postoperative pain scores or opioid consumption.

Trial registration This trial was registered at Iranian clinical trial registering: IRCT registration number: IRCT2017052734091N2

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-022-06125-w.

A double-blinded randomized clinical trial for pain perception: The efficacy and safety of topical cold saline solution anesthesia in phacoemulsification

Purpose:

To compare the efficacy and safety of cold saline solution (0.9% NaCl) with topical ophthalmic proparacaine for maintaining topical anesthesia of patients undergoing phacoemulsification surgery.

Methods:

The prospective, double-blinded, and randomized clinical study was randomly assigned to two groups that underwent phacoemulsification surgery due to cataracts. The cold saline group included 86 eyes of 86 patients with topical anesthesia of cold saline solution alone. The proparacaine group included 84 eyes of 84 patients with topical ophthalmic proparacaine (room temperature) anesthesia alone. The patients were scored according to a pain survey questionnaire of Visual Analog Scale (VAS) ranked between 0 and 10. The surgeon scored surgical experience by a Surgeon Questionnaire Scale (SQS) in three parameters, each of which was ranked from 1 to 3 based on questions regarding ease and comfort during the surgery.

Results:

The mean VAS scores were 1.29 ± 0.65 and 1.22 ± 0.66 for the cold saline and proparacaine groups, respectively (P = 0.182). The mean scores of SQS (lower values represented favorable results) were 4.11 ± 0.76 and 3.97 ± 0.74 in the cold saline and proparacaine groups, respectively (P = 0.163). Ten patients in the proparacaine group experienced corneal epitheliopathy in the postoperative period.

Conclusion:

As an easily accessible and cost-effective method, cold saline solution alone might be an alternative to topical ophthalmic proparacaine alone with comparable safe and effective results. The absence of allergic or toxic effects also provided a significant advantage in the cold saline application.

Cryoirrigation in phacoemulsification facilitates a quicker cornea endothelia recovery

OBJECTIVE

To compare the recovery of cornea endothelia after phacoemulsification (phaco) with anterior chamber irrigation at different temperatures.

STUDY DESIGN

A between-group design was used.

PARTICIPANTS

Thirty-eight patients with cataract.

METHODS

Phaco was done on 40 eyes in these patients with exactly the same procedure except for the temperature of the anterior chamber: cryoirrigation at 12 masculine C for group 1 and at room temperature (25 masculine C) for group 2, 20 eyes in each group, randomly distributed. The cornea edema, keratic precipitate (KP), and anterior chamber flare were observed with micro-slit lamp and graded on a 4-point scale at 1, 3, and 7 days after surgery and compared between groups.

RESULTS

The corneas in group 1 were found to be clearer than those in group 2 at 1 and 3 days after surgery. The difference was statistically significant (p < 0.05) in favour of group 1, suggesting a lighter reaction of cornea endothelia and a quicker recovery in group 1 after the surgery with cryoirrigation. Corresponding recovery in group 2 was found to occur latterly between day 3 and day 7. However, the recovery in both groups was complete, yielding no difference between groups, at day 7 after surgery. In addition, no significant difference was found in Tyndall phenomenon and KP between groups.

CONCLUSIONS

Cryoirrigation during phaco could reduce postoperative cornea edema and promote recovery. The result advocates the use of cryoirrigation in clinic.