Non-Toxic Anesthesia for Cataract Surgery
01 Nov 2021-Applied Sciences (Multidisciplinary Digital Publishing Institute)-Vol. 11, Iss: 21, pp 10269
TL;DR: In this paper, the safety and efficacy of minimal and localized anesthesia in cataract surgery were evaluated in two groups of 50 patients, which respecitvely received conventional topical anesthesia consisting of preservative-free Oxibuprocaine hydrochloride 0.4% drops or minimal localized anesthesia, administered with a cotton bud soaked in preservative free OxibUp-to-date O-O-HCl 0.5% applied to clear cornea for 10 s immediately before surgery.
Abstract: Background: To study the safety and efficacy provided by a minimal and localized anesthesia in cataract surgery. Methods: Randomized controlled trial. A total of 100 patients undergoing cataract surgery were randomly divided into two groups of 50, which respecitvely received conventional topical anesthesia consisting of preservative-free Oxibuprocaine hydrochloride 0.4% drops or minimal localized anesthesia, administered with a cotton bud soaked in preservative-free Oxibuprocaine hydrochloride 0.4% applied to clear cornea on the access sites for 10 s immediately before surgery. The mean outcome measures were intraoperative pain and the incidence of postoperative ocular discomfort. Results: All patients tolerated well the procedure, giving patin scores between 1–3. Fifteen patients (30%) of group 1 and ten of group 2 (25%) required supplemental anesthesia. No intraoperative complications were recorded. No eyes had epithelial defects at the end of the surgery or at postoperative check-ups. Conclusions: Minimal anesthesia in cataract surgery resulted quick, safe and non-invasive.
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TL;DR: It is confirmed that IVCM helps assess the tunnel after cataract surgery due to its ability to provide microscopic details in vivo, and therapy was well-tolerated and safe.
Abstract: Cataract surgery is widespread. The surgical procedure is associated with damage to the epithelial barrier and interruption of the corneal innervation. In addition, pathological events sustain signs and symptoms that may persist for a long time. Recently, a fixed combination of alpha-glycerylphosphorylcholine and D-Panthenol (Oftassiale) has been available as eye drops. The present study investigated the effects of an Oftassiale therapy in 20 patients undergoing cataract surgery. A comparison group included 20 patients treated with topical hyaluronic acid. Standard prophylactic and anti-inflammatory treatment was prescribed to all patients. Clinical signs and symptoms were assessed over time. In vivo confocal microscopy (IVCM) was performed accordingly. Oftassiale treatment significantly reduced clinical features and improved IVCM outcomes. In addition, therapy was well-tolerated, and no clinically significant adverse events occurred. In conclusion, this study confirmed that IVCM helps assess the tunnel after cataract surgery due to its ability to provide microscopic details in vivo. Topical therapy with alpha-glycerylphosphorylcholine and D-Panthenol eye drops promoted and stabilized the reepithelialization process. This fixed combination also accelerated and modulated the repair of the corneal innervation. Moreover, this treatment was well-tolerated and safe.
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TL;DR: In this article , the authors compared the efficacy and safety of the local anesthetic bupivacaine 0.5% and oxybuprocaine hydrochloride 0.4.
Abstract: Aim This study aimed to compare the efficacy and safety of the local anesthetic bupivacaine 0.5% and oxybuprocaine hydrochloride 0.4% used topically to provide surface anesthesia before intravitreal injection (IVI) procedures. Settings and design This double-blinded, randomized, controlled trial was carried out at the Research Institute of Ophthalmology, Egypt. Patients and methods This trial included diabetic patients with glycated hemoglobin less than 7.5 mmol/l of both sexes, aged from 30 to 70 years, American Society of Anesthesiologists I, II, or III, who had central retinal vein occlusion and choroidal neovascularization. A total of 110 eligible patients were randomly allocated into two groups. Patients in group A received bupivacaine 0.5%, while those in group B received oxybuprocaine hydrochloride 0.4%. Both drugs were topically applied, three times, at 5 min intervals, for 15 min, which was followed by the IVI. The primary outcome was pain during the injection and the secondary outcome was corneal adverse effects. Results The frequency of pain-free IVI was equal in both groups (83.6% each, P=0.100). The difference in the mean heart rate after injection between groups A (81.4±12.7) and B (82.5±15.6) was nonsignificant (P=0.678). The rate of corneal side effects in terms of opacity or allergy to the topically applied drugs was nonsignificantly lower in group A compared with group B (9.1 vs. 12.7%, P=0.541). Conclusions The topical use of bupivacaine 0.5% had anesthetic efficacy similar to that of oxybuprocaine hydrochloride 0.4% during the IVI. Both the topical anesthetics were well tolerated by patients.
References
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TL;DR: After cataract surgery, the incidence of dry eye increased dramatically; NEI-VFQ25 and OSDI indicated that most patients developed this symptom after surgery, and IC suggested the presence of serious squamous metaplasia in the epithelial layer of the globe conjunctiva, especially the lower lid region.
Abstract: Purpose:To study dry eye and analyze pathogenic factors in patients after cataract surgery.Methods:A total of 37 patients (50 eyes) were studied by using a 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ25) and Ocular Surface Disease Index (OSDI) 3 days before and 1 week, 1 mon
250 citations
TL;DR: It is recommended that ophthalmologists should evaluate patients both before and after phacoemulsification to prevent further damage to the ocular surface and able to manage the patient promptly and effectively so the patient will not have a poor quality of life and vision due to dry eye syndrome.
Abstract: Purpose
To evaluate the incidence and severity pattern of dry eye after phacoemulsification.
Setting
King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Design
Prospective descriptive study.
Methods
Samples were collected from ninety-two uncomplicated cataract patients who were 18 years old or older. Dry eye incidence and pattern were analyzed at days 0, 7, 30 and 90 after phacoemulsification using (1) Ocular Surface Disease Index (OSDI) questionnaire, (2) tear break up time (TBUT), (3) Oxford ocular surface staining system, and (4) Schirmer I test without anesthesia.
Results
Seven days after phacoemulsification, the incidence of dry eye was 9.8% (95% confidence interval; 3.6–16.0%). The severity of dry eye peaked seven days post-phacoemulsification and was measured by OSDI questionnaire and all three clinical tests. Within thirty days and 3 months post-surgery, both the symptoms and signs showed rapid and gradual improvements, respectively. However, dry eye post-phacoemulsification was not significantly associated with sex and systemic hypertension (P = 0.26, 0.17 and 0.73, respectively).
Conclusions
The incidence of dry eye after phacoemulsification was 9.8%. Symptoms and signs of dry eye occurred as early as seven days post-phacoemulsification and the severity pattern improved over time. We recommend that ophthalmologists should evaluate patients both before and after phacoemulsification to prevent further damage to the ocular surface and able to manage the patient promptly and effectively so the patient will not have a poor quality of life and vision due to dry eye syndrome.
184 citations
TL;DR: Topical ocular anesthetic abuse can lead to superficial punctate keratitis, persistent epithelial defects, stromal/ring infiltrates, corneal edema, endothelial damage and ocular inflammation, even when used in a dilute concentration.
Abstract: Introduction: Topical ocular anesthetics are generally well tolerated in clinical settings but have great potential for abuse if used by patients at home This abuse can lead to significant ocular complications Topical ocular anesthetic abuse can lead to superficial punctate keratitis, persistent epithelial defects, stromal/ring infiltrates, corneal edema, endothelial damage and ocular inflammation, even when used in a dilute concentration Patient characteristics may include a healthcare association and/or psychiatric illness In these instances, patients often do not admit to anesthetic use and are often initially treated for acanthamoeba keratitis Local anesthetics are thought to cause direct toxicity to the corneal epithelium, stroma and endothelium This in turn may lead to release of antigens and from there an inflammatory response in the form of infiltrate and edema It is thought that preservatives in anesthetics may play a further role in toxicity Areas covered: The authors provide a brief his
56 citations
TL;DR: Ophthalmologists should be suspicious of topical anesthetic abuse keratopathy in young male manual laborers specialized in welding business and foundry work presenting with persistent epithelial defects, ring-shaped keratitis, and accompanying severe ocular pain.
Abstract: Purpose:To evaluate the clinical course, treatment modality, factors affecting the epithelization period, and visual outcome in patients with topical anesthetic abuse keratopathy.Methods:The medical records of 19 patients with a confirmed diagnosis of topical anesthetic abuse keratopathy were retros
52 citations
TL;DR: This review addresses a variety of topical issues in ophthalmic anesthesia with special emphasis on cannula and needle-based blocks and the new-generation antithrombotic agents.
Abstract: In the past decade ophthalmic anesthesia has witnessed a major transformation. The sun has set on the landscape of ophthalmic procedures performed under general anesthesia at in-hospital settings. In its place a new dawn has ushered in the panorama of eye surgeries conducted under regional and topical anesthesia at specialty eye care centers. The impact of the burgeoning geriatric population is that an increasing number of elderly patients will present for eye surgery. In order to accommodate increased patient volumes and simultaneously satisfy administrative initiatives directed at economic frugality, administrators will seek assistance from anesthesia providers in adopting measures that enhance operating room efficiency. The performance of eye blocks in a holding suite meets many of these objectives. Unfortunately, most practicing anesthesiologists resist performing ophthalmic regional blocks because they lack formal training. In future, anesthesiologists will need to block eyes and manage common medical conditions because economic pressures will eliminate routine preoperative testing. This review addresses a variety of topical issues in ophthalmic anesthesia with special emphasis on cannula and needle-based blocks and the new-generation antithrombotic agents. In a constantly evolving arena, the sub-Tenon's block has gained popularity while the deep angulated intraconal (retrobulbar) block has been largely superseded by the shallower extraconal (peribulbar) approach. Improvements in surgical technique have also impacted anesthetic practice. For example, phacoemulsification techniques facilitate the conduct of cataract surgery under topical anesthesia, and suture-free vitrectomy ports may cause venous air embolism during air/fluid exchange. Hyaluronidase is a useful adjuvant because it promotes local anesthetic diffusion and hastens block onset time but it is allergenic. Ultrasound-guided eye blocks afford real-time visualization of needle position and local anesthetic spread. An advantage of sonic guidance is that it may eliminate the hazard of globe perforation by identifying abnormal anatomy, such as staphyloma.
52 citations