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Behera G, Kothari A, Subramanian A, Jayaraman R, Rene S. Comparing Peribulbar and Topical Anesthesia in Cataract Surgery among Patients with Cardiovascular Disease. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:71-76. [PMID: 38224720 PMCID: PMC10869419 DOI: 10.3341/kjo.2023.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/10/2024] [Indexed: 01/17/2024] Open
Abstract
PURPOSE To compare topical and peribulbar anesthesia in cataract surgery for hemodynamic changes, rate of complications and pain score in patients with cardiovascular disease. METHODS A prospective comparative study at a tertiary care center in India. Patients >40 years old with treated/controlled hypertension and cardiovascular disease scheduled for cataract surgery under topical or peribulbar anesthesia were recruited. Heart rate, blood pressure, and ophthalmic and systemic complications were noted: preoperatively, immediately after block, intraoperatively, immediately postoperatively and 1 hour postoperatively. A visual analog scale was used to assess the pain score. RESULTS A total of 150 patients (75 in each group) underwent cataract surgery. There was a significant rise in pulse rate and blood pressure after peribulbar injection and intraoperatively, which gradually reduced to baseline 1 hour after surgery in both groups (p < 0.001), with systolic blood pressure intraoperatively being significantly greater in the peribulbar group (155.49 ±18.14 mmHg vs. 147.95 ±17.71 mmHg, p = 0.01). The topical group had slightly lower visual analog scale scores (1.12 ± 0.99) than the peribulbar group (1.44 ± 0.90, p = 0.04). CONCLUSIONS Cataract surgery appears safe in patients with adequately controlled cardiovascular disease, and topical anesthesia may be preferable due to noninvasiveness, adequate analgesia, and minimal effect on hemodynamic parameters. Therefore, hemodynamically stable patients of cardiovascular disease undergoing uncomplicated cataract surgery may be counselled for topical anesthesia.
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Affiliation(s)
- Geeta Behera
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry,
India
| | - Akhilesh Kothari
- Department of Ophthalmology, Indira Gandhi Government General Hospital and Post Graduate Institute, Puducherry,
India
| | - Anandaraja Subramanian
- Department of Cardiology, Indira Gandhi Government General Hospital and Post Graduate Institute, Puducherry,
India
| | - Ramesh Jayaraman
- Department of Internal Medicine, Indira Gandhi Government General Hospital and Post Graduate Institute, Puducherry,
India
| | - Senthamizhan Rene
- Department of Ophthalmology, Indira Gandhi Government General Hospital and Post Graduate Institute, Puducherry,
India
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Khezri MB, Akrami A, Majdi M, Gahandideh B, Mohammadi N. Effect of cryotherapy on pain scores and satisfaction levels of patients in cataract surgery under topical anesthesia: a prospective randomized double-blind trial. BMC Res Notes 2022; 15:234. [PMID: 35765086 PMCID: PMC9241292 DOI: 10.1186/s13104-022-06125-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 06/17/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Marzieh Beigom Khezri
- Department of Anesthesiology, Professor of Anesthesiology, Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Abbas Akrami
- Department of Ophthalmology, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Matina Majdi
- Department of Anesthesiology, Resident of Anesthesiology, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Bijan Gahandideh
- Department of Nursing, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Navid Mohammadi
- Children Growth Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.,Researcher, Canada Optimax Access Consulting, Port Coquitlam, BC, Canada
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Demir M, Akpolat C, Karapapak M, Sendul SY, Guven D. A double-blinded randomized clinical trial for pain perception: The efficacy and safety of topical cold saline solution anesthesia in phacoemulsification. Indian J Ophthalmol 2021; 70:124-130. [PMID: 34937223 PMCID: PMC8917576 DOI: 10.4103/ijo.ijo_876_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Mehmet Demir
- Department of Ophthalmology, Sisli Hamidiye Training and Research Hospital, Istanbul, Turkey
| | - Cetin Akpolat
- Department of Ophthalmology, Sisli Hamidiye Training and Research Hospital, Istanbul, Turkey
| | - Murat Karapapak
- Department of Ophthalmology, Basaksehir Cam and Sakura City Hospital, Turkey
| | - Selam Yekta Sendul
- Department of Ophthalmology, Sisli Hamidiye Training and Research Hospital, Istanbul, Turkey
| | - Dilek Guven
- Department of Ophthalmology, Sisli Hamidiye Training and Research Hospital, Istanbul, Turkey
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Meduri A, Bergandi L, Oliverio GW, Rechichi M, Acri G, Perroni P, Silvagno F, Aragona P. The cold eye irrigation BSS solution used during phacoemulsification reduces post-surgery patients discomfort preventing the inflammation. Eur J Ophthalmol 2021; 32:11206721211018377. [PMID: 34011203 DOI: 10.1177/11206721211018377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to assess whether the intraoperative use of the cold eye irrigation balanced salt solution (BSS) could have a protective effect in preventing the anterior chamber flare and conjunctival hyperemia and, thus, in reducing patients discomfort after phacoemulsification. MATERIALS AND METHODS About 214 patients were enrolled and randomly divided into: patients whose eye were irrigated with BSS at ~ 20°C (Group 1) and patients whose eye were irrigated with BSS at 2.7°C (Group 2). Anterior chamber flare, visual analogue score and conjunctival hyperemia were evaluated at 1, 3, 5, and 30 days after surgery. RESULTS In patients of Group 2 the anterior chamber flare, the visual analogue score and the conjunctival hyperemia, used as parameters to evaluated clinical inflammation, at 1 day after surgery were significantly lower than those in Group 1 who received BSS solution at operating room temperature (p < 0.001), while at day 3, 5, and 30 there were not any significant differences. CONCLUSION Our study provided evidence supporting the efficacy of the treatment with cold irrigation solution on reduction of anterior chamber flare, pain and conjunctival hyperemia already at 1 day after phacoemulsification, suggesting that cooling procedure was fully effective at controlling early post-operative inflammation.
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Affiliation(s)
- Alessandro Meduri
- Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy
| | | | - Giovanni William Oliverio
- Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy
| | - Miguel Rechichi
- Centro Polispecialistico Mediterraneo, Sellia Marina, Catanzaro, Italy
| | - Giuseppe Acri
- Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy
| | - Pietro Perroni
- Department of Ophthalmology, Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, Milano, Italy
| | | | - Pasquale Aragona
- Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy
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Small A, Fisher AD, Lee C, Colditz I. Analgesia for Sheep in Commercial Production: Where to Next? Animals (Basel) 2021; 11:ani11041127. [PMID: 33920025 PMCID: PMC8070992 DOI: 10.3390/ani11041127] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Increasing societal and customer pressure to provide animals with ‘a life worth living’ continues to apply pressure on industry to alleviate pain associated with husbandry practices, injury and illness. Although a number of analgesic solutions are now available for sheep, providing some amelioration of the acute pain responses, this review has highlighted a number of potential areas for further research. Abstract Increasing societal and customer pressure to provide animals with ‘a life worth living’ continues to apply pressure on livestock production industries to alleviate pain associated with husbandry practices, injury and illness. Over the past 15–20 years, there has been considerable research effort to understand and develop mitigation strategies for painful husbandry procedures in sheep, leading to the successful launch of analgesic approaches specific to sheep in a number of countries. However, even with multi-modal approaches to analgesia, using both local anaesthetic and non-steroidal anti-inflammatory drugs (NSAID), pain is not obliterated, and the challenge of pain mitigation and phasing out of painful husbandry practices remains. It is timely to review and reflect on progress to date in order to strategically focus on the most important challenges, and the avenues which offer the greatest potential to be incorporated into industry practice in a process of continuous improvement. A structured, systematic literature search was carried out, incorporating peer-reviewed scientific literature in the period 2000–2019. An enormous volume of research is underway, testament to the fact that we have not solved the pain and analgesia challenge for any species, including our own. This review has highlighted a number of potential areas for further research.
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Affiliation(s)
- Alison Small
- CSIRO Agriculture & Food, Locked Bag 1, Armidale, NSW 2350, Australia; (C.L.); (I.C.)
- Correspondence: ; Tel.: +61-2-6776-1435
| | - Andrew David Fisher
- Animal Welfare Science Centre, University of Melbourne, Parkville, VIC 3052, Australia;
| | - Caroline Lee
- CSIRO Agriculture & Food, Locked Bag 1, Armidale, NSW 2350, Australia; (C.L.); (I.C.)
| | - Ian Colditz
- CSIRO Agriculture & Food, Locked Bag 1, Armidale, NSW 2350, Australia; (C.L.); (I.C.)
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Toro MD, Nowakowska D, Brzozowska A, Reibaldi M, Avitabile T, Bucolo C, Murabito P, Chisari C, Nowomiejska K, Rejdak R. Pain Following the Use of Anesthesia Formulation Among Individuals Undergoing Cataract Surgery: A Randomized Controlled Trial. Front Pharmacol 2020; 11:440. [PMID: 32372954 PMCID: PMC7176993 DOI: 10.3389/fphar.2020.00440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/20/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the pain intensity of two intracameral anesthetic solutions in patients undergoing cataract surgery and evaluate the factors influencing the patients’ postoperative activities. Methods Sixty-two patients undergoing cataract surgery were randomized to receive the study drug – a manufactured solution of 0.02% tropicamide/0.31% phenylephrine/1% lidocaine (Mydrane) or a traditional anesthetic formulation - solution of 1% lidocaine/0.025% adrenaline as an intraocular anesthetic. The pain intensity was assessed by Visual Analog Scale for Pain (VAS Pain) and Brief Pain Inventory-short form (BPI) on the next day after the surgery. Results The mean pain score measured preoperatively with VAS Pain was 0.34 in Mydrane group and 0.09 in the reference group (p = 0.51). There were no statistically significant differences between the two anesthetic methods with respect to pain intensity during the surgery (p = 0.94) and the influence of pain during the last 24 h on activity (p = 0.79), mood (p = 0.31), social contacts (p = 0.29), sleep (p = 0.5) and the joy of life (p = 0.39). Additionally, there was no statistically significant influence of age, sex, lateralization, co-existing ophthalmological diseases (p = 0.98) and post-operative complications (p = 0.4) on the experienced pain measured during the surgery and in the last 24 h. Conclusions New commercially available intraocular anesthetic solution (Mydrane™) seems to be as effective as off-label traditional anesthetic formulation, in reducing the pain experienced during cataract surgery under topical anesthesia.
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Affiliation(s)
- Mario D Toro
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland.,Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University, Warsaw, Poland
| | - Dominika Nowakowska
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Brzozowska
- Department of Mathematics and Medical Biostatistics, Medical University of Lublin, Lublin, Poland
| | - Michele Reibaldi
- Department of Ophthalmology, School of Medicine, University of Catania, Catania, Italy
| | - Teresio Avitabile
- Department of Ophthalmology, School of Medicine, University of Catania, Catania, Italy
| | - Claudio Bucolo
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Paolo Murabito
- Department of General Surgery and Surgical Specialties, Division of Anesthesiology, Azienda Ospedaliero-Universitaria Policlinico, Catania, Italy
| | - Clara Chisari
- Department "GF. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | | | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
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Abstract
PURPOSE To evaluate the analgesic effect of bromfenac, a topically administered nonsteroidal antiinflammatory agent, in patients undergoing intravitreal injections (IVIs) of anti-vascular endothelial growth factor agents. METHODS A single center, prospective, randomized, double-blind, placebo-controlled, cross over interventional study. Patients scheduled to undergo IVI of anti-vascular endothelial growth factor were randomized to receive topical bromfenac or placebo before IVI. Pain perception was assessed using the short form of the McGill Pain Questionnaire. Pain intensity was evaluated with the visual analog scale, the main component of the short form of the McGill Pain Questionnaire, and the Present Pain Intensity scores immediately and 6 hours postinjection. RESULTS Sixty-five patients (65 eyes) were enrolled in the study. Immediately after IVI, pain perception was statistically significant lower in patients treated with bromfenac compared with placebo as assessed by the visual analog scale pain score and the main component of the short form of the McGill Pain Questionnaire (P = 0.002 and 0.001, respectively). At 6 hours postIVI, pain was statistically significant lower in patients treated with bromfenac, according to the visual analog scale pain score, the main component of the short form of the McGill Pain Questionnaire, and the Present Pain Intensity score (P < 0.001, <0.001, and P = 0.001, respectively). Multivariable regression analysis revealed that pain perception, as evaluated with the visual analog scale pain score immediately after IVI, was significantly lower in patients of older age, female patients and those with higher number of previous injections. Immediately after IVI, bromfenac seemed to be more effective in younger patients and in those who had already undergone an amount of injections. CONCLUSION Topical instillation of bromfenac significantly reduced the IVI-related pain immediately after and 6 hours postinjection.
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Makri OE, Tsapardoni FN, Pagoulatos DD, Pharmakakis N, Georgakopoulos CD. Diclofenac for pain associated with intravitreal injections: a prospective, randomized, placebo-controlled study. Clin Exp Ophthalmol 2017; 45:867-874. [DOI: 10.1111/ceo.12988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Olga E Makri
- Department of Ophthalmology, Medical School; University of Patras; Patras Greece
| | - Foteini N Tsapardoni
- Department of Ophthalmology, Medical School; University of Patras; Patras Greece
| | | | - Nikolaos Pharmakakis
- Department of Ophthalmology, Medical School; University of Patras; Patras Greece
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Gonzalez-Salinas R, Guarnieri A, Guirao Navarro MC, Saenz-de-Viteri M. Patient considerations in cataract surgery - the role of combined therapy using phenylephrine and ketorolac. Patient Prefer Adherence 2016; 10:1795-1801. [PMID: 27695298 PMCID: PMC5029911 DOI: 10.2147/ppa.s90468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cataract, a degradation of the optical quality of the crystalline lens, progressive and age-related, is the leading cause of treatable blindness worldwide. Cataract surgery is the most common surgical procedure performed by ophthalmologists and is the only effective treatment for cataracts. Advances in the surgical techniques and better postoperative visual outcomes have progressively changed the primary concern of cataract surgery to become a procedure refined to yield the best possible refractive results. Sufficient mydriasis during cataract removal is critical to a successful surgical outcome. Poor pupil dilation can lead to serious sight-threatening complications that significantly increase the cost of surgery and decrease patients comfort. Mydriasis is obtained using anticholinergic and sympathomimetic drugs. Phenylephrine, an α1-adrenergic receptor agonist, can efficiently dilate the pupil when administered by intracameral injection. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) like ketorolac, which inhibit the synthesis of prostaglandins, are used to decrease intraoperative miosis, control pain and inflammation associated with cataract surgery, and to prevent the development of cystoid macular edema following surgery. Recently, a new combination of phenylephrine and ketorolac (Omidria®) has been approved by United States Food and Drug Administration for use during cataract surgery to maintain intraoperative mydriasis, prevent miosis, and reduce postoperative pain and inflammation. Clinical trials have shown that this new combination is effective, combining the positive effects of both drugs with a good safety profile and patient tolerability. Moreover, recent reports suggest that this combination is also effective in patients with high risk of poor pupil dilation. In conclusion, cataract is a global problem that significantly affects patients' quality of life. However, they can be managed with a safe and minimally invasive surgery. Advances in surgical techniques and newer pharmacological agents such as the combination of phenylephrine and ketorolac, together with better intraocular lenses, have greatly improved visual outcomes and thus patients' expectations regarding visual recovery are also increasing.
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Affiliation(s)
- Roberto Gonzalez-Salinas
- Department of Biomedical Research, Universidad Autónoma de Querétaro, Querétaro, Mexico
- Department of Research, Asociación para Evitar la Ceguera en México, Mexico City, Mexico
| | - Adriano Guarnieri
- Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Manuel Saenz-de-Viteri
- Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
- Correspondence: Manuel Saenz-de-Viteri, Ave Pio XII 36, 31008 Pamplona, Navarra, Spain, Tel +34 948 948 25 54 00, Fax +34 948 296 500, Email
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Pain during phacoemulsification with and without cryoanalgesia. J Cataract Refract Surg 2015; 41:1795-6. [PMID: 26432153 DOI: 10.1016/j.jcrs.2015.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 07/18/2015] [Indexed: 11/21/2022]
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Kumar DA, Agarwal A. No-anesthesia cataract surgery. J Cataract Refract Surg 2015; 41:1548. [PMID: 26287905 DOI: 10.1016/j.jcrs.2015.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
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