Subjective visual experience and pain level during phacoemulsification and intraocular lens implantation under topical anesthesia.

PURPOSE: To investigate the subjective visual experiences and pain during the phacoemulsification and intraocular lens (IOL) implantation under topical anesthesia, and whether these parameters change according to the stage of phacoemulsification cataract surgery. METHODS: Forty eyes of 40 patients with cataract undergoing phacoemulsification and IOL implantation under topical anesthesia were included in this study. The patients were told that they would be asked about their visual experiences and pain level, if any, during every stage of the surgery. As for degree of the pain, a 5-grade scale was used. The surgery was divided into 9 stages, i.e., clear corneal incision, continuous curvilinear capsulorhexis, side-port incisions at 3 and 9 o'clock positions, hydrodissection, nuclear rotation, phacoemulsification, bimanual irrigation and aspiration, IOL implantation, apposition of corneal incisions with stromal hydration. RESULTS: All subjects (100%) reported that they had seen some kind of light during the operation. Thirty-eight patients (95%) said that they had seen one or more colors. In 32 patients (80%), the light intensity decreased, and colors blurred significantly following the hydrodissection. As for the pain level during surgery, the overall pain score was found to be 0.40. The highest mean pain score was noted during IOL implantation stage followed by phacoemulsification and bimanual irrigation-aspiration. CONCLUSION: Topical anesthesia is both a safe and effective method for small-incision clear corneal phacoemulsification cataract surgery. Patients may experience visual sensations, and the pain felt during the operation is low and tolerable. Visual experiences and pain level may change according to the stage of phacoemulsification cataract surgery.

Quantitative analysis of apoptosis in retinoblastoma.

PURPOSE: The rate of apoptosis in retinoblastoma (Rb) and the factors that may influence this rate, such as therapy prior to surgery, amount of necrosis in tumour tissue, differentiation and laterality of the tumour, were investigated. METHODS: Thirty-one specimens (25 enucleation, six exenteration) with Rb were studied. Prior to final surgery, three patients received systemic chemotherapy, one intravitreal chemotherapy, one transpupillary thermotherapy, one external beam radiotherapy and one high-dose oral methylprednisolone therapy. The apoptotic index (AI,%) was calculated by counting at least 1000 cells under light microscopy (x 100) using TUNEL (terminal deoxynu-cleotidyl transferase-mediated dUTP nick-end labelling) method. RESULTS: The mean AI was 2.75 plus minus 1.2. No statistically significant association was observed between rate of apoptosis and the presurgical treatment, extent of necrosis, tumour differentiation and laterality. CONCLUSION: Apoptosis is an important mechanism of cell death, and may be a limiting factor for tumour progression. In this study, the rate of apoptosis was not affected by any of the studied parameters.