A two-year prospective study comparing lidocaine 2% jelly versus peribulbar anaesthesia for 25G and 23G sutureless vitrectomy.

PURPOSE: To evaluate the efficacy of topical lidocaine 2% gel with or without peroral preoperative sedation as an alternative anaesthetic method in sutureless vitreoretinal surgery. MATERIAL-METHOD: A prospective study was designed to assess the intraoperative and postoperative pain, using a visual analogue scale (VAS) in three groups of patients, comprised of 23 patients each. The first group included cases that were operated with 25-gauge (25G) instruments under topical anaesthesia with lidocaine jelly, the second group with 23-gauge (23G) under the same topical anaesthesia and finally the third group (control group) with sutureless (23- or 25-gauge) vitrectomy under peribulbar anaesthesia. Mann Whitney U test was used to compare the results. The subjective surgeon's opinion about the difficulty of each procedure was recorded on a 1-5 scale and the results were evaluated with a chi-square test. RESULTS: No statistically significant difference in the level of pain was detected between the three groups. Topical anaesthesia vitrectomy procedures were performed more easily (p = 0.0002) with 23-gauge than with 25-gauge instruments. The painful steps of the surgery that were capable of causing moderate to severe pain were endolaser, scleral indentation and peribulbar injection. The goal of the operations was accomplished in all cases. CONCLUSION: Lidocaine 2% jelly with or without peroral preoperative morphine and dixyrazine offers adequate analgesia to perform sutureless vitrectomy. Lack of akinesia does not prevent a successful surgical result.

Surgically induced miosis during phacoemulsification in patients with diabetes mellitus.

PURPOSE: To assess the incidence of surgically induced miosis during phacoemulsification in diabetic patients. METHODS: A total of 76 patients with diabetes mellitus were compared to 76 age- and race-matched controls. A combination of cyclopentolate 1%, phenylephrine 2.5% and diclofenac sodium 0.1% was applied topically 60, 45 and 30 min before surgery. Adrenaline mixed with buffered saline solution was used for irrigation during surgery. The procedure included phacoemulsification and implantation into the bag of a foldable acrylic implant. Measurements of the horizontal pupillary diameter were taken at three stages: before corneal incision, after phacoemulsification, and at the end of surgery. The duration of phacoemulsification was also recorded. RESULTS: Surgically induced miosis or dilation of the pupil was defined as constriction or dilation noted at any interval during surgery. The pairs of diabetic-control were grouped into three groups: those in which constriction was noted, those in which dilation was noted, and those in which there was no change in pupil size during the procedure. Surgically induced miosis was noted more often in the diabetics (McNemar's test, chi(2), P=0.016). The mean pupil size at the beginning of surgery was 7.38 (+/-0.95) mm in the diabetics as compared to 7.65 (+/-0.89) mm in the control group. No statistically significant difference was noted between the two groups (paired t-test, P=0.07). The mean (+/-SD) duration of phacoemulsification in the diabetic group was 2.31 (+/-1) min as compared to 2.05 (+/-0.82) min in the control group. No statistically significant difference was found between the two groups (paired t-test, P=0.08). CONCLUSION: Surgically induced miosis occurred more often in the diabetics. Therefore, it is advisable that phacoemulsification in this group of patients is undertaken by an experienced surgeon.