1
|
Wang XQ, Zheng SJ, Xiang YG, Huang FF, Huang RX, Wan WJ, Hu K. Investigation of subclinical ocular inflammation in the aqueous humor of patients with myopia following bilateral sequential collamer lens implantation. Transpl Immunol 2024; 85:102052. [PMID: 38750973 DOI: 10.1016/j.trim.2024.102052] [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: 11/09/2023] [Revised: 05/08/2024] [Accepted: 05/11/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND The aqueous humor, a transparent fluid secreted by the ciliary body, supports the lens of the eyeball. In this study, we analyzed the cytokine and chemokine profiles within the aqueous humor of the contralateral eye post-implantation of an implantable collamer lens (ICL) to evaluate potential subclinical inflammation in the second eye subsequent to ICL implantation in the first eye. METHODS Aqueous humor samples were procured from both eyes of 40 patients (totaling 80 eyes) prior to bilateral ICL insertion. Subsequently, a comprehensive statistical analysis was conducted using the Luminex assay to quantify 30 different cytokines in these samples. RESULTS Compared to the first eye, the aqueous humor of the second eye demonstrated decreased concentrations of IFN-γ (P = 0.038), IL-13 (P = 0.027), IL-17/IL-17 A (P = 0.012), and IL-4 (P = 0.025). No significant differences were observed in other cytokine levels between the two groups. Patients were then categorized based on the postoperative rise in intraocular pressure (IOP) in the first eye. The group with elevated IOP displayed elevated levels of EGF in the aqueous humor of the first eye (P = 0.013) and higher levels of PDGF-AB/BB in the aqueous humor of the second eye (P = 0.032) compared to the group with normal IOP. Within the elevated IOP group, the levels of EGF (P = 0.013) and IL-17/IL-17 A (P = 0.016) in the aqueous humor were lower in the second eye than in the first eye. In the normal IOP group, cytokine levels did not differ notably between eyes. CONCLUSION Following sequential ICL implantation, it appears that a protective response may be activated to mitigate subclinical inflammation in the second eye induced by the initial implantation in the first eye. Additionally, the increase in IOP subsequent to surgery in the first eye may correlate with the presence of inflammatory mediators in the aqueous humor.
Collapse
Affiliation(s)
- Xiao-Qin Wang
- Chongqing Medical University, Chongqing 400016, China; Department of ophthalmology, People's Hospital of Tongliang District, Chongqing 400000, China
| | - Shi-Jie Zheng
- Chongqing Medical University, Chongqing 400016, China; Department of ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400016, China
| | | | - Fan-Fan Huang
- Chongqing Medical University, Chongqing 400016, China
| | - Rong-Xi Huang
- Department of Endocrinology, Chongqing People's Hospital, Chongqing 400000, China
| | - Wen-Juan Wan
- Chongqing Medical University, Chongqing 400016, China; Department of ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400016, China.
| | - Ke Hu
- Chongqing Medical University, Chongqing 400016, China; Department of ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400016, China.
| |
Collapse
|
2
|
Bhadari AH, Tagare S, Wagh AS, Nair M, Venkatesh R. Innovative microscope simulator for cataract patients: Enhancing understanding and comfort. Indian J Ophthalmol 2024; 72:1070-1071. [PMID: 38905468 PMCID: PMC11329808 DOI: 10.4103/ijo.ijo_3158_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024] Open
Affiliation(s)
- Anand H Bhadari
- Department of General Ophthalmology, Aravind Eye Hospital, Pondicherry, India
| | - Shivraj Tagare
- Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Akshay S Wagh
- Department of General Ophthalmology, Aravind Eye Hospital, Pondicherry, India
| | - Megha Nair
- Cornea and Refractive Surgery Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Rengaraj Venkatesh
- Chief Medical Officer, Glaucoma Services, Aravind Eye Hospital, Pondicherry, India
| |
Collapse
|
3
|
Wutthayakorn W, Chansangpetch S, Tunruttanakul S. Topical and subconjunctival anesthesia versus topical anesthesia alone in patients with senile cataracts undergoing phacoemulsification: a double-blind randomized controlled trial. BMC Ophthalmol 2024; 24:20. [PMID: 38216983 PMCID: PMC10785538 DOI: 10.1186/s12886-024-03284-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND This study compared topical anesthesia to a combination of topical anesthesia and subconjunctival anesthesia for phacoemulsification. METHODS This double-blinded parallel placebo-controlled randomized trial involved senile cataract patients scheduled for phacoemulsification between May and December 2022. Patients were randomly assigned to receive either topical anesthesia with 0.5% tetracaine hydrochloride and subconjunctival balanced salt solution injection (Control group) or topical anesthesia and subconjunctival injection with 2% lidocaine (Lidocaine group). Baseline parameters, cataract grades, and various outcomes were recorded, including pain scores at specific time points, patient cooperation scores, requests for additional anesthesia, and complications. Statistical methods included Fisher's exact test, the t-test, ordinal logistic regression, and linear regression with robust standard errors. RESULTS In total, 176 patients were included in the study after excluding 33 patients. A significant reduction in immediate postoperative pain was achieved in the Lidocaine group (p < 0.001) and was maintained for 2 h (p = 0.011). Additionally, better cooperation was observed in this group (p = 0.038). However, patients in the Lidocaine group experienced more pain during the subconjunctival injection (p = 0.001) and a significant increase in subconjunctival hemorrhage related to the injection (p < 0.001). Despite this, the rates of surgical complications were comparable between the groups, and all phacoemulsification procedures were successfully completed using the assigned anesthetic technique. CONCLUSIONS The addition of subconjunctival lidocaine injection to topical anesthesia reduced postoperative pain and improved patient cooperation during phacoemulsification. However, the lidocaine injection was painful, and it carried a higher risk of spontaneous-relief subconjunctival hemorrhage. TRIAL REGISTRATION Trial Registration Number: TCTR20220804003, date of registration August 4, 2022, retrospectively registered.
Collapse
Affiliation(s)
| | - Sunee Chansangpetch
- Center of Excellent in Glaucoma, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Suppadech Tunruttanakul
- Department of Surgery, Sawanpracharak Hospital, 43 Atthakawee Road, Muang, Nakhon Sawan, 60000, Thailand.
| |
Collapse
|
4
|
Loong LJ, Ling KK, Tai ELM, Kueh YC, Kuan G, Hussein A. The Effect of Binaural Beat Audio on Operative Pain and Anxiety in Cataract Surgery under Topical Anaesthesia: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10194. [PMID: 36011825 PMCID: PMC9408317 DOI: 10.3390/ijerph191610194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/26/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
Background: The aim of this paper was to examine the analgesic and anxiolytic effects of binaural beat audio in patients undergoing cataract surgery under topical anaesthesia. Methods: This was a prospective, randomized controlled trial of 61 patients undergoing cataract surgery under topical anaesthesia. They were divided into two research conditions; the binaural beat audio group, and a sham-control group (ear phones with no music). Patients completed the State-Trait Anxiety Inventory questionnaire (STAI), and their blood pressure (BP) and heart rate (HR) were measured pre- and post-intervention. Intraoperative pain levels were ascertained using a visual analog scale (VAS) completed immediately after the surgery. Results: The binaural beat group had significantly lower pain scores (p < 0.001), HR (p < 0.001), diastolic BP (p = 0.003), mean arterial pressure (p = 0.007) and anxiety (p = 0.009) than the control group. Within the binaural beat group, subjects experienced a statistically significant reduction in HR (p = 0.004) and anxiety (p < 0.001) levels compared to baseline values, while all parameters, except anxiety, increased significantly in the control group. Conclusions: Binaural beat audio decreases operative pain and anxiety in cataract surgery under topical anaesthesia. It may have additional benefits in modulating the tachycardic response to stress.
Collapse
Affiliation(s)
- Ling Jiunn Loong
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Koh Koon Ling
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Evelyn Li Min Tai
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Yee Cheng Kueh
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Garry Kuan
- Exercise and Sports Science, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Adil Hussein
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Incidence and Risk Factors of Moderate to Severe Postoperative Pain Following the Placement of Primary and Secondary Orbital Implants: A Prospective Observational Study. Ophthalmic Plast Reconstr Surg 2021; 37:27-32. [PMID: 32282646 DOI: 10.1097/iop.0000000000001664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To prospectively explore the incidence and risk factors of moderate to severe pain after primary and secondary orbital implantation following evisceration or enucleation surgery. METHODS One hundred eighteen patients under general anesthesia for orbital implantation were enrolled in this study. In 91 patients, primary orbital implantation followed evisceration, and in 27 patients, the implantation was secondary after previous evisceration or enucleation surgery. Medical interventions for all participants were followed by standardized surgical, anesthetic, and analgesic protocols. Postoperative pain (POP) intensity was quantified by an 11-point numerical rating scale within 72 hours after the surgery, numerical rating scale ≥4 was considered moderate to severe POP. Multivariate logistic regression was utilized to identify the risk factors related to the development of POP. RESULTS Thirty-five patients (29.7%) displayed moderate to severe POP, particularly within 6 to 24 hours after surgery, which peaked at 24 hours. Of these patients, 26 patients who were unable to tolerate the pain received additional doses of analgesics during in-hospital stay. Logistic regression model revealed that preoperative anxiety (odds ratios = 4.890; p = 0.002), congenital microphthalmia (odds ratios = 14.602; p = 0.038), and surgical time longer than 60 minutes (odds ratios = 5.586; p = 0.001) were significantly associated with moderate to severe POP after orbital implantation. CONCLUSIONS Orbital implantation after evisceration or enucleation surgery is likely to cause moderate to severe pain intensity in the early postoperative period. Preoperative anxiety, prolonged surgical time, and congenital microphthalmia were the risk factors.
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
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).
Collapse
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
| |
Collapse
|
9
|
Chen Y, Zhang Y, Sun K, Yan H. Higher TGF-β2 Level in the Aqueous Humor of the Second Eye Versus the First Eye in the Course of Sequential Cataract Surgery. Ocul Immunol Inflamm 2020; 28:439-445. [PMID: 30973281 DOI: 10.1080/09273948.2019.1578888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose: To assess the differences in cytokine levels in the aqueous humor (AH) of bilateral eyes receiving sequential phacoemulsification and intraocular lens implantation.Methods: The levels of 33 cytokines in AH samples collected from separate single-eye operations of 26 age-related cataract patients who experiencing sequential cataract surgery were compared between the first-eye and second-eye groups.Results: The AH level of transforming growth factor beta 2 (TGF-β2), an immunosuppression regulator, in the second-eye group was significantly higher than that in the first-eye group (p = 0.002). No differences in the concentrations or detection rates of other cytokines were observed between the first- and second-eye groups.Conclusion: During bilateral sequential cataract surgery, the AH of the second eye had a higher level of TGF-β2 but not of proinflammatory cytokines or chemokines compared with those in the first eye, implying a protective mechanism preventing the sympathetic immune reaction induced by the first-eye cataract surgery.
Collapse
Affiliation(s)
- Ying Chen
- Department of Ophthalmology, First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Yu Zhang
- Department of Ophthalmology, First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Kexin Sun
- Department of Ophthalmology, First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Hong Yan
- Department of Ophthalmology, First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, China.,Department of Ophthalmology, Xi'an No. 4 Hospital, Shaanxi Eye Hospital, Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| |
Collapse
|
10
|
Patients' Experience of Anxiety and Pain during Retrobulbar Injections prior to Vitrectomy. J Ophthalmol 2019; 2019:8098765. [PMID: 31467696 PMCID: PMC6701333 DOI: 10.1155/2019/8098765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 06/29/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the correlation between pain associated with retrobulbar block and anxiety levels before the injection. Methods This prospective observational, noninterventional study included consecutive patients who received a retrobulbar block by a single surgeon prior to undergoing 25G PPV at the Department of Ophthalmology, Rambam Health Care Campus, between April 2016 and August 2017. Patients plotted their anxiety levels (scale 0–10) using the visual analogue scale for anxiety (VASA), and immediately after receiving the injection, they plotted their experienced level of pain (scale 0–10) using the visual analogue scale for pain (VAS), with scores ≥7 defined as severe. Results Overall, 48 eyes of 48 patients aged 68.4 ± 10.3 years were included, of which 62.5% were of male gender. Severe anxiety and pain were experienced by 10.4% and 12.5%, respectively. There was a significant correlation between VASA and VAS scores (r = 0.43, p=0.002) with no other preprocedural parameters demonstrating a significant association with the VAS score. In multivariate analysis, the VASA score was the only factor that was significant (p=0.01), and a patient with a severe VASA score was 20 times more likely of experiencing severe pain (p=0.006). The ROC curve analysis revealed an area under the curve of 0.89 (p < 0.001), and a VASA score >4 demonstrated a sensitivity of 83.3% and a specificity of 73.8% in predicting severe pain. Conclusions Approximately 10% of patients experience severe anxiety and pain during retrobulbar blocks. Considering the importance of compliance, reducing anxiety and premedication may be considered, particularly in high-risk patients (VASA score > 4).
Collapse
|
11
|
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. J Ophthalmol 2019; 2019:4106893. [PMID: 31341651 PMCID: PMC6612398 DOI: 10.1155/2019/4106893] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/21/2019] [Indexed: 01/11/2023] Open
Abstract
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.
Collapse
|
12
|
Ye H, Chen R, Lian X, Huang J, Mao Y, Lu R, Ai S, Ma W, Lin J, Yang H, Guo W. Risk factors associated with postoperative pain and discomfort in oculoplastic surgery with general anesthesia: a prospective study. J Pain Res 2018; 11:407-415. [PMID: 29503577 PMCID: PMC5827462 DOI: 10.2147/jpr.s156104] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate patient pain and discomfort following oculoplastic surgery performed under general anesthesia and to assess key factors associated with postoperative pain and discomfort. Methods A prospective observational cohort study was conducted among 212 consecutive patients who underwent oculoplastic surgery performed under general anesthesia. The patients were assessed according to quantified levels of pain and discomfort postoperatively. Analgesic requests were recorded, and responses were statistically analyzed. Results Pain and discomfort after oculoplastic surgery under general anesthesia were reported by 32.1% and 28.3% of the patients, respectively; 2.8% of the patients requested analgesic medication within 18 hours after surgery. The patients who underwent orbital decompression, secondary orbital implantation, and orbital fracture repair were more likely to develop significant postoperative pain and discomfort (P<0.001), and the patients who underwent enucleation/evisceration during orbital implantation were more likely to develop postoperative discomfort (P<0.001). The predictors of pain were smoking history, prior surgery on the operative eye, and anxiety (P<0.05), and the predictor of discomfort was anxiety (P<0.05). Conclusion Patients undergoing oculoplastic surgery tend to experience postoperative pain and discomfort. Anxiety is a risk factor for both postoperative pain and discomfort, while smoking history and prior surgery on the operative eye may be associated with postoperative pain.
Collapse
Affiliation(s)
- Huijing Ye
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Rongxin Chen
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xiufen Lian
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Jingxia Huang
- Department of Anesthesia, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Yuxiang Mao
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Rong Lu
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Siming Ai
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Wenfang Ma
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Jingyi Lin
- Department of Anesthesia, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Huasheng Yang
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Wenjun Guo
- Department of Anesthesia, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| |
Collapse
|
13
|
Kong SJ, Jang C, Lim TH, Choi KY, Cho BJ. Comparison between Active and Gravity-based Phacoemulsification Fluidics Systems in Immediate Sequential Bilateral Cataract Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.1.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
14
|
Akkaya S, Özkurt YB, Aksoy S, Kökçen HK. Differences in pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification. Int Ophthalmol 2016; 37:545-552. [DOI: 10.1007/s10792-016-0295-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 07/14/2016] [Indexed: 11/28/2022]
|
15
|
Comparison between Subjective Sensations during First and Second Phacoemulsification Eye Surgeries in Patients with Bilateral Cataract. J Ophthalmol 2016; 2016:6521567. [PMID: 27239336 PMCID: PMC4863115 DOI: 10.1155/2016/6521567] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 04/08/2016] [Accepted: 04/17/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. To evaluate and compare the subjective sensations reported by patients during first and second cataract extractions. Methods. Consecutive patients undergoing bilateral sequential cataract extraction using phacoemulsification were recruited. Following cataract surgery, patients completed questionnaires designed to evaluate subjective sensations, including anxiety, eye bulges, pain, and light sensitivity. Changes in painful sensations experienced by patients between the two surgeries were also recorded. Comparisons were also performed for each subjective sensation between different age groups (<50, 50-59, 60-69, 70-79, and >79 years). Results. A total of 127 patients were included in the final evaluation. Statistical comparison of the results showed that there were significant differences in perception of anxiety, eye bulges, and pain scores between the first and second cataract surgeries (P < 0.05). However, there was no statistically significant difference for light sensitivity scores between the two surgeries (P = 0.555). The differences in anxiety, perception of eye bulges, pain, and light sensitivity scores between both the surgeries showed no correlation with age (P > 0.05 for all). Conclusions. Our research confirms the common observation that patients with bilateral cataracts often report more ocular discomfort during the second surgery. There are, therefore, additional factors that should be considered upon treating patients with bilateral cataracts, and the provision of preoperative counseling could play an important role in providing adequate patient care.
Collapse
|
16
|
Lesin M, Dzaja Lozo M, Duplancic-Sundov Z, Dzaja I, Davidovic N, Banozic A, Puljak L. Risk factors associated with postoperative pain after ophthalmic surgery: a prospective study. Ther Clin Risk Manag 2016; 12:93-102. [PMID: 26858525 PMCID: PMC4730994 DOI: 10.2147/tcrm.s97024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Risk factors associated with postoperative pain intensity and duration, as well as consumption of analgesics after ophthalmic surgery are poorly understood. METHODS A prospective study was conducted among adults (N=226) who underwent eye surgery at the University Hospital Split, Croatia. A day before the surgery, the patients filled out questionnaires assessing personality, anxiety, pain catastrophizing, sociodemographics and were given details about the procedure, anesthesia, and analgesia for each postoperative day. All scales were previously used for the Croatian population. The intensity of pain was measured using a numerical rating scale from 0 to 10, where 0 was no pain and 10 was the worst imaginable pain. The intensity of pain was measured before the surgery and then 1 hour, 3 hours, 6 hours, and 24 hours after surgery, and then once a day until discharge from the hospital. Univariate and multivariate analyses were performed. RESULTS A multivariate analysis indicated that independent predictors of average pain intensity after the surgery were: absence of premedication before surgery, surgery in general anesthesia, higher pain intensity before surgery and pain catastrophizing level. Independent predictors of postoperative pain duration were intensity of pain before surgery, type of anesthesia, and self-assessment of health. Independent predictors of pain intensity ≥5 during the first 6 hours after the procedure were the type of procedure, self-assessment of health, premedication, and the level of pain catastrophizing. CONCLUSION Awareness about independent predictors associated with average postoperative pain intensity, postoperative pain duration, and occurrence of intensive pain after surgery may help health workers to improve postoperative pain management in ophthalmic surgery.
Collapse
Affiliation(s)
- Mladen Lesin
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Mirna Dzaja Lozo
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | | | - Ivana Dzaja
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | | | - Adriana Banozic
- Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia
| | - Livia Puljak
- Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia
| |
Collapse
|
17
|
Adatia FA, Munro M, Jivraj I, Ajani A, Braga-Mele R. Documenting the subjective patient experience of first versus second cataract surgery. J Cataract Refract Surg 2015; 41:116-21. [PMID: 25532639 DOI: 10.1016/j.jcrs.2014.04.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/04/2014] [Accepted: 04/25/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To examine the subjective patient experience after cataract surgery. SETTING Single multisurgeon cataract facility. DESIGN Prospective intraindividual observational study. METHODS Patients completed a questionnaire immediately after cataract extraction performed in their second eye. All patients had second-eye surgery within 6 months of first-eye surgery. Cases longer than 30 minutes were excluded. RESULTS Of the 292 patients who completed the questionnaire, 12 were excluded based on surgical time. The response rate varied per question. The surgery was rated as taking longer or being more painful in the second eye by 127 patients (45.4%) and in the first eye by 38 patients (13.5%) (P < .05); 115 patients (41.1%) reported no difference. Patients (47.83%) who rated the second eye as the generally more negative experience thought their vision would be better and 3.48% worse (P < .05); 48.70% thought it would be the same. No difference was noted in length of surgery (P = .3) or sedation used (P = .96). CONCLUSIONS Of 125 patients who rated second-eye surgery as the generally more unpleasant procedure, 90 (72.0%) were similarly or more relaxed during the second procedure. Second-eye cataract surgery was perceived as being a longer and/or more painful procedure by a significant number of patients (45.4%), and only 3.48% thought that vision in the second eye would be worse. These results can help surgeons when counseling patients regarding expectations for second surgery. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- Feisal A Adatia
- From the Section of Ophthalmology (Adatia, Munro), University of Calgary, the Mitchell Eye Centre (Adatia), Southern Alberta Eye Center, Calgary, and the Department of Ophthalmology (Jivraj), University of Alberta, Edmonton, Alberta, and the Department of Ophthalmology (Braga-Mele), University of Toronto, Toronto, Ontario, Canada; the Department of Emergency Medicine (Ajani), Wayne State University, Detroit, Michigan, USA.
| | - Monique Munro
- From the Section of Ophthalmology (Adatia, Munro), University of Calgary, the Mitchell Eye Centre (Adatia), Southern Alberta Eye Center, Calgary, and the Department of Ophthalmology (Jivraj), University of Alberta, Edmonton, Alberta, and the Department of Ophthalmology (Braga-Mele), University of Toronto, Toronto, Ontario, Canada; the Department of Emergency Medicine (Ajani), Wayne State University, Detroit, Michigan, USA
| | - Imran Jivraj
- From the Section of Ophthalmology (Adatia, Munro), University of Calgary, the Mitchell Eye Centre (Adatia), Southern Alberta Eye Center, Calgary, and the Department of Ophthalmology (Jivraj), University of Alberta, Edmonton, Alberta, and the Department of Ophthalmology (Braga-Mele), University of Toronto, Toronto, Ontario, Canada; the Department of Emergency Medicine (Ajani), Wayne State University, Detroit, Michigan, USA
| | - Abdallah Ajani
- From the Section of Ophthalmology (Adatia, Munro), University of Calgary, the Mitchell Eye Centre (Adatia), Southern Alberta Eye Center, Calgary, and the Department of Ophthalmology (Jivraj), University of Alberta, Edmonton, Alberta, and the Department of Ophthalmology (Braga-Mele), University of Toronto, Toronto, Ontario, Canada; the Department of Emergency Medicine (Ajani), Wayne State University, Detroit, Michigan, USA
| | - Rosa Braga-Mele
- From the Section of Ophthalmology (Adatia, Munro), University of Calgary, the Mitchell Eye Centre (Adatia), Southern Alberta Eye Center, Calgary, and the Department of Ophthalmology (Jivraj), University of Alberta, Edmonton, Alberta, and the Department of Ophthalmology (Braga-Mele), University of Toronto, Toronto, Ontario, Canada; the Department of Emergency Medicine (Ajani), Wayne State University, Detroit, Michigan, USA
| |
Collapse
|
18
|
Lesin M, Domazet Bugarin J, Puljak L. Factors associated with postoperative pain and analgesic consumption in ophthalmic surgery: a systematic review. Surv Ophthalmol 2014; 60:196-203. [PMID: 25890623 DOI: 10.1016/j.survophthal.2014.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 10/21/2014] [Accepted: 10/31/2014] [Indexed: 01/08/2023]
Abstract
Pain in ophthalmic surgery is a neglected area. We systematically reviewed the factors associated with postoperative pain and analgesic consumption in ophthalmic surgery and found 12 studies with 1,515 participants. The median number of patients in the included studies was 59. Female sex, longer duration of surgical procedure, second eye surgery as a consecutive procedure, type of surgery, general anesthesia, lower satisfaction with anesthesia, and postoperative nausea may contribute to increased postoperative pain intensity. Type of surgery, type of anesthesia, and patient satisfaction with anesthesia were associated with increased analgesic consumption. The studies reviewed were heterogeneous in terms of surgical procedures, patient populations, tools for pain assessment, and timing of postoperative pain measurement. Multiple factors may be associated with increased postoperative pain and analgesic consumption and warrant further research.
Collapse
Affiliation(s)
- Mladen Lesin
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Josipa Domazet Bugarin
- Department of Anesthesiology, Reanimation and Intensive Care, University Hospital Split, University of Split School of Medicine, Split, Croatia
| | - Livia Puljak
- Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia.
| |
Collapse
|
19
|
Aslankurt M, Aslan L, Başkan AM, Aksoy A, Silay E, Yıldız H. Pain and cooperation in patients having dominant-side or nondominant-side phacoemulsification. J Cataract Refract Surg 2013; 40:199-202. [PMID: 24291336 DOI: 10.1016/j.jcrs.2013.07.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 07/13/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the relationship between laterality and perceived pain and cooperation during phacoemulsification under combined topical and intracameral anesthesia. SETTING University ophthalmology clinic and eye hospital, Kahramanmaraş, Turkey. DESIGN Cohort study. METHODS Seventy-eight patients with senile cataracts who had ocular surgery were included prospectively. The dominant side was determined with the Edinburg Handedness Inventory. Phacoemulsification and intraocular lens implantation were performed. The surgeon graded the patient's cooperation from 0 (best) to 3 (worst). The duration of surgery was recorded. Another researcher rated perceived pain from 0 (no pain) to 10 (unbearable pain) using a visual analogue scale (VAS). Pain scores and the degree of cooperation for dominant-side and nondominant-side surgery were the primary outcomes. RESULTS Forty-six patients had surgery in the dominant eye and 32 in the nondominant eye. The 2 groups were similar in age, sex, and severity and type of cataract. The mean VAS score was significantly higher in patients having dominant-side surgery than in those having nondominant-side surgery (P<.01). Similarly, the mean cooperation score was significantly poorer in the patients having dominant-side surgery (P<.05). Visual analogue scores were correlated with patient cooperation (r = 0.890, P<.0001). CONCLUSION Pain scores were higher in dominant-side surgery for cataract under topical and intracameral anesthesia, which should be kept in mind when selecting anesthesia and in studies in which pain is scored. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- Murat Aslankurt
- From the Department of Ophthalmology (Aslankurt, Aslan, Aksoy) and Department of Anesthesiology and Reanimation (Silay, Yıldız), Faculty of Medicine, Sutcu Imam University, and Uğur Eye Hospital (Başkan), Kahramanmaraş, Turkey.
| | - Lokman Aslan
- From the Department of Ophthalmology (Aslankurt, Aslan, Aksoy) and Department of Anesthesiology and Reanimation (Silay, Yıldız), Faculty of Medicine, Sutcu Imam University, and Uğur Eye Hospital (Başkan), Kahramanmaraş, Turkey
| | - Ahmet M Başkan
- From the Department of Ophthalmology (Aslankurt, Aslan, Aksoy) and Department of Anesthesiology and Reanimation (Silay, Yıldız), Faculty of Medicine, Sutcu Imam University, and Uğur Eye Hospital (Başkan), Kahramanmaraş, Turkey
| | - Adnan Aksoy
- From the Department of Ophthalmology (Aslankurt, Aslan, Aksoy) and Department of Anesthesiology and Reanimation (Silay, Yıldız), Faculty of Medicine, Sutcu Imam University, and Uğur Eye Hospital (Başkan), Kahramanmaraş, Turkey
| | - Emin Silay
- From the Department of Ophthalmology (Aslankurt, Aslan, Aksoy) and Department of Anesthesiology and Reanimation (Silay, Yıldız), Faculty of Medicine, Sutcu Imam University, and Uğur Eye Hospital (Başkan), Kahramanmaraş, Turkey
| | - Hüseyin Yıldız
- From the Department of Ophthalmology (Aslankurt, Aslan, Aksoy) and Department of Anesthesiology and Reanimation (Silay, Yıldız), Faculty of Medicine, Sutcu Imam University, and Uğur Eye Hospital (Başkan), Kahramanmaraş, Turkey
| |
Collapse
|