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Eom Y, Koh E, Lee DH, Lee SJ, Nam DH. Comparison of patient experiences and clinical outcomes between an illuminated chopper and a conventional chopper under a surgical microscope. J Cataract Refract Surg 2023; 49:1036-1042. [PMID: 37440456 DOI: 10.1097/j.jcrs.0000000000001257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE To compare patient experiences and cooperation and the clinical outcomes illuminated chopper vs conventional chopper during cataract surgery. SETTING 4 tertiary institutions in Korea. DESIGN Prospective, randomized, paired-eye, controlled pilot study. METHODS 152 eyes of 76 patients who underwent bilateral cataract surgeries were enrolled in this study. The surgical method was randomly assigned to each patient's eye (1 eye using the illuminated chopper with a light source and the other using the conventional chopper under the microscope light). Patient suffering scores (the degree of strong light perception, glare, inability to fixate, anxiety, discomfort, and fear) from 0 to 10 (10 being the most severe level); cooperation score from 0 to 3 (3 being the best cooperation); operating time; and corneal endothelial cell density (ECD) preoperatively and postoperatively were compared between the 2 groups. RESULTS The mean patient suffering score of all 6 parameters in the iChopper group was significantly smaller than those in the control group (all P < .05). The mean patient cooperation score of the iChopper group (2.3 ± 0.8) was significantly greater than that of the control (1.6 ± 0.9; P < .001). There was no significant difference in the mean operating time and corneal ECD at each visit between the groups, albeit the mean corneal ECD was significantly decreased from baseline to 1 month after cataract surgery in both groups. CONCLUSIONS Phacoemulsification using the illuminated chopper provides less glare and anxiety and better cooperation during cataract surgery without increasing the operating time and damaging corneal endothelium compared with the conventional chopper.
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Affiliation(s)
- Youngsub Eom
- From the Department of Ophthalmology, Korea University Ansan Hospital, Gyeonggi-do, South Korea (Eom); Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea (Eom); Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia (Eom); Medical College of Georgia, Augusta University, Augusta, Georgia (Koh); Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea (D.H. Lee); Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea (S.J. Lee); Department of Ophthalmology, Gachon University Gil Hospital, Gachon University College of Medicine, Incheon, South Korea (Nam)
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Putri IV, Effendy E, Nasution NM. The Difference in Anxiety Scores Prior and After Cataract Surgery among Bilateral Senile Cataract Patients at Sumatera Eye Center Medan. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: A cataract defines as a dense, cloudy area that forms in the lens of the eyes, altering one’s physical function, as well as social and psychological aspects. The only definitive treatment option for cataracts is surgery which may lead to anxiety either before the intervention, on intervention, or after the intervention.
AIM: This study is to investigate the difference in anxiety scores among bilateral senile cataract patients at Sumatera Eye Centre Medan before and after undergoing cataract surgery.
METHOD: This comparative analytical study was carried out using Hospital Anxiety and Depression Scale-Anxiety Subscale to assess anxiety symptoms experienced by 40 bilateral senile cataract patients. Measurement was taken twice, before the surgery ad after undergoing surgery.
RESULT: There is a significant difference in anxiety scores before and after undergoing surgery (p < 0.001).
CONCLUSION: There is a significant difference in anxiety scores before and after undergoing surgery among our subjects. We also found that anxiety is more likely to occur before the surgery.
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Taylan S, Çelik GK. The Effect of Preoperative Fear and Related Factors on Patients’ Postcataract Surgery Comfort Level: A Regression Study. J Perianesth Nurs 2022; 37:398-403. [DOI: 10.1016/j.jopan.2021.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/05/2021] [Accepted: 08/28/2021] [Indexed: 10/18/2022]
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Fan Z, Fan C, Qi B, Zhang B, Li W, Qi X, Liu X, Zhang BN, Huang Y. Sympathetic Nerve-Mediated Fellow Eye Pain During Sequential Cataract Surgery by Regulating Granulocyte Colony Stimulating Factor CSF3. Front Cell Neurosci 2022; 16:841733. [PMID: 35281296 PMCID: PMC8907920 DOI: 10.3389/fncel.2022.841733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Patients were found to experience more pain during their second eye cataract surgery compared with their first eye surgery. This study aimed to explore the inflammatory alterations along time in the fellow eye after the first eye surgery and to reveal the underlying mechanism. Eighty patients with bilateral cataracts were recruited and were divided into four groups based on the time of having the second eye surgery. The second eye aqueous humor samples were collected just before surgery and analyzed by mass spectrometry and PCR array. Cytokine activity was enriched in the aqueous humor of the contralateral eye with granulocyte colony-stimulating factor CSF3 significantly upregulated at both gene and protein levels. Rabbits with or without superior cervical ganglionectomy (SCGx) were subjected to lensectomy to mimic human situations. In both human and rabbit models, the fellow eye CSF3 peaked at 1 week post the first eye surgery. Consistently, more neutrophils were recruited to the contralateral eye aqueous humor. Corneal sensitivity and trigeminal electrophysiology were recorded to imply the pain severity in rats receiving capsulorrhexis with or without SCGx. A more intense pulse was detected in the contralateral trigeminal ganglion after the rat received one eye surgery. SCGx could effectively reduce the fellow corneal sensitivity and trigeminal nerve pain. These alterations were under direct regulation of the sympathetic nerves on the surgical eye side. Our results suggest that CSF3 and sympathetic activity could serve as potential analgesic targets during ocular surgeries.
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Affiliation(s)
- Zheng Fan
- Medical College of Qingdao University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
| | - Caixia Fan
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Benxiang Qi
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Bin Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Wenfeng Li
- Department of Medical Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xia Qi
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Xiaomin Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Bi Ning Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- *Correspondence: Bi Ning Zhang,
| | - Yusen Huang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- Yusen Huang,
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Karakahya RH. Do Consecutive Phacoemulsification Surgeries Under Topical Anesthesia Differ in Terms of Pain Perception and Cooperation? Cureus 2021; 13:e19915. [PMID: 34966612 PMCID: PMC8710248 DOI: 10.7759/cureus.19915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 12/02/2022] Open
Abstract
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.
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Obuchowska I, Konopinska J. Fear and Anxiety Associated with Cataract Surgery Under Local Anesthesia in Adults: A Systematic Review. Psychol Res Behav Manag 2021; 14:781-793. [PMID: 34177276 PMCID: PMC8219311 DOI: 10.2147/prbm.s314214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
Cataract surgery is one of the most frequently performed surgical procedures worldwide. Patients usually experience strong negative emotions, such as fear and anxiety. A systematic review of the recent literature regarding the emotional states experienced during cataract surgery under local anaesthesia was performed based on the PubMed and Scopus databases. The objective of this review was to determine the causes and frequency of fear and anxiety, as well as methods for improving intraoperative experience and supporting the patient prior to surgery. Anxiety is mainly caused by fear of the surgery itself, fright of pain, and loss of vision. Abstaining and visual sensations experienced during cataract surgery also increased the preoperative anxiety. Women and hypochondriacs showed higher levels of anxiety. The greatest intensity of negative emotions occurred on the day of the cataract surgery. Patients operated on both eyes experienced greater fear and anxiety before the operation of the first eye surgery. In order to reduce patients’ negative experiences, pharmacological sedation, preoperative education and counselling, manual massage immediately before surgery, and listening to music during surgery are used. Taking this information into consideration allows the introduction of effective methods of eliminating the patient’s negative feelings in connection with cataract surgery, which leads to an improvement in the results of the operation and an increase in the patients’ sense of satisfaction and quality of life.
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Affiliation(s)
- Iwona Obuchowska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, Poland
| | - Joanna Konopinska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, Poland
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Use of Simultaneous Bilateral Cataract Surgery (SBCS) to Optimize Parameters Affecting the Subjective Perception of the Procedure. J Ophthalmol 2021; 2021:5584906. [PMID: 34194819 PMCID: PMC8214475 DOI: 10.1155/2021/5584906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/11/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022] Open
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.
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Konopińska J, Ługowska D, Mariak Z, Obuchowska I. Comparison of auditory sensations in patients who underwent cataract phacoemulsification surgery in the first and second eye. Sci Rep 2021; 11:10026. [PMID: 33976341 PMCID: PMC8113497 DOI: 10.1038/s41598-021-89594-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/29/2021] [Indexed: 01/26/2023] Open
Abstract
To compare subjective auditory sensations of patients during the first and second eye cataract surgeries. Consecutive patients who underwent phacoemulsification of the first eye (group I) and second eye (group II) completed questionnaires designed to evaluate their auditory sensations in the operating room including background music, sound of working equipment, staff conversations, and surgeon's voice. This study included 124 patients in group I and 76 patients in group II. Patients most often heard nursing staff's conversations (91.9% and 96%, respectively, p > 0.05), surgeon's voice (87.9% and 86.8%, respectively, p > 0.05), and music (70.9% and 75%, respectively, p > 0.05). Music was the most pleasant experience (78.2% and 78.9%, respectively, p > 0.05). The sound of the working phacoemulsifier was the most undesirable sound (20.2% and 15.8%, respectively, p > 0.05). Patients in group II more often indicated that none of the sounds required elimination (69.7% and 52.6%, respectively, p = 0.013) or that staff conversations should be eliminated (13.2% and 3.1%, respectively, p = 0.005). The most desirable sounds during phacoemulsification include music and the surgeon's voice regarding the procedure. The most unpleasant sound was that that of phacoemulsifier. The commonest sounds to be eliminated in groups I and II included those of equipment and staff conversations.
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Affiliation(s)
- Joanna Konopińska
- Department of Ophthalmology, Medical University of Bialystok, M. Sklodowska-Curie 24A, 15-276, Bialystok, Poland.
| | - Dorota Ługowska
- Department of Ophthalmology, Medical University of Bialystok, M. Sklodowska-Curie 24A, 15-276, Bialystok, Poland
| | - Zofia Mariak
- Department of Ophthalmology, Medical University of Bialystok, M. Sklodowska-Curie 24A, 15-276, Bialystok, Poland
| | - Iwona Obuchowska
- Department of Ophthalmology, Medical University of Bialystok, M. Sklodowska-Curie 24A, 15-276, Bialystok, Poland
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Local Anesthesia Injection in Upper Blepharoplasty Surgery: A Side at a Time or Both Sides at Once? A Prospective Randomized Study. Dermatol Surg 2021; 47:241-244. [PMID: 33481452 DOI: 10.1097/dss.0000000000002718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perceived pain during local anesthesia injections can be effected by the injection sequence. OBJECTIVE We sought to compare pain levels during local anesthesia injections during upper lid blepharoplasty (ULB) using 2 surgical sequences. MATERIALS AND METHODS We conducted a prospective, randomized clinical trial. Patients with ULB were randomized to either have local anesthesia injection followed by ULB in the right eyelid and then in the left (Group A) or to have local anesthesia injection to both eyelids followed by ULB on both eyelids (Group B). Pain was assessed using a visual analog scale (VAS) for pain score of 0 to 10. RESULTS Forty patients were included and randomized. The mean VAS score in Group A was 2.60 ± 1.84 and 3.30 ± 1.62 (right and left, respectively, p value = .035). The mean VAS score in Group B was 2.55 ± 1.63 and 2.80 ± 1.67 (right and left eyelids, respectively, p value = .258). No intergroup difference in pain was found. CONCLUSION Patients having sequential anesthesia during ULB perceived more pain on injection to the second eyelid, whereas patients having local anesthesia followed by ULB perceived the same amount of pain in both eyes. Pain levels in both groups were similar. Local anesthesia injections in both groups were well tolerated.
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Zhang F, Wang JH, Zhao MS. Dynamic monocyte chemoattractant protein-1 level as predictors of perceived pain during first and second phacoemulsification eye surgeries in patients with bilateral cataract. BMC Ophthalmol 2021; 21:133. [PMID: 33711968 PMCID: PMC7953781 DOI: 10.1186/s12886-021-01880-z] [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] [Received: 10/07/2020] [Accepted: 02/25/2021] [Indexed: 07/02/2024] Open
Abstract
Background The purpose of the study was to investigate whether dynamic monocyte chemoattractant protein-1 (MCP-1) level might be as predictors of perceived pain during the first and second phacoemulsification eye surgeries in patients with bilateral cataract. Methods Consecutive bilateral cataract patients undergoing bilateral sequential phacoemulsification were retrospectively enrolled. Patients’ preoperative anxiety score and intraoperative pain score were registered. Aqueous humor samples were obtained during surgery. MCP-1 level in the aqueous humor was measured by enzyme linked immunosorbent assay (Elisa). Patients were assigned to seven subgroups based on the interval between first-eye and second-eye cataract surgery. Comparisons were performed for a subjective sensation and MCP-1 levels among different subgroups. Results pain score during second-eye surgery was significantly higher than during first-eye surgery. Whereas there was no statistical difference in anxiety score between both surgeries. Result from subgroups comparison showed that the visual analog scale (VAS) pain score was statistically greater in 1-group and 6-group during the second eye surgery. Anxiety score did not statistically differ in subgroups. Additionally, the second-eye MCP-1 level was significantly higher at week 1and 6 intervals. Preoperative MCP-1 level was positively correlated with perceiving pain score during both surgeries. Conclusions MCP-1 level in aqueous humor significantly correlated with perceived pain during cataract surgery. Dynamic MCP-1 level could function as predictors of perceived pain during the first and second phacoemulsification eye surgeries in patients with bilateral cataract, which might support clinicians in treatment optimization and clinical decision-making.
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Affiliation(s)
- Feng Zhang
- Department of Ophthalmology, The Second Clinical Medical College, Jing Zhou Central Hospital, Yangtze University, Hubei, 434020, Jing Zhou, China.,Department of Cataract, Ophthalmic Center, The Second Affiliated Hospital of Jilin University, Jilin, 130041, Chang Chun, China
| | - Jin-Hua Wang
- Department of Ophthalmology, The Second Clinical Medical College, Jing Zhou Central Hospital, Yangtze University, Hubei, 434020, Jing Zhou, China
| | - Mei-Sheng Zhao
- Department of Cataract, Ophthalmic Center, The Second Affiliated Hospital of Jilin University, Jilin, 130041, Chang Chun, China.
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Obuchowska I, Ługowska D, Mariak Z, Konopińska J. Subjective Opinions of Patients About Step-by-Step Cataract Surgery Preparation. Clin Ophthalmol 2021; 15:713-721. [PMID: 33658752 PMCID: PMC7917310 DOI: 10.2147/opth.s298876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 01/22/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose We analyzed the subjective feelings and opinions of patients regarding modified cataract phacoemulsification procedures. Patients and Methods A consecutive case series of patients undergoing phacoemulsification of cataracts, who completed questionnaires designed by the authors to evaluate their subjective opinions about hospital admission, medical examination, and intraoperative procedures carried out at the operating theater. Results Two hundred patients (82 men and 118 women) were included in the study. Subjects aged ≥65 years more often than younger respondents presented negative opinions about hospital admission procedures (15% vs. 2.5%, p=0.032) and were less satisfied with physicians’ explanations about the matter of phacoemulsification (71.3% vs. 92.5%, p=0.004), type of artificial lens to be implanted (43.8% vs. 85%, p<0.001), and potential complications (69.4% vs. 95%, p<0.001). The most unpleasant intraoperative experiences included venipuncture (35.5%), artificial lens implantation (30.5%), and peeling off of a sterile surgical drape (24%). Conclusion Persons aged ≥65 years presented with negative opinions about routine procedures related to phacoemulsification. Older age seems to be associated with less tolerance to time-consuming bureaucratic procedures and a lesser understanding of the specific stages of the surgery. Older patients should be notified in advance about all routine procedures to be carried out and provided with a rationale for these activities. Trial Registration The study was registered on clinicaltrials. gov (NCT04327856).
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Affiliation(s)
- Iwona Obuchowska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Dorota Ługowska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Zofia Mariak
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Joanna Konopińska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
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Heard JA, Zacarias AAG, Lawrence AT, Stoicea N, Palettas M, Fiorda-Diaz J, Guertin MG, Tandon A, Lowery DS. A prospective observational cohort study to evaluate patients' experience during sequential cataract surgery under monitored anesthesia care and topical anesthesia. Medicine (Baltimore) 2020; 99:e21834. [PMID: 33217786 PMCID: PMC7676552 DOI: 10.1097/md.0000000000021834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cataract surgery is the most common ambulatory surgery at our outpatient surgery center. Several studies have shown that patients with bilateral cataracts may experience different levels of anxiety, pain, and awareness during the first and second cataract extraction.A prospective observational cohort study was conducted at The Ohio State University Wexner Medical Center Eye and Ear Institute in order to compare anxiety, general comfort, awareness, and pain levels in patients undergoing sequential cataract surgeries. Likert and numerical rating scale were used to assess the outcomes. Patients receiving monitored anesthesia care and topical anesthesia were included.A total of 198 patients were enrolled in this study, 116 patients (59%) were female and 157 patients (78%) were Caucasians with a median age of 67 years among participants. Patients with rating "no anxiety" or feeling "somewhat anxious" were significantly higher during surgery 2 (P =< .001). Most of the patients felt "extremely comfortable" during surgery 1 when compared to surgery 2 (54% vs 42.9%; P = .08). No significant differences were found between surgeries regarding intraoperative awareness (P = .16). Overall, patients experienced mild pain during both procedures (92.4% in surgery 1 compared to 90.4% in surgery 2; P = .55). During the postoperative visit, 54% of the patients associated surgery 2 with less anxiety levels, 53% with no differences in general comfort, 60% felt more aware, and 59% had no differences in pain levels.Previous exposure to surgery could have been associated with a significant reduction in anxiety levels reported during surgery 2. Non-pharmacological strategies aiming to reduce perioperative anxiety may be considered an alternative or additional approach to premedication in patients undergoing consecutive cataract surgeries.
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Affiliation(s)
| | | | | | | | | | | | | | - Amit Tandon
- Department of Ophthalmology, The Ohio State University Wexner Medical Center, Columbus, OH
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Ługowska D, Konopinska J, Mariak Z, Obuchowska I. Comparison of Subjective Preoperative Experiences of Patients Before First- or Second-Eye Cataract Surgeries. Clin Ophthalmol 2020; 14:2883-2889. [PMID: 33061274 PMCID: PMC7524183 DOI: 10.2147/opth.s270196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/25/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the subjective preoperative experiences of patients undergoing their first- or second-cataract surgeries. Patients and Methods Consecutive patients undergoing phacoemulsification were asked to complete postoperative questionnaires evaluating their subjective preoperative experiences, including their emotional state, decision-making process, and opinions on the admission and examination processes, medical interviews, and quality of service. The obtained data were compared between patients undergoing their first (group I)- or second (group II)-cataract surgeries. Results Two hundred patients (group I, 124; group II, 76) were included in the evaluation. Presurgical anxiety was more prevalent in group I than in group II (55.7% vs 34.2%, P = 0.005). Fear was the major trigger for reconsidering the decision to undergo surgery, with 29% and 13.2% of patients in groups I and II, respectively, considering abandoning the operation (P = 0.016). The preoperative medical examination was reported to be sufficiently accurate by 66.1% and 80.3% of patients in groups I and II, respectively (P = 0.047), while 28.2% and 21% of patients in groups I and II, respectively, did not understand the information presented about possible complications of surgery (P = 0.039). Administration of eyedrops before surgery was uncomfortable for 71.4% and 68.4% of patients in groups I and II, respectively (P = 0.553), while 22.6% and 9.2% of patients in groups I and II, respectively, found repeated administration of drops to be highly uncomfortable (P = 0.026). Conclusion Patients experienced greater anxiety before their first-cataract surgery than before their second-cataract surgery. Moreover, many patients from both groups did not understand the medical information provided by doctors regarding the surgery and its possible complications. The most unpleasant stage of preparation for cataract surgery was repeated administration of eyedrops. Trial Registration The study was registered on clinicaltrial.gov under the number NCT04327856.
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Affiliation(s)
- Dorota Ługowska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok 15-276, Poland
| | - Joanna Konopinska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok 15-276, Poland
| | - Zofia Mariak
- Department of Ophthalmology, Medical University of Bialystok, Bialystok 15-276, Poland
| | - Iwona Obuchowska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok 15-276, Poland
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Gong X, Ren Y, Fang X, Cai J, Song E. Substance P induces sympathetic immune response in the contralateral eye after the first eye cataract surgery in type 2 diabetic patients. BMC Ophthalmol 2020; 20:339. [PMID: 32811461 PMCID: PMC7437040 DOI: 10.1186/s12886-020-01598-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 08/05/2020] [Indexed: 12/20/2022] Open
Abstract
Background Substance P (SP) is a nociceptive tachykinin which regulates the immune inflammatory reactions including monocyte chemoattractant protein 1 (MCP-1) production. Sequential second-eye cataract surgery patients often suffer more pain than the first one partly because of the MCP-1 increase in aqueous humor (AH). This study aims to illustrate whether SP is involved in sympathetic inflammatory responses in the contralateral eye in patients with or without type 2 diabetes. Methods This prospective randomized clinical study included 51 cataract patients (22 with diabetes and 29 without). Bilateral sequential cataract surgeries were conducted with 1-day or 1-week interval randomly. More than 100 μl of AH were obtained before surgery and stored for later analysis using magnetic Luminex assays to detect interleukin (IL)-1β, IL-1ra,IL-6, IL-8, IL-10, MCP-1, vascular endothelial growth factor, spinal macrophage inflammatory protein (MIP-1a), interferon-inducible protein 10 (IP-10), regulated on activation, normal T expressed and secreted (RANTES), as well as the enzyme-linked immunosorbent assay for SP. Results Among the 4 groups, no significant differences were found in age, sex distribution, the R/L ration of the first surgery eye, or the lens nucleus hardness (P ≥ 0.802). Over 100 μl of AH samples were collected safely in all cases without intraoperative complications. SP and MCP-1 levels were both increased significantly in the second eye of the diabetic patients with 1-day and 1-week interval (P ≤ 0.040). The SP increase in the second eye of the diabetic patients were significantly higher than that of the patients without diabetes (P ≤ 0.030) both in the groups with 1-day and 1-week interval. Similarly, the MCP-1 increase was significantly higher in the diabetic patients in the group with 1-week interval (P = 0.042). Conclusions Substance P and MCP-1 productions elevated in the AH of the contralateral eye after the first-eye cataract surgery in diabetic patients, indicating that SP and MCP-1 were involved in the sympathetic inflammatory responses. Diabetic patients are susceptible to noninfectious inflammation after cataract surgery, and perceive more pain in the second-eye phacoemulsification. Trial registration Chinese Clinical Trial Registry, ChiCTR1900028374, retrospectively registered on 20th December, 2019.
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Affiliation(s)
- Xianhui Gong
- The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China.,The Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yueping Ren
- The Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiuxiu Fang
- The Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junyong Cai
- The Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - E Song
- Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China.
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15
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Giannaccare G, Bernabei F, Pellegrini M, Guaraldi F, Turchi F, Torrazza C, Senni C, Scotto R, Sindaco D, Di Cello L, Versura P, Scorcia V, Traverso CE, Vagge A. Bilateral morphometric analysis of corneal sub-basal nerve plexus in patients undergoing unilateral cataract surgery: a preliminary in vivo confocal microscopy study. Br J Ophthalmol 2020; 105:174-179. [PMID: 32245849 DOI: 10.1136/bjophthalmol-2019-315449] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/02/2020] [Accepted: 03/20/2020] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate bilateral morphometric changes of corneal sub-basal nerve plexus (CSNP) occurring after unilateral cataract surgery by in vivo confocal microscopy (IVCM) images analysed with automated software. METHODS IVCM was performed before (V0) and 1 month after surgery (V1) in both operated eyes (OEs) and unoperated eyes (UEs) of 30 patients. Thirty age and sex-matched subjects acted as controls. Corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD), corneal nerve fibre length (CNFL), corneal nerve total branch density (CTBD), corneal nerve fibre area (CNFA), corneal nerve fibre width, corneal nerve fractal dimension (CNFrD) and dendritic cells density were calculated. RESULTS Mean CNFD, CNBD, CNFL, CTBD, CNFA and CNFrD significantly decreased at V1 versus V0 in both eyes (respectively, 15.35±7.00 vs 21.21±6.56 n/mm2 in OEs and 20.11±6.69 vs 23.20±7.26 in UEs; 13.57±12.16 vs 26.79±16.91 n/mm2 in OEs and 24.28±14.88 vs 29.76±15.25 in UEs; 9.67±3.44 mm/mm2 vs 13.49±3.42 in OEs and 12.53±3.60 vs 14.02±3.82 in UEs; 22.81±18.77 vs 42.25±24.64 n/mm2 in OEs and 38.06±20.52 vs 43.93±22.27 in UEs; 0.0040±0.0021 vs 0.0058±0.0020 mm2/mm2 in OEs and 0.0049±0.0016 vs 0.0057±0.0019 in UEs; 1.418±0.058 vs 1.470±0.037 in OEs and 1.466±0.040 vs 1.477±0.036 in UEs; always p<0.049). CONCLUSION Patients undergoing cataract surgery exhibit bilateral alterations of CSNP. This finding could have broad implications in the setting of sequential cataract surgery.
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Affiliation(s)
- Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Federico Bernabei
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Marco Pellegrini
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Fabio Guaraldi
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Federica Turchi
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Carlo Torrazza
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Carlotta Senni
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Riccardo Scotto
- Department of Neuroscience Rehabilitation Ophthalmology Genetics and Maternal and Child Health Genova, University of Genoa, Genova, Italy
| | - Daniele Sindaco
- Department of Neuroscience Rehabilitation Ophthalmology Genetics and Maternal and Child Health Genova, University of Genoa, Genova, Italy
| | - Luca Di Cello
- Department of Neuroscience Rehabilitation Ophthalmology Genetics and Maternal and Child Health Genova, University of Genoa, Genova, Italy
| | - Piera Versura
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Carlo E Traverso
- Di.N.O.G, Centro di Ricerca Clinica e Laboratorio per il Glaucoma e la Cornea, Eye Clinic, Genova, Italy
| | - Aldo Vagge
- Department of Neuroscience Rehabilitation Ophthalmology Genetics and Maternal and Child Health Genova, University of Genoa, Genova, Italy
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16
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Lerch D, Venter JA, James AM, Pelouskova M, Collins BM, Schallhorn SC. Outcomes and Adverse Events of Sub-Tenon's Anesthesia with the Use of a Flexible Cannula in 35,850 Refractive Lens Exchange/Cataract Procedures. Clin Ophthalmol 2020; 14:307-315. [PMID: 32099315 PMCID: PMC6999771 DOI: 10.2147/opth.s234807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/11/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To describe our technique of sub-Tenon’s anesthesia and report adverse events and patient comfort. Setting Optical Express, United Kingdom. Design Retrospective case series. Methods The outcomes of 35,850 intraocular procedures (phacoemulsification and implantation of an intraocular lens) were retrospectively reviewed and the incidence of adverse events related to sub-Tenon’s anesthesia was calculated. On the first postoperative day, patients were asked to complete a questionnaire enquiring about their comfort during and after the procedure. The anesthetic solution consisted of a combination of Lidocaine and Hyaluronidase, which was administered into sub-Tenon’s space with a single-use sterile polyurethane 22G x 1” (0.9 x 25 mm) cannula. Mild conscious sedation (midazolam) was used during anesthetic and surgical procedure. Results No significant adverse events that would affect the posterior segment of the eye or result in vision loss were recorded. Subconjunctival haemorrhage related to sub-Tenon’s anesthesia was noted in 4.3% of eyes. Five minutes after the administration of sub-Tenon’s block, 80.6% of eyes had no chemosis, 14.8% had chemosis that affected only 1 quadrant of the eye and 4.5% of eyes had chemosis affecting 2 or more quadrants of the eye. Other adverse events included 14 cases of cyst/granuloma formation in the area of sub-Tenon’s incision and 7 eyes required suturing of the conjunctival cut. Of all patients, 93.2% experienced no or only mild discomfort during or after surgical procedure. Conclusion Sub-Tenon’s anesthesia with the use of a flexible cannula is a safe option for ophthalmic anesthesia. No sight-threatening adverse events occurred.
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Affiliation(s)
- Dagobert Lerch
- Montanamed Ltd., Sankt Gallen, Switzerland.,Optical Express, Glasgow, UK
| | | | - Anca M James
- Montanamed Ltd., Sankt Gallen, Switzerland.,Optical Express, Glasgow, UK
| | | | | | - Steven C Schallhorn
- Optical Express, Glasgow, UK.,University of California, Department of Ophthalmology, San Francisco, CA, USA.,Carl Zeiss Meditec, Dublin, CA, USA
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17
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Liu P, Zhang S, Geng Z, Yuan R, Ye J. Factors affecting pain in patients undergoing bilateral cataract surgery. Int Ophthalmol 2019; 40:297-303. [PMID: 31624986 DOI: 10.1007/s10792-019-01178-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/19/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE To compare the perceived pain and estimated operative duration among patients undergoing bilateral cataract surgery and to demonstrate correlations with the surgical interval and the demographic and medical characteristics of the patients. METHODS A total of 466 patients with cataract who underwent ocular surgery were included. The patients estimated the perceived operative duration and pain they felt during the operation at two times, immediately after surgery and on the first postoperative day; pain was scored using a visual analog scale ranging from 0 (no pain) to 10 (unbearable pain). Patients undergoing bilateral surgeries were divided into four subgroups based on the interval between the two operations (1, 2, 4, or 6 weeks). The perceived pain score and the estimated operative duration were the primary outcomes. RESULTS The pain scores were higher for the second surgery than for the first surgery both immediately after surgery (P = 0.043) and on the first postoperative day (P = 0.002). The estimated operative duration was longer for the second surgery (P = 0.001). Only patients who underwent the second surgery at an interval of 2 weeks perceived more pain both immediately and 1 day postoperatively (P = 0.002, P = 0.022) and a longer operative duration (P < 0.001). Gender, age, and education level might also influence the pain score. CONCLUSIONS Female patients, patients with a younger age, and patients with higher education level are likely to report more pain. Patients who require bilateral cataract surgery should not undergo the second surgery before an interval of 2 weeks.
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Affiliation(s)
- Pei Liu
- Department of Ophthalmology, Daping Hospital, Army Special Medical Center, Army Medical University, Chongqing, 400042, People's Republic of China.,, Chongqing, People's Republic of China
| | - Shuoji Zhang
- Department of Ophthalmology, Daping Hospital, Army Special Medical Center, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Zhao Geng
- Department of Ophthalmology, Daping Hospital, Army Special Medical Center, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Rongdi Yuan
- Department of Ophthalmology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, People's Republic of China.
| | - Jian Ye
- Department of Ophthalmology, Daping Hospital, Army Special Medical Center, Army Medical University, Chongqing, 400042, People's Republic of China.
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18
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Socea SD, Abualhasan H, Magen O, Zayit-Soudry S, Blumenthal EZ, Duvdevan N, Mimouni M. Preoperative Anxiety Levels and Pain during Cataract Surgery. Curr Eye Res 2019; 45:471-476. [DOI: 10.1080/02713683.2019.1666996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sergiu D. Socea
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hamza Abualhasan
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Or Magen
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shiri Zayit-Soudry
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Eytan Z. Blumenthal
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nitsan Duvdevan
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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19
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Clinical Analysis of Ocular Parameters Contributing to Intraoperative Pain during Standard Phacoemulsification. J Ophthalmol 2017; 2017:9463871. [PMID: 28491473 PMCID: PMC5405601 DOI: 10.1155/2017/9463871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/09/2017] [Accepted: 03/19/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose. To study the correlation between ocular parameters and subjective pain that patients perceived during phacoemulsification. Methods. Medical records of 142 patients who underwent standard phacoemulsification under topical anesthesia between March and August 2016 were retrospectively reviewed. The pain during phacoemulsification and 1 h after surgery was assessed and compared using a visual analog scale. In addition, demographic data, preoperative biometric parameters, and intraoperative surgical parameters were recorded. Results. Mean age of patients was 67.49 ± 12.50 years. The mean pain score was 2.26 ± 0.85 during phacoemulsification and 0.40 ± 0.69 postoperatively. Intraoperative pain was significantly associated with higher preoperative intraocular pressure (β = 0.220, P = 0.016), greater anterior chamber depth (β = 0.210, P = 0.028), and greater axial length (β = 0.181, P = 0.043). Conclusions. To reduce the subjective pain when patients have high preoperative intraocular pressure, large anterior chamber depth, or great axial length, supplementary procedures may be required.
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20
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Iwasaki K, Takamura Y, Nishida T, Sawada A, Iwao K, Shinmura A, Kunimatsu-Sanuki S, Yamamoto T, Tanihara H, Sugiyama K, Nakazawa T, Inatani M. Comparing Trabeculectomy Outcomes between First and Second Operated Eyes: A Multicenter Study. PLoS One 2016; 11:e0162569. [PMID: 27622906 PMCID: PMC5021342 DOI: 10.1371/journal.pone.0162569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/24/2016] [Indexed: 12/17/2022] Open
Abstract
Objective To compare surgical outcomes between the first and second operated eyes in patients who underwent trabeculectomy in both eyes. Methods This retrospective clinical cohort study at five clinical centers in Japan included 84 patients with open-angle glaucoma who underwent primary trabeculectomy in both eyes. The primary outcome was surgical success or failure, with failure being defined according to three criteria: <20% reduction of the preoperative intraocular pressure (IOP), or Criterion A, IOP >21 mmHg; Criterion B, IOP >18 mmHg; or Criterion C, IOP >15 mmHg. Cases of reoperation, a loss of light perception vision, or hypotony were also considered as “failures”. Results There were no significant differences in success rate for any of the three criteria between the first and second operated eyes. For patients whose first trabeculectomy was successful, when the second trabeculectomy was performed ≥2 months after the first, the survival curves for all three criteria for the second trabeculectomy were significantly worse than those for patients waiting a shorter interval between trabeculectomies (Criterion A, 52.0% vs 83.6%, P = 0.0031; Criterion B, 51.5% vs 80.4%, P = 0.026; Criterion C, 51.1% vs 80.4%, P = 0.048). In multivariable analyses, a longer interval between trabeculectomies was a significant prognostic factor for surgical failure (Criterion A, P = 0.0055; Criterion B, P = 0.0023; Criterion C, P = 0.027). However, no dependency on the interval between trabeculectomies was found among patients whose first trabeculectomy failed. Conclusions If the first trabeculectomy is successful, a long interval before the second trabeculectomy increases the risk of surgical failure in the second eye. This result has clinical implications for developing surgical strategies for patients with bilateral glaucoma.
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Affiliation(s)
- Kentaro Iwasaki
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Takashi Nishida
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Akira Sawada
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Keiichiro Iwao
- Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ayano Shinmura
- Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Shiho Kunimatsu-Sanuki
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuya Yamamoto
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hidenobu Tanihara
- Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kazuhisa Sugiyama
- Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
- * E-mail:
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