[Agreement between ophthalmologist and nurse in the first postoperative exploration following cataract extraction]

INTRODUCTION

Nursing activity in the cataract extraction process extends from carrying out biometry in the preoperative stage and collaboration in surgery, to providing the initial care in the postoperative stage and keeping the patient and family informed throughout the whole process. This article analyses agreement between ophthalmologists and nurses in the findings of the first post-surgical exploration of patients of cataract extraction using facoemulsification and without complications in surgery.

METHODS

The study was carried out between May and June of 2005 on 129 patients who had been operated on for cataracts, 78 women and 51 men with an average age of 73.1 years. The variables to be evaluated in the first post-surgical exploration were defined, and a study was made of the agreement between ophthalmologists and nurses in identification of the most frequent complications in cataract surgery.

RESULTS

Agreement was 100% in the cases of intraocular pressure >22 mm Hg, pupil irregularity, inflammatory reaction of the anterior chamber and iris prolapse; it was 65.9% on the presence of Seidel; and 60.5% on severe corneal edema.

CONCLUSIONS

The high rate of agreement between ophthalmologists and nurses in 4 of the variables might offer the possibility of the nurse carrying out this post-surgical exploration. However, a moderate rate of agreement in the other variables makes a longer training period for nursing personnel necessary in order to obtain higher values.

An evaluation of the administration of sub-Tenon local anaesthesia by a nurse practitioner

AIM

To evaluate the administration of sub-Tenon local anaesthesia (LA) by a nurse practitioner.

METHODS

106 consecutive patients listed for cataract surgery were given sub-Tenon's anaesthesia by a nurse practitioner. The surgical procedure was performed within 15 minutes of the administration of the LA. Pain, state and adequacy of anaesthesia, appearance of the eye, and patient anxiety were measured. Patients' experiences of this new nursing role were gained through interview.

RESULTS

At the beginning of surgery, few patients showed eye movement in any of the four quadrants and the surgeons reported that akinesia was inadequate in only seven (7.1%) cases. Three patients (3.3%) gave a pain score of 3 out of 10 or above during surgery whereas the surgeons assessed the pain relief to be inadequate in eight (8.1%) cases. Five (5.3%) patients required a top up of anaesthesia and 51 (39.8%) patients developed conjunctival chemosis in two or more quadrants. Overall, patients' comments indicate that they were pleased with the new service.

CONCLUSION

The results suggest that nurse practitioner delivered sub-Tenon LA is an effective and safe method of LA administration for cataract surgery.

Phacoemulsification procedures performed with topical anesthesia

Phacoemulsification procedures with topical anesthesia, performed with small corneal incisions and 4% lidocaine hydrochloride methylparaben-free eye drops, have very high patient satisfaction rates because patients do not experience intraoperative pain, do not require sutures or eye patches, and have immediate improvements in their vision. Phacoemulsification procedures with topical anesthesia are cost-effective for surgery departments because patients have shorter hospitalizations and require fewer chargeable items. The perioperative nursing role is essential to the success of phacoemulsification procedures with topical anesthesia.

Phacoemulsification needle enhances cataract surgery

Phacoemulsification, a cataract removal technique, can be facilitated by certain instruments. A micro-incision needle can help improve surgical team comfort and patient outcomes. Infusional flow helps prevent thermal damage and wound leakage in the eye.