Cataract surgery anaesthesia: is topical anaesthesia really better than retrobulbar?

Do Consecutive Phacoemulsification Surgeries Under Topical Anesthesia Differ in Terms of Pain Perception and Cooperation?

Background

Although intraoperative ocular pain has been investigated extensively in the literature, few studies have evaluated the pain perception between consecutive surgeries. Determining the facts about pain perception during phacoemulsification will allow surgeons to decide the type of anesthesia that best fits the patient when planning the contralateral cataract surgery. The aim of this study was to determine the level of pain perception, factors affecting pain perception, level of patient cooperation, and perception of operation time during consecutive phacoemulsification surgeries.

Methodology

This study included 314 eyes of 157 patients with bilateral senile cataracts who underwent phacoemulsification surgery under topical anesthesia with an interval of no more than six months. All patients underwent complete ophthalmic examination. Operation time, phaco time, surgeon’s comfort, and patient’s cooperation were recorded. Immediately after the operation, the patients graded the pain they experienced via the Visual Analogue Scale (VAS) from 0 to 10 and estimated the operation time.

Results

The mean VAS score was 0.88 ± 0.97 for the first eye and 1.50 ± 1.27 for the second eye (p < 0.011) surgery. The perception of the mean operation time was significantly lower in the first eye surgery (p < 0.001), even though the real objective operation time and phaco time were lower in the second eye surgery. The surgeon reported significantly more comfort during the first eye surgery. VAS was found to be positively correlated with nonsteroidal anti-inflammatory drug use, intraocular pressure, axial length, anterior chamber depth, central corneal thickness, phaco time, and operation time perception, and inversely correlated with best-corrected visual acuity and mature cataract morphology.

Conclusions

Consecutive phacoemulsification surgeries appear to differ not only in terms of pain perception but also operation time perception, patient cooperation, and surgeons’ comfort. Determining and controlling the factors that can influence patients’ pain perception and comfort will increase the safety of the contralateral surgery.

Patient preference and pain-reported outcomes for topical versus subtenon anesthetic for cataract surgery

PURPOSE:

Cataract extraction and lens implantation is the most common surgical procedure performed worldwide, with surgeons opting for either a topical or a subtenon anesthetic in majority of cases. While complication rates and pain scores have been previously examined in a bid to determine which modality was better, patients who have had both eyes operated upon under different techniques have never previously been asked which method they prefer. We undertook this study to fill in this crucial gap in our knowledge.

METHODS:

This is a retrospective study of patients who have undergone bilateral cataract surgery with one eye operated on with topical anesthesia and the other eye with subtenon anesthesia. Patients were identified who had had surgery undertaken in the previous 6 months at Singleton Hospital, Swansea, where both eyes had been operated upon using different anesthetic techniques. Telephone interviews with these patients were performed and their pain scores recorded on a scale from 0 (no pain) to 10 (severe pain) for both eyes, with the patients then being asked which the method of anesthetic they preferred. Statistical analysis of pain scores was compared using Wilcoxon rank-sum testing.

RESULTS:

One hundred and fifty-two patients in total were identified. One hundred and forty-one of the applicable patients participated in the study. Of these, 78 patients received topical anesthesia for their first operation and 63 had subtenon block for their first operation. The mean pain scores reported for surgery with topical anesthesia and subtenon block were 2.30 and 1.38, respectively. The pain data were analyzed using a Wilcoxon signed-rank test, returning a z-score of 4.038. This result therefore suggests that patients experience statistically significantly less pain from cataract surgery when given a subtenon block. Patients expressed a preference for subtenon anesthesia, with 70% preferring subtenon block, 23% preferring topical anesthesia, and 7% having no preference.

CONCLUSIONS:

Patients report less pain with subtenon anesthesia compared with topical anesthesia in cataract surgery, where both eyes were operated upon with different anesthetic techniques. This is the first study in which patients who have had both anesthetic techniques performed independently for cataract surgery have had their pain scores reported and statistically analyzed.

Oculocardiac reflex in phacoemulsification: Peribulbar vs topical anesthesia

Purpose:

This study compares the vital parameters and pain experienced during phacoemulsification under peribulbar and topical anesthesia to determine the incidence of OCR.

Methods:

One hundred six patients are enrolled for phacoemulsification in a prospective and randomized study. Fifty-two patients undergo surgery in a peribulbar block (Group PB) and 54 in topical anesthesia (Group TA). Mean arterial pressure (MAP) and pulse rate are recorded during a preoperative check-up and at four other steps of surgery. Pain experienced during surgery and on a postoperative day, 5, is graded with a verbal analogue scale. OCR defined as a decrease in pulse rate by greater than 20% is calculated. Chi-square test, Fisher‘s exact test, paired t test and the comparison of means give the statistical analysis. A value of P < 0.05 was taken as significant.

Results:

MAP readings at baseline versus MAP at other steps of surgery show a trend towards rising with a P value of < 0.05 in both groups. Pulse rate measured at all steps of surgery versus baseline pulse rate in Group TA shows P < 0.05. OCR is present in nine patients in peribulbar block verses eleven patients in topical anesthesia with P value of 0.687. The pain scores using verbal analogue scale were higher in Group TA compared with Group PB with a P < 0.0001.

Conclusion:

Oculocardiac reflex can occur during phacoemulsification under both peribulbar block and topical anesthesia, and the difference is not significant.

Intraoperative Pain Sensation During Cataract Surgery: Why Does Timing Matter?

Purpose: To investigate whether timing influences pain perception during cataract surgery and to investigate the possible mechanisms.Methods: Patients scheduled for cataract surgery both in the morning and afternoon were consecutively enrolled. Questionnaires to evaluate anxiety, including the Simplified State-Trait Anxiety Inventory, Amsterdam Preoperative Anxiety and Information Scale, and a visual analogue scale (VAS) for anxiety, were completed preoperatively, whereas a VAS for pain and the Wong-Baker FACES® Pain Rating Scale questionnaire were completed after surgery. Preoperative blood pressure and heart rate were recorded. Blood samples were acquired before surgery, and plasma cortisol, adrenocorticotropic hormone, adrenalin, and noradrenalin were tested.Results: Fifty-five patients underwent uneverntful cataract surgery (28 in the morning and 27 in the afternoon) were included in the final analysis. Greater intraoperative pain perception during cataract surgery was reported in the afternoon than in the morning. Overall anxiety levels were significantly higher in the afternoon. Plasma adrenalin levels were significantly higher in the afternoon. Cortisol levels were higher in the afternoon. Preoperative anxiety levels were closely related to intraoperative pain perception. Both adrenalin and cortisol correlated positively with preoperative anxiety, but only adrenalin correlated significantly with the pain scores.Conclusions: Patients undergoing cataract surgery in the afternoon showed more preoperative anxiety, which may have increased their relevant stress hormones. Both the patient's emotional state and hormone levels may together aggravate his/her perceived pain in the afternoon. Monitoring preoperative anxiety levels, blood pressure, and heart rate should help to identify patients at higher risk of perceived intraoperative pain.Clinical trial registration:Trial registration number: NCT02182921Registration site: clinicaltrials.gov.

Topical anesthesia versus peribulbar anesthesia in phacoemulsification cataract surgery and intraocular lens implantation

Topical anesthesia during phacoemulsification cataract surgery has become the best choice for ophthalmologists, which broadens the indications for surgery, and eliminates the risk of peribulbar injections. The aim of our study is to assess the advantages and disadvantages, the efficacy and the tolerance of this protocol. Prospective study extending from January 2018 to December 2019, including 116 patients operated for cataracts under topical anesthesia (group 1), and 179 patients under peribulbar anesthesia (group 2). All patients were operated by phacoemulsification. The patients evaluated their pain on a visual analog scale graduated from 1 to 10. The two groups were comparable in age, gender and history of high blood pressure. All patients received premedication before surgery (Atarax). It was the first eye operated for cataracts in 79 patients in group 1 and 75 patients in group 2. The two groups did not differ significantly in systolic blood pressure rate (p= 0,36), pain score (p=0.54), duration of surgery (p=0.52), anaesthesia-related intraoperative difficulties (p=0.17), or intraoperative surgical complication rate (p=0.49) or blood oxygen saturation (p=0.74). However, in the peribulbar groups, better patient and surgeon satisfaction scores were obtained (P < .005).

A Comparison of Retrobulbar Versus Topical Anesthesia in Trabeculectomy and Aqueous Shunt Surgery

PURPOSE

The purpose of this study was to compare the required supplemental anesthesia and postoperative patient pain score in individuals undergoing glaucoma surgery under topical anesthesia (TA) versus retrobulbar anesthesia (RB).

MATERIALS AND METHODS

A retrospective, interventional, comparative cohort study of 261 eyes of 225 patients undergoing glaucoma and combined glaucoma with cataract surgery were included in the study. The main outcome measures were the amount of supplemental, systemic intraoperative anesthesia used and the postoperative pain scale between patients undergoing TA versus RB anesthesia. A secondary analysis was performed between combined glaucoma and cataract surgery versus glaucoma surgery alone.

RESULTS

About 6.2% patients complained of pain after glaucoma surgery (8.1% among TA group and 3.1% among RB group; P=0.049). Overall, pain tended to be mild with a mean score of 0.32 of 10 for TA and 0.08 of 10 for RB (P=0.027). The amount of IV anesthetics used intraoperatively was lower in the RB anesthesia compared with the TA group (midazolam, P=0.042; fentanyl, P<0.001; propofol, P<0.001). In addition, patients undergoing RB anesthesia were less likely to use postoperative pain medication (P<0.001). There was no difference in pain score (P=0.707) or in the amount of IV anesthetics (all P>0.350) between eyes undergoing combined versus glaucoma surgery alone.

CONCLUSIONS

Although supplemental anesthesia and pain scores were statistically increased in the topical group, the prevalence and the severity of pain was low. Therefore, TA is feasible and a reasonable option for glaucoma surgery. Furthermore, this conclusion applies when glaucoma surgery is performed alone or in combination with the other eye surgery.

Pain Perception of the First Eye versus the Second Eye during Phacoemulsification under Local Anesthesia for Patients Going through Cataract Surgery: A Systematic Review and Meta-Analysis

Background

Phacoemulsification under local anesthesia is regarded as the major surgery for cataract treatment. Recent research has compared the pain perception between the first eye and the second eye during phacoemulsification. However, these studies have also yielded controversial findings. Consequently, we performed a systematic review and a meta-analysis to investigate the difference in the pain perception between the first and second eyes during phacoemulsification.

Method

We searched the PubMed, EMBASE, and Cochrane CENTRAL databases for the studies published up to October 5, 2018. Prospective observational studies were included. The meta-analysis was conducted by means of random-effects model and fixed-effects model according to the heterogeneity. Evaluation of the methodological quality of studies was based on Newcastle-Ottawa Scale (NOS).

Results

Overall, eight studies were included in the meta-analysis. The analysis of pooled data showed that the pain scores of the first eye shortly after surgery under local anesthesia were significantly lower as compared to the second eye (WMD: 0.69; 95% CI: 0.40, 0.98; P < 0.00001). The average pain scores of the first eye shortly after surgery under the topical anesthesia were also lower than those of the second eye (WMD: 1.08; 95% CI: 0.79, 1.36; P < 0.00001). Conversely, anxiety scores in the first eye surgery were significantly higher than those in the second eye surgery (SMD: −0.40; 95% CI: −0.64, −0.16; P=0.001). However, the difference of the pain scores accessed on the first postoperative day between the first and second eye surgeries (WMD: −0.05; 95% CI −0.40, 0.31; P=0.79) as well as cooperation grades of patients between the first and second eye surgeries (WMD: 0.35; 95% CI −0.07, 0.76; P=0.10) was not statistically significant.

Conclusion

Patients experienced more pain in the surgery of the second eye than that of the first eye, which probably related to lower anxiety before the second surgery. It suggests that we should consider preoperative intervention to reduce the perceived pain during second eye cataract surgery.

Validity and time course of surgical fear as measured with the Surgical Fear Questionnaire in patients undergoing cataract surgery

OBJECTIVES

The primary aim of the study was to assess the convergent validity of the Surgical Fear Questionnaire (SFQ) with other self-report instruments and biological indices of stress. Secondary aims were the examination of predictors of the level and time course of fear and preferences for fear treatment.

METHODS

In a prospective observational cohort study SFQ short-term (SFQ-s) and long-term (SFQ-l) scores were assessed one week, one day, and the morning before cataract surgery, together with salivary cortisol and alpha-amylase (sAA) levels, and numeric rating scale (NRS) fear score. SFQ-scores were also assessed before second eye surgery. Expected pain and recovery, and sociodemographic and medico-psychological predictors of fear were assessed at baseline.

RESULTS

Data of 98 patients were analyzed. Scores of both SFQ-subscales (range 0-40) were generally low, all mean ≤ 9.0. SFQ-s and SFQ-l correlated significantly with the other self-report instruments: NRS fear .83 and .89, expected pain .49 and .54, expected recovery -.27 and -.44. No association was found between SFQ-scores and cortisol or sAA level. Predictors of the level of fear were baseline pain and stress. Additional effects of time were found for subgroups based on educational level, antidepressant use, and presurgical stress (SFQ-l). SFQ-scores were significantly lower before the second cataract surgery than before the first, and higher in patients who would have appreciated treatment of fear.

DISCUSSION

Convergent validity of the SFQ with other self-report measures is shown. The sensitivity of the SFQ permits the detection of small variations in fear caused by time or other factors.

The effect of post-traumatic-stress-disorder on intra-operative analgesia in a veteran population during cataract procedures carried out using retrobulbar or topical anesthesia: a retrospective study

Background

A growing proportion of veterans treated at the Veterans Health Administration (VA) have a history of post-traumatic-stress-disorder (PTSD), and there exists a higher rate of PTSD amongst veterans than the general population. The purpose of this study is to determine the correlation between PTSD and intra-operative analgesia, intra-operative time, and anesthesia type for cataract surgery in a veteran population. Secondary objectives are to determine if patient age, and first or second eye surgery affect intra-operative pain control or are correlated with type of anesthesia modality.

Methods

A retrospective study of 330 cataract surgeries performed by resident physicians between January and September 2012 at the Veterans Affairs Medical Center Tennessee Valley Healthcare System, Nashville and Murfreesboro Campuses was completed. Three hundred and thirty veteran patients were selected if their cataract surgery was performed between January and September 2012. Combined cases were excluded. The primary outcome evaluated was intra-operative analgesia. Secondary outcomes included history of post-traumatic-stress-disorder, anesthesia type, first or second eye, pain control, intra-operative heart rate and blood pressure, age, and case complexity. Data was analyzed using an unpaired two-sample Welch’s t-test assuming unequal variance and Z test of comparison of proportions.

Results

Patients with post-traumatic-stress-disorder reported higher pain scores, had longer operative times, and were more likely to have received a retrobulbar block. Operative time was not associated with an increased pain score, irrespective of anesthesia type, when controlled for PTSD. Complex cases had longer operative times, more sedation, and higher pain scores. P < 0.05 was used consistently.

Conclusions

Post-traumatic stress disorder and anxiety are more prevalent in the veteran population. Our data suggests that a history of post-traumatic-stress-disorder was correlated with higher pain scores, longer operative times, and with having received a retrobulbar block. Patients without a history of PTSD were more likely to have received topical anesthesia with or without sedation. The veteran population requires more sedation to allay anxiety and perceptions of discomfort, which may account for longer surgical times. The veteran population is a special population and it is important to investigate how PTSD in the veteran population affects intra-operative analgesia.

Pain Perception in Phacoemulsification with Topical Anesthesia and Evaluation of Factors Related with Pain

OBJECTIVES

Evaluation of pain during and after phacoemulsification with topical anesthesia in patients with senile cataract and investigation of factors related with pain.

MATERIALS AND METHODS

Ninety-two adult patients scheduled for routine clear corneal phacoemulsification with topical anesthesia who had no previous cataract surgery in their fellow eyes were included in the study. Verbal pain scale and visual analog scale were used to measure pain intensity. Demographic characteristics, concomitant systemic diseases, drug consumption, need of additional anesthesia during surgery, surgical complications, duration of surgery and surgeon comfort were also evaluated for each patient.

RESULTS

Seventy-two patients (78.3%) reported pain during surgery and 68 patients (73.9%) reported pain in the period after the surgery. When the intensity of pain during the surgery was evaluated, the percentage of patients reporting mild, moderate and intense pain was 35.9%, 25.0% and 17.4%, respectively. The average verbal pain score during the surgery was 1.4±1.0 (0-3). Reported pain level was not associated with age or gender (p>0.05). Diabetic patients and patients who consumed nonsteroidal anti-inflammatory drugs in the morning before operation reported less pain during and after the surgery (p<0.05). There were no complications except posterior capsule rupture in one patient. Duration of surgery was longer in patients who reported pain during surgery (p<0.05). There was no significant difference between pain reported during surgery and surgeon comfort (p>0.05).

CONCLUSION

Patients frequently experience pain during phacoemulsification with topical anesthesia. Although pain perception does not affect surgical success, preoperative administration of analgesics in suitable patients or giving additional anesthesia to patients reporting severe pain during surgery may increase patient comfort.

PRESSÃO INTRAOCULAR, PRESSÃO ARTERIAL MÉDIA E DIÂMETRO PUPILAR EM COELHOS ( (Oryctolagus cuniculus) ) SUBMETIDOS AO BLOQUEIO RETROBULBAR COM DIFERENTES PROTOCOLOS ANESTÉSICOS

Resumo O objetivo deste estudo foi buscar novos protocolos de anestesia loco regional para procedimentos oftálmicos que proporcionem segurança e manutenção das funções vitais, além de manter a pressão intraocular estável, com centralização do bulbo do olho e acinesia palpebral. Foram utilizados 20 coelhos da raça Nova Zelândia para a realização de quatro protocolos de anestesia local através do bloqueio retrobulbar com lidocaína 2% com vasoconstritor, lidocaína 2% sem vasoconstritor associada ao tramadol, ropivacaína 1% e bupivacaína 0,5%, cada animal recebeu o volume anestésico de 1,0 mL. Todos os protocolos anestésicos utilizados promoveram acinesia palpebral e centralização do bulbo do olho durante todo o período de avaliação. A realização do bloqueio retrobulbar com os protocolos anestésicos demonstrou ser factível e segura quanto à manutenção da pressão intraocular, pressão arterial invasiva e diâmetro pupilar e pode ser utilizada para realização de cirurgias intraoculares. Os anestésicos proporcionaram bom bloqueio retrobulbar, entretanto a bupivacaína foi o anestésico que ocasionou o maior diâmetro pupilar comparativamente aos demais fármacos testados.

Comparing the effect of topical anesthesia and retrobulbar block with intravenous sedation on hemodynamic changes and satisfaction in patients undergoing cataract surgery (phaco method)

BACKGROUND

Cataract is one of the most common surgical procedures in the elderly. In most cases, the elderly have cardiac ischemia or chronic coronary diseases, which would lead to more ischemic events during general anesthesia. Therefore, surgeons and anesthetists prefer regional aesthesia to the general one owing to its more advantages and less complications.

OBJECTIVES

Therefore, this study aimed to compare topical method and retrobulbar block for pain intensity, patient's satisfaction, hemodynamic changes and intra and postoperative complications.

PATIENTS AND METHODS

In a single-blinded clinical trial, 114 patients scheduled for cataract surgery, aged 50 to 90 years with ASA physical status of I-III, were randomly assigned to two groups under monitored anesthesia care as topical anesthesia and retrobulbar block. After the injection of intravenous sedation, which was the combination of midazolam 0.5-1 mg with fentanyl 0.5-1 µ/kg, patients received retro bulbar block or topical anesthesia. During the operation, heart rate, systolic and diastolic blood pressure, mean arterial blood pressure and arterial saturation of O2were measured every five minutes. In addition, pain (VAS) and satisfaction (ISAS) scores were recorded every 15 minutes, then at recovery and one hour after the ending of operation in the ward. Findings were statistically analyzed using SPSS 16.

RESULTS

In this study, no significant association was found between age, gender, education and physical condition of patients in both topical and retro bulbar block groups. Comparison of pain based on VAS, satisfaction based on ISAS score and MAP in the studied periods had no significant differences between the two groups of patients undergoing cataract surgery. However, significant differences were found between the two groups (P = 0.045, 0.02, 0.042 and P < 0.05) regarding heart rate, systolic and diastolic blood pressure and arterial oxygen saturation percentage after 20-30 minutes of the operation.

CONCLUSIONS

Both methods, topical and retro bulbar block had similar impression in cataract surgery regarding analgesia and patient satisfaction. However, in non-complicated cataract surgeries with short duration, topical anesthesia may be the preferable method, because of non-invasiveness, appropriate analgesia, patient satisfaction and hemodynamic stability.

Is second eye phacoemulsification really more painful?

AIM

To demonstrate a numerical data set for intraoperative pain during phacoemulsification and compare the pain scores for first and second procedures.

METHODS

From 200 consecutive cases requiring bilateral cataract removals 187 were enrolled into this prospective, observational, single-surgeon, single-centre study. To evaluate the pain a 10-point visual analogue scale was used. The pain scores for both eyes of each patient were collected perioperatively (T) as well as 2-4 weeks (mean: 2.43 weeks) later, at the follow-up visit (C). Data were pooled and the four groups were compared by ANOVA All Pairweise Multiple Comparison Procedures.

RESULTS

Median C-score was 1 for both eyes, T-score was 1 and 0 for the first and second eye, respectively. There wasn't any difference between the first and second eyes either in T- (1.50 ± 1.43 vs 1.51 ± 1.36) or in C-scores (0.71 vs 1.10). C-values were lower than T-values for either eye (0.71 vs 1.50 and 1.10 vs 1.51), indicating that patients recalled less pain 2-3 weeks after the surgery than that they indicated on the day of the procedure

CONCLUSIONS

Consecutive phacoemulsifications do not differ in the perceived pain nevertheless, patients may believe the second eye surgery more painful because they practically compare it with the lower remembered pain for the first eye procedure. In order to avoid any disappointment we suggest warning patients before their second eye operations that they are likely to experience more pain or discomfort.

Comparison of sedative drugs under peribulbar or topical anesthesia during phacoemulsification

BACKGROUND AND OBJECTIVE

To compare dexmedetomidine and midazolam+fentanyl sedation primarily based on patient satisfaction during phacoemulsification under topical and peribulbar anesthesia.

PATIENTS AND METHODS

Prospective, randomized, and double-blind study of 80 American Society of Anesthesiology grade I-II patients who underwent phacoemulsification with local anesthesia under sedation. Patients were divided into four groups (20 patients for each): dexmedetomidine and topical anesthesia, dexmedetomidine and peribulbar anesthesia, midazolam+fentanyl and topical anesthesia, and midazolam+fentanyl and peribulbar anesthesia. Patient and surgeon satisfaction were determined on a 5-point scale. The pain was determined by verbal pain scale intraoperatively and postoperatively. Drugs were given to a Ramsay sedation scale of 3. Topical and peribulbar anesthesia were performed by an ophthalmologist. Hemodynamic, respiratory, and intraocular pressure monitoring was done. Operative and recovery times were recorded.

RESULTS

In the midazolam+fentanyl groups, better patient and surgeon satisfaction scores were obtained (P < .005), verbal pain scale scores were significantly lower (P < .001), and patients needed less postoperative analgesia. Ramsay sedation scale scores were between 3 and 4 in all patients and there were no significant differences. Intraocular pressure alterations were similar between groups. Recovery time was longer in the dexmedetomidine groups (P < .05).

CONCLUSION

The study demonstrated that the midazolam+fentanyl combination provided high-level patient satisfaction scores, low-level pain scores, and shorter recovery time. Also, both of the peribulbar and topical anesthesia procedures showed similar efficiency.

Local anesthesia for cataract surgery

Various aspects of local anesthesia for cataract surgery, such as the anesthetic agents and their interaction with ocular nerve supply, anesthesia requirements, available clinical techniques and their inherent complications are reviewed. A comparative evaluation of clinical techniques in terms of efficacy, akinesia, and patient-perceived pain during both anesthesia administration and intraoperative cataract surgery is presented, along with the prevailing practice patterns of anesthesia techniques among refractive surgeons in the United Kingdom and United States. More randomized clinical trials are needed to facilitate statistical methods of metaanalysis to establish convincingly the overall benefits and efficacy of the various local anesthesia procedures in cataract surgery. The wide scope of the present review is of relevance in structuring ophthalmology and anesthesia specialist training programs for junior staff.

Phacoemulsification in vitrectomized eyes: results using a 'phaco chop' technique

PURPOSE

To evaluate the intraoperative and early postoperative complications of phacoemulsification using a 'phaco chop' technique in previously vitrectomized eyes.

METHODS

A prospective interventional case series. Seventy-five previously vitrectomized eyes of 73 consecutive patients underwent phacoemulsification using a 'phaco chop' technique via clear corneal incision. Patients were observed for any intraoperative or early postoperative complications.

RESULTS

Fifty-four eyes (72%) had predominant nuclear sclerosis or posterior subcapsular cataract. The intraoperative findings included intraoperative miosis [seen in 21 eyes (28%)] and posterior capsule plaques [in 15 eyes (20%)]. No other significant intraoperative complication (posterior capsule rupture, zonular lysis or dropped nuclei) was observed. In the early postoperative period, one patient had massive serous choroidal detachment, which resolved with conservative treatment. Mean preoperative visual acuity (LogMar scale) was 0.74, which improved to 0.36 postoperatively (p < 0.001).

CONCLUSION

Phacoemulsification using a 'phaco chop' technique is a safe procedure in vitrectomized eyes.