Pain experience in patients undergoing topical anesthesia alone versus topical plus intracameral anesthesia during cataract surgery.

PURPOSE: To evaluate and compare the pain experience and discomfort during cataract surgery and over the 24 hours after surgery in patients undergoing either topical anesthesia alone or topical anesthesia plus intracameral anesthesia, provided by using a standard topical anesthesia regimen and a 0.2-mL dose of Mydrane®. METHODS: Prospective study involving 100 patients who underwent cataract surgery receiving either topical anesthesia alone (group 1, n = 50) or topical anesthesia plus intracameral anesthesia (group 2, n = 50) between January 2021 and March 2022. The pain experienced by patients during and after surgery was assessed using a pain scale and a questionnaire. One hour after surgery, patients were asked to rate the intensity of discomfort they experienced throughout the procedure by pointing to a 0-100 Visual Analogue Scale (VAS). RESULTS: According to VAS measurements, patients who underwent surgery under topical anesthesia reported more significant pain than those who underwent surgery under topical anesthesia plus intracameral anesthesia during and over the 24 hours after surgery. (p = 0.02 and p = 0.01, respectively). Patients undergoing topical anesthesia had 2.34-fold greater odds of having pain during surgery [95% Confidence Interval (CI): 1.58-5.25, p = 0.03]. CONCLUSIONS: Topical anesthesia plus intracameral anesthesia lower intraoperative and postoperative pain levels, improving patient cooperation and representing a useful analgesic delivery method in cataract surgery.

Manual small-incision cataract surgery under topical anesthesia.

Manual small-incision cataract surgery is one of the most common surgical procedures in ophthalmology. Most cataract surgeries are performed under local anaesthesia. Peribulbar or retrobulbar anaesthesia is commonly used to achieve analgesia and akinesia during surgery but it has various complications. Our aim was to study patient comfort and surgeon's perspective in terms of patient cooperation in MSICS under topical anaesthesia using only proparacaine 0.5% eye drops without any periocular block or intracameral drug. Also to popularise Topical MSICS similar to Topical Phacoemulsification. A prospective analytical study of 33 patients who underwent MSICS surgery from March 2022 to June 2022 using Topical proparacaine eye drops 0.5% was done and patient's comfort and surgeon's perspective in terms of patient cooperation was studied on a scale of 1-5. Out of 33 patients who underwent surgery, the average comfort score based on patient feedback was 3.45± 0.96 and average patient cooperation score based on surgeon assessment was 3.42 ± 1.07 on a scale of 1-5. We concluded that MSICS using only topical proparacaine 0.5% eye drops, can provide sufficient patient comfort and can avoid complications related to peribulbar anaesthesia. Hence it can be used in large scale cataract surgeries and also provides economical utilisation of resources, lesser complications and early post operative recovery without compromising surgical outcome.

Minimal anesthetic manual small-incision cataract surgery (MSICS): A novel technique in use for anesthesia in MSICS.

Ever-evolving modern day cataract extraction techniques have been accompanied by the use of smaller quantities and less invasive methods of anesthesia. Topical anesthesia is routinely used for phacoemulsification. However, peribulbar block or some modification of it is used for anesthesia in manual small-incision cataract surgery (MSICS) by most practitioners. The authors describe a technique using a combination of 1.5-2 milliliters of anesthetic mixture given subconjunctivally and supplemented with commercially available intracameral anesthetic and mydriatic for MSICS. It is possible to get high level of anesthetic effect and ease of surgery with this technique though there is a small learning curve. Several modifications from topical phacoemulsification like two side ports six o'clock hours apart make this surgery easy to adapt to. No special instrumentation is required. It gives adequate analgesia and anesthesia to complete the surgery. a minimalistic anesthetic approach in MSICS can be used with enhanced safety and by avoiding usual complications of traditional peribulbar and retrobulbar anesthesia.

Effect of cryotherapy on pain scores and satisfaction levels of patients in cataract surgery under topical anesthesia: a prospective randomized double-blind trial.

OBJECTIVE: To evaluate the effects of cryotherapy on pain scores and satisfaction levels of patients during cataract surgery under topical anesthesia. Eighty patients aged between 55 and 75 years scheduled for cataract surgery were randomly allocated to two study groups to receive topical anesthesia with cryotherapy (TC) or topical anesthesia alone (T) groups. Visual analog pain scores, patient satisfaction level, hemodynamic parameters, and quality of operating conditions were recorded. RESULTS: Cryotherapy significantly reduced VAS pain scores during surgery (P = 0.014). Although no significant difference in postoperative pain scores, opioid consumption, heart rate, and mean arterial blood pressure was seen in the postoperative period. The surgeon reported better quality of operating conditions in the TC group (P = 0.018). Cryotherapy as a complementary method with topical anesthesia reduced pain scores of patients during surgery. It also produced a better quality of operating conditions for surgeons. There was no significant difference in either postoperative pain scores or opioid consumption. Trial registration This trial was registered at Iranian clinical trial registering: IRCT registration number: IRCT2017052734091N2.

Can lubrication of the eyelid speculum reduce overall pain perception associated with cataract surgery by phacoemulsification performed under topical anesthesia?

Purpose: This study aimed to evaluate the effect of using the lubricated eyelid speculum on the overall pain perception by the subject patients who underwent cataract surgery by phacoemulsification technique under topical anesthesia. Methods: A prospective interventional randomized comparative study was conducted at the tertiary eye care center, wherein adult patients scheduled for bilateral cataract surgery with phacoemulsification techniques under topical anesthesia were randomized to undergo surgery with two different modes of eyelid speculum insertion, either with or without lubrication of the eyelid speculum. Fifty percent of the patients underwent surgery with eyelid speculum without lubrication, and 50% with lubrication of the eyelid speculum. The primary outcome was to compare the level of overall pain perception among the subject patients of the two groups by using the Visual Analogue Scale (VAS) in the immediate postoperative period. Results: The study included 130 patients who underwent bilateral cataract surgery (n = 260 eyes) under topical anesthesia, wherein n = 130 eyes underwent surgery using lubricated eyelid speculum and n = 130 eyes underwent surgery with dry eyelid speculum. Pain perception score assessed on the VAS (0-10 cm) ranged from 0.5 to 6, with a mean ± standard deviation of 2.06 ± 1.12. A significant correlation was found with two different methods of eyelid speculum insertion with reduced overall pain perception in patients with the use of lubricated eyelid speculum compared to the dry eyelid speculum (P = 0.0001). Conclusion: The overall pain perception associated with cataract surgery performed by phacoemulsification technique under topical anesthesia can be further minimized by lubricating the eyelid speculum prior to insertion for exposing the globe.

Surgical outcomes of macular hole and epimacular membrane treatment in patients with intraoperative amaurosis under sub-Tenon's anesthesia.

OBJECTIVE: Some patients have been found to develop intraoperative amaurosis under sub-Tenon's anesthesia. We explored whether these patients have poor surgical outcomes during mid- to long-term postoperative follow-up. METHODS: In this case series, 74 of 85 patients with macular diseases who underwent phacoemulsification combined with vitrectomy under sub-Tenon's anesthesia developed intraoperative amaurosis. The surgical outcomes at the 2- and 4-month follow-ups in these patients were investigated and compared with the outcomes in patients without amaurosis using best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and pattern visual evoked potential (PVEP). RESULTS: Both BCVA and the OCT-based macular structure in patients with intraoperative amaurosis showed significant postoperative improvement comparable with that of patients without amaurosis. The presence of intraoperative amaurosis was not associated with either macular hole closure or macular edema regression. PVEP revealed no significant changes in the wave latency or amplitude before and after surgery. CONCLUSION: Intraoperative amaurosis following sub-Tenon's block is commonly seen but does not predict a poor surgical prognosis. When a patient develops amaurosis during surgery, the surgeon should increase patient comfort through verbal communication rather than perform an additional intervention to help relieve the patient's anxiety.

Pure phaco: phacoemulsification without ophthalmic viscosurgical devices.

The ophthalmic viscosurgical device (OVD) is an essential part of modern phacoemulsification surgery. Many times, OVDs are blamed for intraocular pressure spikes, toxic anterior segment syndrome, and capsular bag distension syndrome. To avoid these complications, we developed a technique in which phacoemulsification can be done without using OVDs. The irrigating cannula, on a continuous irrigation mode, was introduced through a side port, and capsulorhexis and incision construction were performed under an irrigating balanced salt solution. No hydroprocedure was performed. Phacoemulsification was done by chopping technique. At the end of the procedure, the intraocular lens was implanted by wound assistance technique under a continuous irrigation mode.

Evaluation of the efficacy of optimal pulsed technology treatment in patients with cataract and Meibomian gland dysfunction in the perioperative period.

BACKGROUND: The aim of this study was to evaluate the efficacy and safety of M22 Optimal Pulsed Technology (OPT) applied in patients with age-related cataract and Meibomian gland dysfunction (MGD) in perioperative period. METHODS: This prospective observational study was carried out in the Jinan Mingshui Eye Hospital (Zhangqiu, China). We studied 60 patients (30 in the OPT treatment group and 30 in the conventional surgery group) with age-related cataract and MGD who underwent phacoemulsification and evaluated the efficacy of OPT treatment before and 1 month and 3 months after surgery. Ocular Surface Disease Index (OSDI) questionnaire, biomicroscopic examination of lid margins, Meibomian gland yielding secretion score (MGYSS), corneal fluorescein staining scores (CFS), tear film break-up time (TBUT), tear meniscus height (TMH) and the morphology of the MG (meibography) followed by Keratograph 5 M (K5M) were used to assess the patients' conditions. RESULTS: There were significant differences in the scores of OSDI, MGYSS, TBUT, and CFS between the preoperative and postoperative outcomes (p < 0.05). In the OPT treatment group, the postoperative ocular surface condition was obviously better and the patient satisfaction rate was higher than those before surgery. There were significant differences in the scores of OSDI, EMAS, MGYSS and CFS before and 1 month after surgery (p < 0.05). In addition, there were also significant differences in the scores of OSDI, EMAS, MGYSS and MGLS before and 3 months after surgery (p < 0.05). No complications appeared during OPT treatment. CONCLUSIONS: Cataract surgery can aggravate MGD and is detrimental to ocular surface health. OPT treatment was a safe and effective intervention for patients with MGD and cataract during perioperative period.

XEN Implant Fracture During Needling Procedure.

PURPOSE: The XEN implant is a small hydrophilic stent designed to be implanted permanently for the treatment of glaucoma. As with other bleb-forming surgical procedures, needling is part of postoperative care. We describe 3 cases of XEN fracture of the subconjunctival portion that occurred during the needling procedure. METHODS: The purpose of this study was to describe the clinical and anatomic outcomes in 3 cases of XEN fracture caused by the needling procedure. RESULTS: In our case series of XEN procedures (n=170), bleb needling has been performed in 98 cases (57.6%). In 3 cases (3.1%), we observed unintentional damage to the implant after the procedure.The mean distal segment length of the fractured XEN measured 0.83 (range: 0.7 to 1) mm. Despite the adverse event, the mean IOP changed from 25.0 (range: 21 to 30) mm Hg before needling to 12.0 (range: 10 to 14) after needling, with a mean follow-up of 15.3 (range: 11 to 18) months. No vision-threatening complications were recorded during the entire follow-up. CONCLUSIONS: XEN fracture related to the needling procedure should be considered as a possible adverse event of bleb management. Because XEN is composed of a soft and flexible gelatin material, it could be easily damaged by the needle. The fracture does not seem to impair the efficacy of the draining device. As a matter of fact, according to Poiseuille's laws, shortening of the implant's length decreases the resistance while increasing the flow rate. Despite our positive results, it is recommended to preserve the integrity of the implant.

Transient retinal artery occlusion after phacoemulsification under local anesthetic block / Oclusão arterial retiniana transitória após facoemulsificação sob bloqueio anestésico

ABSTRACT We here in report the case of a patient subjected to cataract surgery through phacoemulsification under local anesthetic block, without intra-operative complications. The patient presented important visual impairment in the first post-operative day. Fundoscopy showed pallor resembling cherry-red spots at the macula. Fluorescein angiography did not depict signs of vascular occlusion and the spectral-domain optical coherence tomography showed increased reflectivity in the inner layers of the retina, thus suggesting local thickening and edema. The current case led to the diagnostic hypothesis of transient retinal arterial occlusion.

RESUMO Relatamos um caso de um paciente submetido a facectomia por facoemulsificação sob bloqueio anestésico peribulbar, sem intercorrências per-operatória, que apresentou no primeiro dia de pós-operatório baixa visual significativa. À fundoscopia observou-se palidez em aspecto de mácula em cereja. A angiofluoresceinografia não demonstrou sinais de oclusão vascular e a tomografia de coerência óptica mostrou aumento da refletividade das camadas internas da retina, sugerindo espessamento e edema local. No caso descrito foi aventada hipótese diagnóstica de oclusão arterial retiniana transitória.

Deep topical anesthesia with ropivacaine-soaked sponge for phacoemulsification.

PURPOSE: To assess safety and efficacy of deep topical anesthesia with ropivacaine-soaked sponge compared with topical anesthesia with oxybuprocaine in patients undergoing phacoemulsification. METHODS: This was a retrospective study where records of patients operated for cataract were evaluated. Patients using a visual analogue scale scored pain during surgery, and the surgeon on a questionnaire recorded ease of operation. Medical records were evaluated for patients who received topical anesthesia with multiple administrations of oxybuprocaine 0.4% or those who received deep topical anesthesia with a polyvinyl acetal sponge impregnated with ropivacaine 0.75% and positioned under the eyelid 30 min before surgery. RESULTS: A total of one hundred patient records, equally divided in patients receiving deep topical anesthesia or topical anesthesia, were included. The visual analogue scale scores among the groups were statistically significant for a lower pain score in patients who received deep topical anesthesia with ropivacaine-soaked sponges (p = 0.0069). The average surgeon score was significantly higher for the deep topical anesthesia group indicating favorable ease of surgery (p = 0.0341). Six patients had major complications during surgery. No additional anesthesia was necessary to manage the complications in four patients in the deep anesthesia group, whereas propofol was used for the induction and maintenance of anesthesia in two patients in the topical anesthesia group. CONCLUSIONS: Deep topical anesthesia with ropivacaine-soaked sponges performed as well as topical oxybuprocaine regarding safety and efficacy. It provided a lower patient pain score, favorable surgeon satisfaction, and long-lasting anesthesia.

Management of dislocated nucleus with corneal opacity by combined deep anterior lamellar keratoplasty, pars- plana vitrectomy and phaco-fragmentation.

A 32-year-old man presented with bilateral diminution of vision for 10 years. Visual acuity was light perception in both eyes with inaccurate projection in the oculus dextrus(OD) and accurate projection in the in oculus sinister (OS). Intraocular pressure was 6 and 12 mm Hg in the OD and OS, respectively. Slit-lamp examination revealed the presence of leucomatous corneal opacification with microcornea in oculus uterque (OU). Both eyes had a dislocated nucleus in the vitreous cavity on ultrasound B-scan with advanced cupping in the right eye. Ultrasound biomicroscopy revealed ciliary body atrophy in the OD and preserved ciliary processes (two quadrants) in the OS. In view of a partially preserved ciliary body function and a potential for gaining useful vision, we planned surgical intervention in the left eye. Deep anterior lamellar keratoplasty with pars planavitrectomy (PPV) and phacofragmentation of the nucleus was done. Donor lamellar graft was sutured after completion of PPV and nucleus fragmentation. The patient regained useful ambulatory vision postoperatively with clear corneal graft.

Health policy regulations pertaining to advanced surgical devices-their socio-economic effects on ophthalmology practice.

The Israel Ministry of Health enacted regulations that aim to reduce private expenditure on healthcare services and mitigate social inequality. According to the modified rules, which went into effect in the second half of 2016, patients who undergo surgery in a private hospital and are covered by their healthcare provider's supplemental insurance (SI) make only a basic co-payment.The modified regulations limited the option of self-payment for advanced devices not covered by national health basket, meaning that patients for whom such devices are indicated had to pay privately for the entire procedure. These regulations applied to all medical and surgical devices not covered by national health insurance (NHI).Toric intraocular lenses (IOLs) are a case in point. These advanced lenses are implanted during cataract surgery to correct corneal astigmatism and, in indicated cases, obviate the need for complex eyeglasses postoperatively. Toric IOL implantation has been shown to be highly cost-effective in both economic and quality-of-life terms. Limitations of the use of these advanced IOLs threatened to increase social inequality.In 2017, further adjustments of the regulations were made which enabled supplemental charges for these advanced IOLs, performed through the SI programs of the healthcare medical organizations (HMOs). Allowing additional payment for these lenses at a fixed pre-set price made it possible to apply a supplemental part of the insurance package to the surgery itself. In mid 2018 these IOLs were included without budget in the national health basket, allowing for self-payment for the additional cost in addition to the basic coverage for all patients with NHI.This case study suggests that, in their efforts to enhance health care equity, policymakers may benefit if exercising due caution when limiting the extent to which SI programs can charge co-payments. This is because, when a service or product is not available via the basic NHI benefits package, limiting SI co-payments can sometimes result in a boomerang effect - leading to an increase in inequality rather than the sought-after decrease in inequality.

Advanced Subconjunctival Anesthesia for Cataract Surgery.

PURPOSE: Ocular regional blocks generally require blind instrumentation to the posterior orbit, leading to rare but serious complications. However, topical anesthesia does not suppress eye or lid movements and may lead to more surgical complications. Advanced subconjunctival anesthesia (ASCAN) is a technique developed to provide reliable akinesia and anesthesia without anterior dissection or blind intrusion into the posterior orbit, while allowing visualization of the needle-tip position. DESIGN: Nonrandomized case series at a rural health service. METHODS: Advanced subconjunctival anaesthesia was performed on 60 elective adult patients undergoing phacoemulsification surgery. The technique involves piercing the conjunctiva and Tenon's capsule in the superior outer quadrant of the globe with a 25-gauge, 16 mm needle, using either lignocaine 2% plain or in equal mix with bupivicaine 0.5%. Up to 10 mL of anesthetic with hyaluronidase 30 IU/mL is injected in a posterior direction into the sub-Tenon's space. Ocular motor functions were assessed 10 minutes after ASCAN using a Brahma scale. Pain was assessed during surgery and at the end of surgery after subconjunctival injection of antibiotic and steroid using a verbal Numeric Rating Scale. RESULTS: All patients completed surgery without needing supplemental anesthesia. Fifty-eight patients (97%) were pain free, whereas 2 patients experienced transient mild pain. Adequate globe akinesia and reliable lid paralysis was achieved comparable to other studies, with no major surgical or anesthetic complications. CONCLUSIONS: Advanced subconjunctival anesthesia is a visually guided, minimally invasive technique, achieving satisfactory analgesia and akinesia for phacoemulsification surgery.

Face-to-face upright seated positioning for cataract surgery in patients unable to lie flat: Case series of 240 consecutive phacoemulsifications.

PURPOSE: To present a case series of patients who were unable to lie flat for cataract surgery. SETTING: University teaching hospital, district hospital, and private practice, Norwich, United Kingdom. DESIGN: Prospective case series. METHODS: All patients had phacoemulsification using face-to-face upright seated positioning. The patient sits upright or semi-recumbent, and the surgeon sits or stands, facing the patient. The microscope is rotated forward, and surgery is done via an incision in the lower half of the cornea, using topical intracameral anesthesia. All 240 face-to-face cases, performed by the same surgeon, were prospectively recorded. The database included reasons for positioning difficulty, position adopted, and per-operative complications. Data on full systemic monitoring of 34 patients and satisfaction data on 90 patients were also recorded. RESULTS: In 13 years, 240 eyes (179 patients) had face-to-face surgery. Common diagnoses were severe kyphosis, orthopnea, or both. No patient was refused face-to-face surgery since the service was started. The rate of vitreous loss was 12 (5%) of 240 cases. However, all patients (100%) received a posterior chamber intraocular lens. No patient had any systemic adverse event, and vital signs remained stable during surgery. All respondents stated that they would be happy to have face-to-face positioning again. CONCLUSIONS: Face-to-face positioning, in the hands of an experienced surgeon, was an acceptably safe approach for patients unable to lie flat for cataract surgery. It might be the only option for some patients. However, all patients should be counseled regarding the increased risk for operative complications.

Comparison between ropivacaine and bupivacaine in deep topical fornix nerve block anesthesia in patients undergoing cataract surgery by phacoemulsification.

Purpose: In this study, we intend to analyze ropivacaine and bupivacaine in various parameters during phacoemulsification under deep topical fornix nerve block (DTFNB), a known form of nerve block for phacoemulsification. Methods: This prospective randomized study was conducted on 100 patients undergoing elective cataract surgery by phacoemulsification under DTFNB. Patients were divided into two equal groups of fifty patients each, Groups B (bupivacaine) and Group R (ropivacaine). Two sponges, approximately 2 mm × 3 mm dimensions, saturated with either 0.5% bupivacaine or 0.75% ropivacaine were placed deep in the conjunctival fornices to perform the deep topical block. Both groups were evaluated for magnitude of pain and discomfort at various stages of phacoemulsification using a simple pain scoring system. The level of surgeon satisfaction, requirement for supplementary anesthesia, and surgical complications were also evaluated. Quantitative variables between the two groups were compared using unpaired t-test. Qualitative variables were correlated using Chi-square test. Results: Overall demographic parameters of patients were similar in both groups. Similar mean pain scores were found in the ropivacaine and bupivacaine groups, with no statistical significance. Surgical satisfaction and the need for supplemental anesthesia were also statistically insignificant. Conclusion: Ropivacaine is a good alternative for deep topical anesthesia as it has a better safety margin and lesser toxic effect than other comparable local anesthetic agents.

Amaurosis and contralateral cranial nerve pairs III and VI paralysis after peribulbar block - Case report / Amaurose e paralisia do III e do VI pares cranianos contralaterais após bloqueio peribulbar - relato de caso

Abstract Background and objectives: Peribulbar anesthesia has emerged as a safer option compared with intraconal retrobulbar block. Still, peribulbar anesthesia may not be considered without risk. Numerous complications have been described when performing this technique. This report aims to describe a rare case of amaurosis and contralateral paralysis while attempting to perform a peribulbar anesthesia. Case report: Male patient, 75-year old, physical status ASA II, undergoing cataract surgery by phacoemulsification with intraocular lens implantation. Sedated with fentanyl and midazolam and subjected to peribulbar anesthesia. There were no complications during surgery. After finishing the procedure, the patient reported lack of vision in the contralateral eye. Akinesia of the muscles innervated by the cranial nerve pairs III and VI, ptosis, and medium-sized pupils unresponsive to light stimulus were observed. Four hours after anesthesia, complete recovery of vision and eyelid and eyeball movements was seen in the non-operated eye. Conclusions: During peribulbar anesthesia, structures located in the intraconal space can be accidentally hit leading to complications such as described in the above report. Following the technical guidelines and using appropriate size needles may reduce the risk of such complication, but not completely.

Resumo Justificativa e objetivos: A anestesia peribulbar surgiu como uma opção mais segura quando comparada com o bloqueio retrobulbar intraconal. Ainda assim, a anestesia peribulbar não pode ser considerada isenta de riscos. Inúmeras complicações foram descritas quando da aplicação dessa técnica. O presente relato tem como objetivo descrever um caso raro caracterizado por amaurose e paralisia contralaterais quando da tentativa de se fazer a anestesia peribulbar. Relato de caso: Paciente masculino, 75 anos, estado físico ASA II, submetido à facectomia por facoemulsificação com implante de lente intraocular. Sedado com fentanil e midazolam e submetido a APB. Não houve intercorrências durante a cirurgia. Após o término do procedimento o paciente relatou ausência de visão no olho contralateral. Foram observadas acinesia da musculatura inervada pelo III e VI pares cranianos, ptose palpebral e pupilas de tamanho médio, não responsivas ao estímulo luminoso. Após quatro horas da anestesia, houve recuperação completa da visão, da movimentação das pálpebras e do globo ocular não operado. Conclusões: Durante a APB, estruturas localizadas no espaço intraconal podem ser atingidas acidentalmente levando a complicações como a descrita no relato acima. O respeito às diretrizes técnicas e o uso de agulhas com o tamanho adequado podem reduzir o risco de tal complicação, mas não de forma completa.

Comparison of surgeon comfort assessment during phacoemulsification using bilateral topical anesthesia versus ipsilateral topical anesthesia: a randomized controlled study.

AIM: To evaluate the effectiveness of bilateral use of topical anesthetic eye drops during phacoemulsification procedure as compared to use in one eye only. METHODS: This is a prospective double-blind randomized case study of 180 cases undergoing phacoemulsification under topical anesthesia using 0.5% proparacaine: Group 1 consisting of patients who had topical anesthetic eye drop instilled into the operating eye only and Group 2 consisting of patients who had both their eyes anesthetized using topical anesthetic eye drops. Phacoemulsification was done using standard surgical technique. Main parameters evaluated included number of intra-operative patient counseling score (IPCS), surgical comfort score (SCS), total phacoemulsification procedure time (TPPT) and total operation time (TOPT). RESULTS: A comparison of mean value of various variables between Group 1 (60; 33.3% cases) and Group 2 (120; 66.7% cases) using "t" test revealed that there was a statistically significant difference for mean SCS (78.38 ± 10.31 vs. 85.05 ± 8.70; p = 0.00), mean IPCS (12.60 ± 3.11 vs. 6.63 ± 1.74; p = 0.00) and mean TOPT (418.88 ± 89.59 vs. 341.64 ± 79.51; p = 0.00), respectively. However, no statistically significant difference existed for mean TPPT (143.57 ± 87.96 vs. 152.96 ± 78.99; p = 0.48). CONCLUSION: Simultaneous instillation of topical anesthetic eye drops in both the eyes, i.e., operating eye and the fellow eye as against practice of instilling topical anesthetic eye drop in the operating eye only, helps in decreasing the total surgical time by primarily shortening the durations of pre- and post-ultrasonic periods of surgery where effective globe stabilization is wanted. This is achieved by better patient compliance, which in turn enhances surgeon's comfort during phacoemulsification surgery.