Topical versus sub-Tenon's anesthesia without sedation in cataract surgery.

PURPOSE: To compare pain control using topical anesthesia with that using sub-Tenon's anesthesia for clear corneal phacoemulsification cataract surgery and foldable intraocular lens (IOL) implantation. SETTING: Departments of Ophthalmology, General Hospital Asklepeion Voulas and General Hospital of Athens, University of Athens, Athens, Greece. METHODS: One hundred consecutive patients scheduled for bilateral cataract surgery 1 to 2 months apart were prospectively randomized to receive topical anesthesia (100 eyes) or sub-Tenon's anesthesia (100 eyes). The randomization was stratified so that one half of first-eye surgeries and one half of second-eye surgeries were assigned to each anesthesia group, with each patient receiving each type of anesthesia once. All patients had clear corneal phacoemulsification with foldable IOL implantation. Patients were asked to rate their pain level on a 10-point scale for 4 periods: during the administration of the anesthetic agent, during surgery, immediately after surgery, and 24 hours postoperatively. The surgeon recorded his subjective assessment of ease of surgery and surgical complications using a standardized template. RESULTS: Eighty-one percent of patients who received topical anesthesia and 8% of patients who received sub-Tenon's anesthesia reported no pain during delivery of the anesthetic agent. The mean pain score was 0.19 +/- 0.39 (SD) in the topical group and 1.35 +/- 0.63 in the sub-Tenon's group. The difference between groups was statistically significant (P <.001). Seventy-two percent of patients in the topical anesthesia group and 86% in the sub-Tenon's anesthesia group reported no pain or slight discomfort during surgery (mean score 1.13 +/- 1.57 and 0.57 +/- 1.28, respectively) (P <.001). Ninety percent of topical anesthesia patients and 100% of sub-Tenon's anesthesia patients reported no pain or slight discomfort 30 minutes postoperatively (mean score 0.80 +/- 0.93 and 0.12 +/- 036, respectively) (P <.001). All patients in the topical anesthesia group and 77% in the sub-Tenon's group reported no pain 24 hours postoperatively (mean pain 0.00 +/- 0.00 and 0.23 +/- 0.40, respectively) (P <.001). Complications including prolonged akinesia of the globe, chemosis, and conjunctival hemorrhage occurred significantly more frequently in the sub-Tenon's than in the topical group (P <.001). CONCLUSIONS: Patients having cataract surgery under topical anesthesia had more intraoperative and postoperative discomfort than patients receiving sub-Tenon's anesthesia. However, patients having topical anesthesia reported less pain during its administration and had fewer complications. Both anesthesia methods provided high levels of pain control without additional sedation.

Combined clear cornea phacoemulsification and trabecular aspiration in the treatment of pseudoexfoliative glaucoma associated with cataract.

BACKGROUND: In the present prospective randomized study the effectiveness and safety of trabecular aspiration combined with clear cornea phacoemulsification (phaco) was compared to clear cornea phaco alone in patients with pseudoexfoliation (PEX) glaucoma and visually disabling cataract. METHODS: Twenty-seven patients suffering from visually significant cataract (visual acuity < 5 Snellen lines) and PEX glaucoma were randomly assigned to either phaco combined with trabecular aspiration (14 eyes of 14 patients) or phaco alone (13 eyes of 13 patients). Inclusion criteria for glaucoma were IOP < or = 22 mmHg under treatment with up to two antiglaucomatous agents, excluding pilocarpine 4%, and no previous surgery or laser trabeculoplasty treatment. Clear cornea phaco with foldable acrylic intraocular lens (IOL) implantation was carried out in all patients uneventfully. Trabecular aspiration was performed using a special probe in the inferior 180 deg of the angle after IOL implantation. RESULTS: Follow-up duration ranged from 12 to 18 months. In the combined procedure group there was a statistically significant decrease in postoperative IOP during the whole follow-up period (P < 0.01), while in 9 of the 14 patients the IOP was controlled without medications at the last examination. In the phaco alone group a statistically significant decrease in postoperative IOP was recorded at 9 and 12 months after surgery (P < 0.05), while in 4 of the 13 patients the IOP was controlled without medications at the last examination. Comparing the two groups, a statistically significantly lower number of medications was being used in the combined procedure group at the last recorded examination (P < 0.05). CONCLUSIONS: It seems that the combined clear cornea phaco and trabecular aspiration procedure in cases of PEX glaucoma associated with cataract is a safe and effective method. This technique controls IOP more effectively and with fewer postoperative medications than clear cornea phaco alone.

Twelve years' continuous wear of the same therapeutic soft contact lens: a case report.

PURPOSE: To describe a case of a patient who had worn the same therapeutic soft contact lens (TSCL) continuously for twelve years, since he had failed to attend normal follow-up visits. METHODS: Microbiological histological and scanning electron microscopic (SEM) studies of conjunctiva, cornea and TSCL were done. RESULTS: Cultures were negative. Corneal histology revealed mild stromal edema and mild epithelial parakeratosis. Corneal SEM was remarkable for the preservation to some extent of normal corneal epithelial specialization with microtricae and microvillae. SEM of the TSCL showed a ruffed multi-layer surface with several cracks including different types of cells. CONCLUSIONS: The patient showed surprising tolerance to the continuous wear of the same contact lens for 12 years.

Twelve years continuous wear of the same therapeutic soft contact lens: a case report.

PURPOSE: To describe a case of a patient who had worn the same therapeutic soft contact lens (TSCL) continuously for twelve years, since he had failed to attend normal follow-up visits. METHODS: Microbiological histological and scanning electron microscopic (SEM) studies of conjunctiva, cornea and TSCL were done. RESULTS: Cultures were negative. Corneal histology revealed mild stromal edema and mild epithelial parakeratosis. Corneal SEM was remarkable for the preservation to some extent of normal corneal epithelial specialization with microtricae and microvillae. SEM of the TSCL showed a ruffed multi-layer surface with several cracks including different types of cells. CONCLUSIONS: The patient showed surprising tolerance to the continuous wear of the same contact lens for l2 years. (Eur J Ophthalmol 1999, 9: 312-14).