RESUMO
To evaluate the efficacy of peribulbar [sub-Tenon] versus retro bulbar local anesthesia in cataract surgery by comparing analgesia, akinesia and effect on intraocular pressure. Comparative Consecutive Interventional Case series. One hundred patients undergoing surgery for uncomplicated cataract at Munawwar Memorial Hospital Chakwal. Patients were selected on the basis of convenience sampling. Patients were divided in two equal groups of 50 each. One group received retrobulbar block and other group received sub-Tenon's block. Before starting the surgery complete systemic and ocular examination was done. Efficacy was compared in terms of analgesia, akinesia and effect on intraocular pressure. Out of total 100 patients, 60% were male and 40% were female with a ratio of 3:2. In retrobulbar anesthesia, 30 [65.2%] patients experienced pain free surgery as compared to sub-Tenon's local anesthesia where 49 [98%] patients experienced pain free surgery. Complete akinesia was achieved in 26 [56.52%] cases of retrobulbar anaesthesia group as compared to 5 [10%] cases in sub-Tenon's anaesthesia group. There was a significant elevation of intraocular pressure immediately after administrating the local anesthesia in retrobulbar group as compared to sub-Tenon's group. Conclusion: Sub-Tenon's anaesthesia is a safe and effective technique for patients undergoing day cataract surgery as compared to retrobulbar local anesthesia. It prevents sight and life threatening complications
RESUMO
To determine the role of B-scan ultrasonography [USG] in pre operative assessment of eyes with age-related mature cataract by documenting the frequency and nature of posterior segment intraocular pathologies detected by it. A hospital based descriptive observational study Two hundred nine [209] eyes with age related mature cataract of the patients presenting at the outpatient department of Al-Shifa Trust Eye Hospital, Rawalpindi from May to August 2003 A detailed ocular and medical history was taken keeping in view the inclusion and exclusion criteria. Eyes of these patients were divided into four groups on the basis of their age. All patients underwent a comprehensive ocular evaluation including visual acuity assessment, slit-lamp examination, pupil reactions and applanation tonometry. B-Scan USG of these patients was performed at both high [58-61 db] and low [42-44db] instrument sensitivity settings. By compiling data obtained by these various scanning approaches, a three dimensional concept of the lesion was developed and its topography adequately documented. SPSS software [Ver.10.0] was used for statistical analysis of results. It was observed that out of 209 eyes considered for simple mature cataract, USG revealed that 29 [13.87%] of them also had some other ultrasonically detectable posterior segment pathologies. 10 [4.78%] eyes out of 209 had vitreous haemorrhage [VH], 9 eyes [4.30%] had PVD, 3 eyes [1.43%] had asteroid hyalosis, 4 eyes [1.91%] had membranes in anterior and mid-vitreous, 2 eyes [0.96%] had chorioretinal layer thickening while one eye [0.48%] had optic disc edema. Pre operative B-Scan ultrasonography of cataract patients, when posterior segment examination is not possible by conventional methods, helps in diagnosis of additional posterior segment pathologies. Knowledge of these hidden posterior segment pathologies will then help the surgeon in explaining prognosis and expected outcome of surgery to patients. Surgeons can modify their plan of surgery and can also take measures to combat various predictable complications. In addition many legal and technical problems can also be avoided