Comparison of auditory sensations in patients who underwent cataract phacoemulsification surgery in the first and second eye.

To compare subjective auditory sensations of patients during the first and second eye cataract surgeries. Consecutive patients who underwent phacoemulsification of the first eye (group I) and second eye (group II) completed questionnaires designed to evaluate their auditory sensations in the operating room including background music, sound of working equipment, staff conversations, and surgeon's voice. This study included 124 patients in group I and 76 patients in group II. Patients most often heard nursing staff's conversations (91.9% and 96%, respectively, p > 0.05), surgeon's voice (87.9% and 86.8%, respectively, p > 0.05), and music (70.9% and 75%, respectively, p > 0.05). Music was the most pleasant experience (78.2% and 78.9%, respectively, p > 0.05). The sound of the working phacoemulsifier was the most undesirable sound (20.2% and 15.8%, respectively, p > 0.05). Patients in group II more often indicated that none of the sounds required elimination (69.7% and 52.6%, respectively, p = 0.013) or that staff conversations should be eliminated (13.2% and 3.1%, respectively, p = 0.005). The most desirable sounds during phacoemulsification include music and the surgeon's voice regarding the procedure. The most unpleasant sound was that that of phacoemulsifier. The commonest sounds to be eliminated in groups I and II included those of equipment and staff conversations.

The effects of functionally monocular patients' emotional reactions during phacoemulsification under topical anesthesia / A influência das reações emocionais durante a facoemulsificação com anestesia tópica em pacientes de olho único

ABSTRACT Purpose: To evaluate the relationship between the incidence of complications and functionally monocular patients' emotional reactions during phacoemulsification under topical anesthesia. Methods: We enrolled 22 functionally monocular patients (11 males and 11 females; group 1) and 19 age- and sex-matched controls (6 males and 13 females; group 2) in this prospective, interventional, cross-sectional, case control study. Demographics data, including age, sex, and educational background, were collected. Surgeries were performed by the same surgeon, and during surgery, the patients' vital signs (blood pressure and heart rate) and surgical events (duration, body movements, signs of increased vitreous cavity pressure, difficulty in performing capsulorhexis, and complications) were noted. Pre- and postoperative visual acuity was also analyzed. Results: The mean age of group 1 was 73.05 ± 13.31 years and of group 1 was 69.74 ± 16.81 years. There was no significant between-group difference in systolic and diastolic blood pressures. The average heart rate was similar in both groups, too. During surgery, the surgeon's perception of excessive eye, eyelid, or head movements in both groups was similar, in addition to signs of increased vitreous cavity pressure. Conclusion: It is safe to perform phacoemulsification under topical anesthesia in functionally monocular patients, who apparently behave similarly to binocular patients.(AU)

RESUMO Objetivo: Avaliar a relação entre a incidência de complicações e reações emocionais durante a cirurgia de catarata sob anestesia tópica em pacientes funcionalmente monoculares. Métodos: Estudo prospectivo, transversal, caso-controle de vinte e dois pacientes monoculares e dezenove controles pareados por idade e sexo . Dados demográficos foram analisados: idade, sexo e escolaridade. As cirurgias foram realizadas pelo mesmo cirurgião e durante o procedimento os sinais vitais dos pacientes (como pressão arterial sistêmica e frequência cardíaca) e eventos cirúrgicos (duração da cirurgia, movimentos corporais, sinais de aumento da pressão vítrea, dificuldade de realização da capsulorrexis e complicações) foram coletados. A acuidade visual pré e pós foi analisada. A distribuição normal dos dados foi confirmada com o teste de Shapiro-Wilk. Os dados foram expressos como média ± DP e porcentagem. A comparação dos diferentes testes clínicos entre os grupos foi realizada utilizando Student's t-test e ANOVA com correção de Bonferroni. O qui-quadrado foi usado para comparar dados demográficos. Valor de p<0,05 foi considerado estatisticamente significante. Resultados: Este estudo incluiu vinte e dois olhos de 22 pacientes funcionalmente monoculares (6 homens e 13 mulheres) e dezenove olhos de 19 controles (11 homens e 11 mulheres). A média de idade foi de 73,05 ± 13,31 anos nos indivíduos monoculares e 69,74 ± 16,81 no controle. Considerando-se os sinais vitais não houve diferença significativa entre os grupos (p>0,05). Durante o procedimento, a percepção do cirurgião em relação aos movimentos excessivos de olho, pálpebra ou cabeça em ambos os grupos foi semelhante, assim como sinais de aumento da pressão vítrea (p=0,2 e p=0,1, respectivamente). Conclusão: Este estudo sugere que é seguro realizar a extração de catarata com anestesia tópica em pacientes funcionalmente monoculares. Esses pacientes aparentemente se comportam de maneira semelhante aos pacientes binoculares.(AU)

Social impact indicators in patient diagnosed of senile cataract treated with phacoemulsification plus intraocular lens implantation.

PURPOSE: To analyze indicators of social impact in patients with senile cataract treated with phacoemulsification and intraocular lens (IOL) implant. MATERIAL AND METHODS: Patients ≥ 60 years, better corrected visual acuity (BCVA) ≥ 0.6 logarithm of the minimum angle of resolution (LogMAR) and senile cataract treated with PHACO + IOL for cases and incipient senile cataract without surgical treatment with MVCA < 0.6 LogMAR for controls. Exclusion criteria; pathologies that modify the quality of life. The WHOQOL-OLD test was applied: presurgical, one postoperative month and three postoperative months. RESULTS: 54 controls and 56 cases were included. The preoperative BCVA was 1.57 ± 1.041, third month was 0.68 ± 0.7817 (p < 0.001). The results of the preoperative WHOQOL-OLD survey vs the third month: INT 12.96 versus 11.06 (p < 0001); DAD, 10.48 versus 6.389 (p < 0.00001); SOP 12.07 versus 13.76 (p < 0.0007) and SAB, 13.02 versus 8.648 (p < 0.0001). The survey of the 3rd month versus the controls: INT 9.66 versus 11.06 (p < 0.001); PPF, 13.89 versus 12.39 (p < 0.001) and AUT 12.47 versus 10.15 (p < 0.001). CONCLUSION: Patients, present an improvement in the BCVA that is reflected in the quality of life, this can be interpreted as positive results and should be taken into account to support the surgical indication.

OBJETIVO: Analizar indicadores de calidad de vida en pacientes con catarata senil tratados con facoemulsificación más implante de lente intraocular. MÉTODO: Pacientes a partir de 60 años de edad, con agudeza visual mejor corregida (AVMC) ≥ 0.6 LogMAR y catarata senil tratada con facoemulsificación más implante de lente intraocular para casos y catarata senil incipiente sin tratamiento quirúrgico con AVMC < 0.6 LogMAR para controles. Criterios de exclusión: patologías que modificaran la calidad de vida. Se aplicó la encuesta WHOQOL-OLD en el preoperatorio y a 1 y 3 meses posquirúrgicos. RESULTADOS: 54 controles y 56 casos. La AVMC preoperatoria fue 1.57 ± 1.041, y al tercer mes 0.68 ± 0.7817 (p < 0.001). Los resultados de la encuesta preoperatoria en comparación con el tercer mes fueron: dominio de intimidad 12.96 vs. 11.06 (p < 0.0001); dominio de muerte y agonía 10.48 vs. 6.389 (p <0.00001); dominio de participación social 12.07 vs. 13.76 (p < 0.0007); y dominio de capacidad sensorial 13.02 vs. 8.648 (p < 0.0001). Los resultados de la encuesta del tercer mes en comparación con los controles fueron: dominio de intimidad 9.66 vs. 11.06 (p < 0.001); dominio de actividades pasadas, presentes y futuras 13.89 vs. 12.39 (p < 0.001) y dominio de autonomía 12.47 vs. 10.15 (p < 0.001). CONCLUSIÓN: Los pacientes presentan una mejora en la AVMC y en los resultados de la WHOQOL-OLD, por lo que deben ser tomados en cuenta para apoyar la indicación quirúrgica.

Effect of a patient-information video on the preoperative anxiety levels of cataract surgery patients.

PURPOSE: To assess whether a cataract surgery patient-information video reduces patients' preoperative anxiety levels. SETTING: Leeds Teaching Hospitals NHS Trust, UK. DESIGN: Prospective controlled trial of an intervention to reduce anxiety for first-eye elective cataract surgery patients. METHODS: Patients attending for first-eye elective cataract surgery were included in the study. The primary outcome measure was a questionnaire based upon the Amsterdam Preoperative Anxiety and Information Score (APAIS), and an 80.0 mm visual analogue scale (VAS) score. The questionnaire was administered to a control group of consecutive preoperative cataract surgery patients who had not seen the information video. Subsequently, the video was introduced to the surgical pathway and the questionnaire was administered preoperatively to an intervention group of consecutive patients who had watched the video. RESULTS: The study comprised 200 patients (100 in the intervention group, 100 in the control group). There was a significant difference in mean VAS anxiety scores between the control group (45.5 mm ± 21.4 [SD]) and the intervention group (11.2 ± 11.4 mm) (P < .001). On a 5-stage Likert scale, responses to the APAIS statement "I am worried about the procedure" (range 1 = not at all to 5 = extremely worried) also showed that the control group patients were significantly more worried than the intervention group (P < .001). The mode response score was 3 in the control group versus 1 in the intervention group. CONCLUSIONS: Providing a patient-information video before cataract surgery was an inexpensive and effective intervention in reducing preoperative anxiety. Such interventions could improve the overall experience of cataract surgery patients.

Vision-related quality of life and visual outcomes from cataract surgery in patients with vision-threatening diabetic retinopathy: a prospective observational study.

BACKGROUND: To examine the benefit of cataract surgery on visual acuity and vision related quality of life in patients with stabilized vision-threatening diabetic retinopathy. METHODS: A total of 126 patients (153 eyes) who were diagnosed with cataract combined with stabilized vision-threatening diabetic retinopathy underwent phacoemulsification. Measurements included the best-corrected visual acuity (BCVA), which was converted into a weighted logarithm of the minimum angle of resolution (logMAR) and vision related quality of life (VRQoL) using the Chinese-version low vision quality of life questionnaire (CLVQOL). RESULTS: Three months after phacoemulsification, statistically significant improvements were observed in postoperative weighted logMAR BCVA (Z = -9.390 P < 0.001). In all of the participants, the CLVQOL total scores (Z = -7.995 P <0.001) and four subscale scores including general vision and lighting level (Z = -7.400 P <0.001), mobility level (Z = -6.914 P <0.001), psychological adjustment level (Z = -8.112 P <0.001) and reading, fine work and activities of daily living level (Z = -5.892 P <0.001), all improved significantly after the surgeries. Linear regression analyses indicated that the increase in CLVQOL total scores exhibited a significant correlation with the better postoperative weighted logMAR BCVA, greater gain of weighted logMAR BCVA after surgery, bilateral surgery, and longer duration of diabetic retinopathy. CONCLUSIONS: Both visual acuity and the vision related quality of life of the patients with diabetic retinopathy improved significantly after cataract surgery. Cataract surgery is an effective intervention for patients with stabilized diabetic retinopathy.

Impacto da facectomia na qualidade de vida de idosos atendidos em campanha assistencial de catarata / Facectomy impact in the quality of life of elderly assisted in cataract care campaign

Objetivou-se avaliar a melhora da acuidade visual (AV) antes e no 15° dia do pós-operatório de facectomia e o seu impacto na qualidade de vida dos idosos. Estudo prospectivo, desenvolvido com 156 pacientes submetidos à facectomia em campanha oftalmológica. De acordo com a tabela de Snellen, a AV média, em logMAR, após 15 dias da cirurgia melhorou de 1,23 para 0,57 nos idosos (p=0,000). Na comparação das médias de qualidade de vida, pelo questionário de avaliação da qualidade de vida Visual Functioning Questionnaire (VQF-25), o subdomínio visão geral apresentou a maior diferença entre as médias antes e após a facectomia (de 29,65 para 89,87). A análise de correlação apontou que a melhora da AV melhorou a satisfação geral, em relação à atividade para longe, dor ocular, saúde mental e dependência, levando a um impacto positivo na qualidade de vida dos idosos. Levantaram-se indicadores que direcionam à terapêutica mais individualizada.

The objective was to improve the visual acuity (VA) before facectomy and at the 15th-day of the post-operative phase, and its impact on elderly quality of life. We developed a prospective study, with 156 patients submitted to facectomy in an ophthalmologic campaign. According to the Snellen table, the mean VA in logMAR at 15 days post-surgery improved from 1.23 to 0.57 for elderly (p=0.000). When comparing the quality of life means using the quality of life tool Visual Functioning Questionnaire (VQF-25), the subdomain general vision presented the highest difference between means before and after facectomy (from 29.65 to 89.87). The correlation analysis pointed that the VA improved general satisfaction for far activities, ocular pain, mental health, and dependency, resulting in a positive impact on elderly quality of life. We brought up indicators to guide a more individualized therapy.

The effect of music with and without binaural beat audio on operative anxiety in patients undergoing cataract surgery: a randomized controlled trial.

PurposeTo investigate the anxiolytic effects of binaural beat embedded audio in patients undergoing cataract surgery under local anesthesia.MethodsThis prospective RCT included 141 patients undergoing cataract surgery under local anesthesia. The patients were randomized into three groups; the Binaural beat music group (BB), the plain music intervention group (MI), and a control group (ear phones with no music). Blood pressure (BP) and heart rate were measured on admission, at the beginning of and 20 min after the start of the operation. Peri-operative anxiety level was assessed using the State-Trait Anxiety Inventory questionnaire (STAI).ResultsThe BB and MI groups comprised 44 patients each and the control group 47. Patients in the MI group and BB group showed significant reduction of STAI state scores after music intervention compared with the control group (P<0.001) but the difference was not significant between the MI and BB group (STAI-S score MI group -7.0, BB group -9.0, P=0.085). Systolic BP was significantly lower in both MI (P=0.043) and BB (0.040) groups although there was no difference between the two groups (P=1.000). A significant reduction in heart rate was seen only in the BB group (BB vs control P=0.004, BB vs MI P=0.050, MI vs control P=0.303).ConclusionMusic, both with and without binaural beat, was proven to decrease anxiety level and lower systolic BP. Patients who received binaural beat audio showed additional decrease in heart rate. Binaural beat embedded musical intervention may have benefit over musical intervention alone in decreasing operative anxiety.

Which colours are seen by the patient during cataract surgery? Results of an intraoperative interview.

PURPOSE: To discover what cataract patients see during phacoemulsification and if these light phenomena influence their anxiety levels during surgery. METHODS: In all, 200 patients were interviewed intraoperatively at the Eye Hospital, Petrisberg, Trier, Germany. The quality of the visual experiences was described and if these were pleasant, neutral or unpleasant. Systemic sedation was noted. RESULTS: Among 200 patients (209 eyes): 88 were men (91 eyes; 44%) and 112 were women (118 eyes; 56%). Median age (years): men (71), women (70). Mean operating time was 8 min. 49/209 (23%) were not anxious before and during surgery. 110/209 (52%) were more anxious before than during surgery, 50/209 (24%) were still anxious during surgery, 27/209 (13%) got sedation with midazolam (1-5 mg). Colours in descending order seen: blue, red, pink, yellow, green, purple, turquois, and orange. The most dominant colour combination was red/blue. Structures were seen by 162/209 (78%). Most (61%) intraoperative visual experiences were pleasant, 38% were neutral, and 1% found them transiently unpleasant. Three patients felt blinded by the light of the operating microscope. CONCLUSIONS: The experience of colours and other light phenomena was pleasant for most patients during phacoemulsification under topical anaesthesia. They occur spontaneously when the patient is fixating on the operating light. They are not dependent on the individual or environment. Sedation only in 13%. Direct questioning for visual sensations by the operating surgeon may lead to less need for sedation and lead to less side effects for elderly and multimorbidity people postoperatively. The surgeon can use this knowledge to reassure patients during surgery.

Patients' visual experience during phacoemulsification cataract surgery and associated fear.

BACKGROUND: Data from several published studies indicate that patients undergoing phacoemulsification cataract surgery can experience a variety of visual sensations which can result in fear. This phenomenon has not been studied in Pakistan to-date. We examined the visual experience and its associated fear among patients undergoing phacoemulsification cataract surgery under topical anaesthesia. METHODS: This cross-sectional study was carried out in Aga Khan University Hospital, a tertiary care hospital, in Karachi, Pakistan from August 2010 to July 2011. Adults >18 years of age scheduled to undergo cataract surgery (phacoemulsification with intraocular lens implantation) under topical anaesthesia by a single surgeon were included. A structured questionnaire was used to collect data on socio-demographics, intraoperative visual experiences and subsequent reaction to these sensations. Participants were asked if they experienced visual sensations such as colours, shapes and movements during surgery. Moreover, they were asked if they developed fear due to these sensations. RESULTS: Fifty three patients (mean age: 60.4 ± 12.4 years) were enrolled. Thirty (56.6%) of them were men and 23 (43.4%) were women. All of them reported having experienced visual sensations during surgery, the most common being light perception (100%), different colours (77.4%), movements of instruments or surgeon's hands (37.7%) and different shapes (7.5%) such as circles, clouds and patches. The most common colours perceived included white (46.2%), blue (35.8%), red (30.2%) and yellow (30.2%). One out of every four (26.4%) participants reported having developed fear due to these visual sensations. Only 4 (7.5%) reported having received preoperative counselling regarding such sensations. CONCLUSION: Patients in our study experienced a variety of visual sensations during cataract surgery under topical anaesthesia. The prevalence of frightening visual sensations is higher than that reported in all previous published studies on the subject and needs to be addressed through targeted interventions.

[Visual experiences during cataract surgery under topical anesthesia]. / Visuelle Erlebnisse unter Kataraktchirurgie in topischer Anästhesie.

BACKGROUND: Cataract patients observe structures, colors and movements during surgery. Is there any pattern to their visual experiences? METHODS: From 2005 to 2011 a total of 20,000 phacoemulsification procedures were performed using topical anesthesia. From these patients we received 45 pictures which had been painted to reflect intraoperative their visual impressions so that approximately 1 out of 500 of the patients painted a picture. A further 98 patients were questioned postoperatively about their intraoperative visual impressions and were shown the 45 pictures. They described their own visual experiences and any similarities with the 45 pictures were documented. RESULTS: All patients were awake and cooperative during surgery. Afterwards they described their visual experiences whereby 36 patients saw mainly blue, 32 red/pink and 27 saw yellow colors. Out of the 45 pictures 30 (67%) were identified as being similar to their own visual images and 10 patients could not describe any postoperative visual phenomena. CONCLUSION: Patients notice optical phenomena during cataract surgery under topical anesthesia with eye drops. Visual images are often similar among patients. The surgeon can use this knowledge to explain these experiences while talking to the patient intraoperatively. This may reassure patients during surgery.

Assessment of vision-related quality of life among patients with cataracts and the outcomes of cataract surgery using a newly developed visual function questionnaire: the VFQ-J11.

OBJECTIVE: To investigate vision-related quality of life (VRQoL) and associated factors in patients with cataracts and the outcomes of cataract surgery using the newly developed VRQoL instrument: the visual function questionnaire, 11-item Japanese version (the VFQ-J11). METHODS: A total of 457 patients scheduled for cataract surgery at 12 clinical sites from November 2008 through February 2010 were included in the study. The patients completed the VFQ-J11 before and 3 months after surgery. The VFQ-J11 was used to investigate factors associated with VRQoL of the cataract patients, the outcome of cataract surgery, and the predictors of improved VRQoL due to cataract surgery. RESULTS: In a multiple regression model, the VFQ-J11 score was significantly associated with corrected distance visual acuity in the better-seeing eye (better eye VA), and improvement in the VFQ-J11 score after cataract surgery was associated not only with improvement in the better eye VA, but also with improvement in the worse eye VA. Compared to one-eye cataract surgery, both-eyes surgery had a greater impact on VFQ-J11 score improvement. CONCLUSIONS: The VFQ-J11 is a good measure of VRQoL in cataract patients. The present study indicates that by including the domains measured in the VFQ, the VFQ-J11 can provide valid data on VRQoL and be less of a burden for patients.

[Evaluation of quality of life of patients after phacoemulsification with accommodating lens implantation]. / Ocena jakosci zycia pacjentów po fakoemulsyfikacji z wszczepieniem akomodacyjnej soczewki wewnatrzgalkowej.

INTRODUCTION: Intraocular lens implantation is an important part of cataract surgery, as it has a significant influence on the final result. Accommodative intraocular lenses (IOLs) are the latest solution for the lack of accommodation in pseudophakic eyes. PURPOSE: To evaluate the quality of life of patients who underwent cataract surgery with accommodating IOL implantation and to compare the data with results of patients after standard monofocal IOL implantation. MATERIAL AND METHODS: The study group consisted of 20 patients (40 eyes), aged from 48 to 73 years old, who underwent phacoemulsification through a 2.75 mm clear corneal incision followed by the implantation of an accommodating IOL Crystalens HD (Bausch & Lomb, USA). The control group consisted of 20 patients (40 eyes), aged from 63 to 83 years old, who underwent phacoemulsification through a 2.75 mm clear corneal incision followed by the implantation of a standard monofocal single-piece acrylic intraocular lens AcrySof (Alcon, USA). All enrolled patients had no coexisting ocular diseases which could influence the final visual acuity. All surgeries were uneventful. At one month postoperatively, the patients were requested to answer 36 questions included in the questionnaire in order to evaluate the quality of visual function. RESULTS: There was a significant improvement in the quality of life in both groups after cataract surgery. The study group tended to assess their own eyesight higher than the control group. Patients from the study group use spectacle correction for a lower number of activities, they find it easier to use fine motor skills when performing activities without spectacle correction in comparison with patients from the control group. Patients from the study group use spectacle correction for reading significantly less frequently, they also find it easier to read the normal size and small print without spectacle correction, in comparison with patients from the control group. CONCLUSIONS: Patients with accommodating IOLs self-evaluate their own eyesight highly, use spectacle correction for a lower number of activities and find it significantly easier to perform precise activities without spectacle correction, in comparison with patients after the standard monofocal intraocular lens implantation.

Analgesic effect of supplemental intracameral lidocaine during phacoemulsification under topical anaesthesia: a randomised controlled trial.

AIMS: To determine the analgesic effect of supplemental intracameral lidocaine 1% during phacoemulsification under topical anaesthesia, and to assess the risk factors associated with pain. METHODS: In a double-masked, randomised, clinical trial, 506 patients undergoing phacoemulsification under topical anaesthesia were randomised to receive a supplemental intracameral injection of either 0.5 cc of 1% lidocaine (277 patients, 54.7%) or balanced salt solution (BSS) (229 patients, 45.3%). Patients were interviewed by a trained interviewer using a standardised questionnaire. The main outcome measure was intraoperative pain, scored on a visual analogue scale of 0-10. Logistic regression was performed to assess ORs. RESULTS: 125 of 277 patients (45.1%) experienced pain in the lidocaine group, compared with 123 of 229 patients (53.7%) in the BSS group. The proportion of patients who experienced pain was significantly lower in the intracameral lidocaine group compared with the BSS group (multivariate OR 0.68, 95% CI 0.47 to 0.97; p=0.034). The median pain score (range) was 0.0 for intracameral lidocaine group compared with 1.0 for BSS group (p=0.039). Pain was more common in females (54.3% vs 43.6%; OR 1.56), non-Chinese (62.3% vs 46.9%; OR 2.13) and those who had previous cataract surgery to the fellow eye (55.3% vs 44.7%; OR 1.61). CONCLUSION: The use of 0.5 cc of 1% intracameral lidocaine during phacoemulsification under topical anaesthesia significantly reduces pain experienced by patients. Risk factors for pain include females, non-Chinese and previous cataract surgery.

Anaesthesia for phacosemulsification surgery: is it as comfortable as we think?

We report an observational prospective study to determine which local anaesthetic technique gave the most comfort during phacoemulsification (cataract) surgery. 1835 patients were recruited. 61.8% were female. Peribulbar (18.2%), subtenons (28.6%), and topical (53.2%) anaesthesia was used. The pain score was assessed by the visual analogue pain scale (VAPS) which ranged from 0 (no pain) to 10 (worse possible pain). The lowest mean pain score occurred in the subtenons group, mean VAPS 0.2 (95% CI 0.1-0.3). The mean pain scores for topical and peribulbar anaesthesia were 0.6 (95% CI 0.5-0.7) and 0.59 (95% CI 0.41-0.76) respectively. Subtenons anaesthesia gave the most comfort during phacoemulsification. Patients experienced more discomfort with 2nd eye surgery. Older patients and males had a higher pain threshold in all three anaesthetic groups.

Melatonin provides anxiolysis, enhances analgesia, decreases intraocular pressure, and promotes better operating conditions during cataract surgery under topical anesthesia.

BACKGROUND: Melatonin has anxiolytic and potential analgesic effects. In this study, we assessed the effects of melatonin premedication on pain, anxiety, intraocular pressure (IOP), and operative conditions during cataract surgery under topical analgesia. METHODS: Forty patients undergoing cataract surgery under topical anesthesia were randomly assigned into two groups (20 patients each) to receive either melatonin 10 mg tablet (melatonin group) or placebo tablet (control group) as oral premedication 90 min before surgery. Anxiety scores, verbal pain scores, heart rate, mean arterial blood pressure, and IOP were recorded. In addition, the surgeon was asked to rate operating conditions. RESULTS: Melatonin significantly reduced the anxiety scores (median, interquartile range) from 5, 3.5-6 to 3, 2-3 after premedication and to 3, 2-3.5 during surgery (P = 0.04 and P = 0.005 compared with the placebo group, respectively). Perioperative verbal pain scores were significantly lower in the melatonin group with less intraoperative fentanyl requirement (median, interquartile range) compared with the control group, 0, 0-32.5 vs 47.5, 30-65 microg, respectively, P = 0.007. Melatonin also decreased IOP (mean +/- sd) significantly from 17.9 +/- 0.9 to 14.2 +/- 1.0 mm Hg after premedication and to 13.8 +/- 1.1 mm Hg during surgery (P < 0.001). It also provided better quality of operative conditions. CONCLUSION: We concluded that oral melatonin premedication for patients undergoing cataract surgery under topical anesthesia provided anxiolytic effects, enhanced analgesia, and decreased IOP resulting in good operating conditions.

Visual perception during phacoemulsification cataract surgery under subtenons anaesthesia.

AIM: The aim of this study was to record the subjective visual experience of patients during phacoemulsification and intraocular lens implantation under subtenons anaesthesia. METHODS: Prospective, nonrandomised, cohort, postoperative questionnaire based study. Patients selected underwent routine phacoemulsification and intraocular lens implantation under regional subtenons anaesthesia. chi(2) and Fisher's exact tests (two-tail) were used to evaluate the data. RESULTS: A total of 104 patients were selected, 38 (36.5%) were male and 66 (63.5%) were female. The mean age of patients was 74.0+/-8.8 years. In all, 87.5% saw light during the operation with 9.6% finding this painful. Photophobia was highest among younger patients (P=0.002). Coloured lights were seen by 56.7% and 13.5% found the visual experience frightening. Frightening visual experiences were significantly associated with the perception of colour (P=0.005) and photophobia (P=0.003). A volume of anaesthetic greater than 4 m was associated with a significant reduction in anxiety as a result of the visual experience (P=0.003). None of the other visual phenomena recorded were associated with a frightening visual experience. CONCLUSIONS: Patients undergoing regional anaesthesia experience a wide variety of visual sensations during cataract surgery. Perception of colour and volumes of anaesthetic less than 4 m appear to be associated with the visual experience being more frightening. Detailed preoperative counselling is mandatory. It should include comprehensive information about visual perception during the procedure relieving the patients from unnecessary distress.

Visual perception during phacoemulsification cataract surgery under topical and regional anaesthesia.

PURPOSE: To compare the subjective visual experiences of patients during phacoemulsification and intraocular lens (IOL) implantation using regional and topical anaesthesia. DESIGN: A prospective, cohort, questionnaire-based study. METHODS: The study cohort consisted of 247 patients without pre-existing ocular pathology who underwent routine phacoemulsification and IOL implantation. The mean age of the subjects was 75.4 +/- 9.4 years and 34.5% of them had a history of cataract surgery. Three different methods of local anaesthesia were used: 66 (26.7%) of the patients were given topical anaesthesia (TA); 74 (30.0%) were given sub-Tenon's anaesthesia (SA), and 107(43.3%) were given peribulbar anaesthesia (PA). The patients were interviewed immediately after surgery by theatre staff using a standardized questionnaire that investigated their intraoperative visual experiences. RESULTS: There was no significant difference between the three methods of anaesthesia regarding light perception during the surgery. However, patients undergoing surgery under TA experienced brighter light intensity levels (78.3%) than those given SA (50.0%) and PA (55.7%) (p = 0.02). A total of 69.6% of subjects who received TA reported visual perception of colours during surgery, as opposed to 56.8% of SA recipients and 49.0% of PA recipients (p = 0.02). In addition, patients under TA were more aware of surgical instruments (26.1%) than those under SA (10.8%) and PA (15.9%) (p = 0.08). The vast majority of patients in all three groups found the visual experience to be non-frightening. There were no associations between intraoperative visual impression and age or sex. Although not statistically significant (p = 0.06), prior cataract surgery appeared to alleviate some of the anxiety associated with the visual experience. CONCLUSION: Patients undergoing regional and topical anaesthesia experience a wide variety of visual sensations during surgery. The differences in visual impressions between the groups may reflect the varying degrees of optic nerve blockade that result from the different anaesthetics.