Comparison of surgically induced astigmatism between anterior and total cornea in 2.2 mm steep meridian incision cataract surgery.

BACKGROUND: This study aimed to compare surgically induced astigmatism (SIA) on the anterior and total cornea during cataract surgery through a 2.2 mm steep meridian incision. METHODS: The study included 69 left eyes of 69 patients who had undergone cataract surgery. The 69 eyes were classified into three subgroups according to the preoperative steep meridian. Following phacoemulsification, an intraocular lens was inserted into the bag. The keratometric measurements were taken 12 months postoperatively, on the anterior cornea (automated keratometer and anterior keratometry [K] from a rotating Scheimpflug camera) and total cornea (equivalent K reading [EKR] 3.0 mm, EKR 4.5 mm, total corneal refractive power (TCRP) 2.0 mm ring, TCRP 3.0 mm zone, TCRP 4.0 mm zone). The SIA was analyzed for each parameter. RESULTS: On the double-angle polar plot, the summated vector mean values of SIA determined by the automated keratometer and Scheimpflug anterior K were 0.28 diopter (axis: 177°) and 0.37 diopter (axis: 175°) in with-the-rule (WTR) astigmatism; 0.03 diopter (axis: 156°) and 0.18 diopter (axis: 177°) in oblique astigmatism; 0.15 diopter (axis: 96°) and 0.17 diopter (axis: 73°) in against-the-rule (ATR) astigmatism. The mean SIAs on the total cornea ranged from 0.31 to 0.42 diopter in WTR astigmatism; from 0.16 to 0.27 diopter in oblique astigmatism; from 0.04 to 0.11 diopter in ATR astigmatism. Mean magnitude SIA ranged from 0.41 to 0.46 diopter on anterior corneal surface and 0.50 to 0.62 diopter on total cornea. J0 and J45 of the posterior cornea showed no significant changes after cataract surgery, and the changes in J0 and J45 did not show any statistical differences between the anterior and total cornea (all p > 0.05). CONCLUSIONS: There were no differences in the summed vector mean values of SIA between the anterior cornea and the total cornea.

Thelazia callipaeda infection during phacoemulsification cataract surgery: a case report.

BACKGROUND: In August 2020, we found one case of thelazia callipaeda infection during phacoemulsification cataract surgery. This maybe the first report for thelazia callipaeda discovered during phacoemulsification cataract surgery in China. CASE PRESENTATION: An 85 years old farmer was found thelazia callipaeda infection during phacoemulsification cataract surgery. The patient admitted whose foreign body sensation was often found in the right eye in recent 2 months. The worm was then taken out with ophthalmic forceps and put into sterile normal saline. The worm was sent to the Eye Institute of Shandong University of Traditional Chinese Medicine for identification. After identification, the worm was regarded as the male thelazia callipaeda. The head is blunt and round, the tail end curls to the abdomen, and the long copulation spines protrudes from the cloaca. The conjunctival sac was washed carefully with a large amount of Sodium Lactate Ringer 's Solution. After operation, antibiotics, pranoprofen eye drops, and tobramycin dexamethasone eye drops were further applied. After continuous examination of conjunctival sac for 2 weeks, the patient's visual acuity maintained 20/20, confirming that there was no residual thelazia. CONCLUSIONS: This report highlights the physician should ask the patient's history carefully before operation and it is necessary to strengthen health publicity and education, maintaining clean environment and keeping personal eye hygiene.

Pain Perception in Cataract Surgery: Topical versus Peribulbar Anaesthesia.

INTRODUCTION: The requirement for very deep akinesia has decreased with the use of modern phacoemulsification technique for cataract surgery. The use of topical anesthesia has increased as a way to reduce complications associated with anaesthesia with injection and to allow the most rapid visual recovery. The objective of this study was to assess the patient reported pain in phacoemulsification cataract surgery under topical anaesthesia versus peribulbar anaesthesia administered using an injection. MATERIALS AND METHODS: The subjects for this study were the patients undergoing phacoemulsification cataract surgery at HEH. Subjects were divided into two groups, one having topical anaesthesia for phacoemulsification and the other having peribulbar anaesthesia with injection. The data for the study was collected in a ten point visual analogue graphic pain scale. After the surgery was over the patients reported on the felt pain wherein the scale zero was assigned for no pain at all, 1 to 3 for mild pain, 4-6 for moderate pain and 7-10 for severe pain. RESULTS: In total, 366 subjects received peribulbar anaesthesia and 336 subjects received topical anaesthetic drops. The mean pain score between the two groups was found to be higher in the peribulbar injection group (p <0.001). The mean pain score for both males and females was found to be higher in the peribulbar injection group (p<0.001 for both genders). CONCLUSION: Topical anaesthesia for phacoemulsification cataract surgery tends to cause less pain and discomfort for patients.

Oculocardiac reflex in phacoemulsification: Peribulbar vs topical anesthesia.

Purpose: This study compares the vital parameters and pain experienced during phacoemulsification under peribulbar and topical anesthesia to determine the incidence of OCR. Methods: One hundred six patients are enrolled for phacoemulsification in a prospective and randomized study. Fifty-two patients undergo surgery in a peribulbar block (Group PB) and 54 in topical anesthesia (Group TA). Mean arterial pressure (MAP) and pulse rate are recorded during a preoperative check-up and at four other steps of surgery. Pain experienced during surgery and on a postoperative day, 5, is graded with a verbal analogue scale. OCR defined as a decrease in pulse rate by greater than 20% is calculated. Chi-square test, Fisher's exact test, paired t test and the comparison of means give the statistical analysis. A value of P < 0.05 was taken as significant. Results: MAP readings at baseline versus MAP at other steps of surgery show a trend towards rising with a P value of < 0.05 in both groups. Pulse rate measured at all steps of surgery versus baseline pulse rate in Group TA shows P < 0.05. OCR is present in nine patients in peribulbar block verses eleven patients in topical anesthesia with P value of 0.687. The pain scores using verbal analogue scale were higher in Group TA compared with Group PB with a P < 0.0001. Conclusion: Oculocardiac reflex can occur during phacoemulsification under both peribulbar block and topical anesthesia, and the difference is not significant.

The effects of functionally monocular patients' emotional reactions during phacoemulsification under topical anesthesia.

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.

Scoring Of Pain Perception During Phacoemulsification Under Topical Anaesthesia.

BACKGROUND: Topical anaesthesia is safe and inexpensive type of anaesthesia used during phacoemulsification as compared to local anaesthesia. The trend of conducting surgeries under topical anaesthesia is increasing globally. The objective of this study was to determine the perception of severity of pain during phacoemulsification using topical anaesthesia. METHODS: This descriptive cross-sectional study was conducted at Jinnah International Hospital Abbottabad for a period of one year and included 196 patients of posterior subcapsular cataracts. Data was collected on a pretested structured questionnaire and analysed by SPSS version 20. Chi square test was used to find association between variables and p-value of equal or less than 0.05 was considered significant. RESULTS: The mean age of the patients was 60.43±14.63 years. Out of 196 patients, 110 (56.1%) were males and 86 (43.9%) were females. During surgery pain score was 0 (no pain) in 149 (76%), 1 (mild) in 14 (7.1%), 2 (moderate) in 15 (7.7%) and 3 (severe) in 18 (9.2%) patients. Pain score was found to be significantly associated with gender (p=0.003) and age group (p=0.008). CONCLUSIONS: Phacoemulsification can be safely performed under topical anaesthesia in patients with posterior subcapsular cataracts with minimum intraoperative pain perception by the patients.

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.

Correlation between sub-Tenon's anesthesia and transient amaurosis during ophthalmic surgery.

PURPOSE: To verify the correlation between sub-Tenon's anesthesia and intraoperative visual loss in ophthalmic surgery. METHODS: Sixty-four patients underwent phacoemulsification combined pars plana vitrectomy under sub-Tenon's anesthesia. Participants were investigated about their light perception at several time points: before anesthesia, immediately after anesthesia, 10 min after anesthesia without any surgical intervention or microscope illumination, and after the whole surgery. Intraoperative amaurosis was determined as that a patient could not see any light from their operative eye. The incidence rate of amaurosis at different time points and among different anesthetists was analyzed. RESULTS: The rate of intraoperative amaurosis was 0%, 1.56%, 48.44%, and 95.31% at several time points, respectively: before anesthesia, immediately after anesthesia, 10 min after anesthesia without any surgical intervention or microscope light exposure during the interval, and immediately after the whole surgery, presenting a significantly time-dependent increase (P < 0.01). There was no correlation between the amaurosis and different diseases and anesthesiologists. The amaurosis was transient, and all operative eyes could perceive light on the first postoperative day. CONCLUSIONS: Sub-Tenon's anesthesia contributes to the intraoperative amaurosis during operation. Temporary interruption of optic nerve conduction by the anesthetic could be a credible explanation. The amaurosis is transient and reversible, requires no additional treatment, and should not be considered as a surgical complication.

Risk Factors for Intraocular Lens Dislocation After Phacoemulsification: A Nationwide Population-Based Cohort Study.

PURPOSE: Few studies have measured the incidence and risk factors of intraocular lens (IOL) dislocation in the total population. We investigate the risk factors for IOL dislocation in a nationwide Korean cohort. DESIGN: Retrospective cohort study. METHODS: National data on 2,162,191 subjects who underwent cataract surgery were collected from the Health Insurance Review and Assessment service database of health claims from 2009 to 2016. The Health Insurance Review and Assessment database was used to identify potential risk factors for IOL dislocation, including age, sex, and various pre- and postoperative ophthalmic conditions. The hazard ratios (HRs) and confidence intervals (CIs) of these risk factors were assessed with a multivariable-adjusted Cox regression model. RESULTS: IOL dislocation occurred in 15,170 patients (0.7%) in the cataract surgery cohort (2,162,191 patients). The incidence rate of IOL dislocation peaked at 40-50 years of age, although the mean age of IOL dislocation was 65.25 ± 10.81 years. The average male:female ratio was 1.8. The adjusted HR for IOL dislocation in patients with partial vitrectomy was 11.93 (95% CI 10.95-12.99; P < .0001). Posterior capsulotomy performed within 1 year after the cataract surgery significantly decreased IOL dislocation, with an adjusted HR of 0.48 (95% CI 0.44-0.51; P < .0001). CONCLUSIONS: IOL dislocation tended to occur in young males. Anterior vitrectomy was a significant risk factor for IOL dislocation, while posterior capsulotomy after surgery was associated with a decreased risk of IOL dislocation.

The effect of tea tree oil on dry eye treatment after phacoemulsification cataract surgery: A randomized clinical trial.

PURPOSE: To evaluate the effect of eyelid scrubbing with eye shampoo containing tea tree oil on dry eye disease following phacoemulsification cataract surgery. METHODS: This prospective triple-blinded randomized clinical trial was performed on 62 eyes of 62 patients. Patients were randomly assigned to two groups-(1) treatment group: for 33 patients in the treatment group, artificial tears, topical steroid drops, and eye shampoos with tea tree oil and (2) for 29 patients in the control group, artificial tears, topical steroids, and eye shampoos without tea tree oil were used. In the first and second (after 1 month) follow-up visits, microscopic Demodex examination, refraction, corrected distance visual acuity, the ocular surface disease index score (by the questionnaire), Schirmer test, tear break-up time test, and osmolarity of tears (by TearLab) were recorded in treatment and control groups. RESULTS: The mean age of patients was 66.37 ± 8.83 (range: 37-82) years, of which 49 (79%) were female and 13 (21%) were male. The results showed a significant improvement in tear break-up time test, corrected distance visual acuity, osmolarity, and ocular surface disease index score in both groups (p < 0.05). However, the number of Demodex decreases significantly only in the treatment group after treatment (p <0.001). Tear break-up time, osmolarity, and ocular surface disease index scores in the treatment group were significantly better than the control group (p < 0.05). However, there was no significant difference between the two groups in the pre- and post-Schirmer test results (p > 0.05). CONCLUSION: Eyelid scrubbing with eye shampoo containing tea tree oil is recommended for dry eye treatment after cataract surgery, especially decrease in the number of Demodex.

Endophthalmitis reduction with intracameral moxifloxacin in eyes with and without surgical complications: Results from 2 million consecutive cataract surgeries.

PURPOSE: To analyze the posterior capsule rupture (PCR) rates among staff and trainee cataract surgeons, and the postoperative endophthalmitis (POE) rates in uncomplicated and complicated eyes both with and without intracameral moxifloxacin prophylaxis (ICMP). SETTING: Ten regional Aravind Eye Hospitals in India. DESIGN: Retrospective multicenter clinical registry within a single hospital network. METHODS: POE rates with and without ICMP were statistically compared for all eyes and separately for trainees versus staff, for phacoemulsification versus manual small-incision cataract surgery (M-SICS), and for a subgroup of eyes complicated by PCR or requiring secondary surgery. RESULTS: All cataract surgeries (2 062 643) performed during the 8-year period from 2011 to 2018 at the 10 regional Aravind Eye hospitals were included in the analysis. With ICMP, the overall POE rate declined from 692 (0.07%) of 993 009 eyes to 185 (0.02%) of 1 069 634 eyes (P < .001). This was independently significant for phacoemulsification and for M-SICS (P < .001). The overall PCR rate was 28 352 (1.37%) of 2 062 643 eyes, and it was statistically higher for trainees irrespective of surgical method (P < .001). Both staff and trainee surgeons had higher PCR rates with phacoemulsification than with M-SICS (P < .001). Absent ICMP, PCR increased the overall POE rate by more than 7-fold to 63 (0.43%) of 14 505 eyes. ICMP reduced the POE rate after PCR to 25 (0.18%) of 13 847 eyes (P = .002). This ICMP benefit was separately significant for both M-SICS (0.54% vs 0.26%, P = .01) and phacoemulsification (0.29% vs 0.06%, P = .005). The POE rate was especially high after secondary IOL implantation (0.90% without ICMP vs 0.34% with ICMP; P = .10). CONCLUSIONS: ICMP reduced the POE rate overall, with phacoemulsification, with M-SICS, and in eyes with PCR.

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.

Optic disk hemorrhage and vitreous hemorrhage after phacoemulsification in a normal tension glaucoma patient: A case report.

RATIONALE: Optic disk hemorrhage has been closely correlated with glaucoma for its development and progression. Phacoemulsification surgery results in large intraocular pressure (IOP) fluctuation. We report a case of optic disk hemorrhage and consequently progressive vitreous hemorrhage after an unsuccessful phacoemulsification surgery in an advanced normal tension glaucoma (NTG) patient. PATIENT CONCERNS: An advanced NTG patient of 82 years old with chronic hypertension underwent an unsuccessful phacoemulsification surgery complicated by posterior capsule rupture. During the postoperative 2 weeks, recurrent episodes of fresh hyphema occurred and B ultrasonography scan revealed the progressive vitreous hemorrhage. The IOP went out of control under the maximum tolerable IOP-lowering medications. DIAGNOSIS: Vitreous hemorrhage after phacoemulsification in an advanced NTG patient. INTERVENTIONS: Vitrectomy was performed to search for the cause of the progressive vitreous hemorrhage. After removal of the thick vitreous hemorrhage, a fresh spot of optic disk hemorrhage was detected at the nasal margin of the significantly-cupping disk. OUTCOMES: Postoperatively, the hemorrhagic vitreous opacity gradually resolved and the IOP remained stable at 10 ∼13 mmHg with topical prostaglandin analogue drops. Fundus examination revealed the dilated disk vessel with localized angiomatous change at the nasal disk margin. LESSONS: Severe optic disk hemorrhage may occur after phacoemulsification in advanced glaucoma patients. Systemic vascular factors, such as chronic hypertension and old age, and surgical complications, such as posterior capsule rupture and postoperative IOP elevation, would further increase the risk. For phacoemulsification in advanced glaucoma cases, extra care should be taken to control intraoperative IOP fluctuations and monitor postoperative IOP.

The risk of ischemic optic neuropathy post phacoemulsification cataract surgery.

INTRODUCTION: The aim was to study the risk of non arteritic ischemic optic neuropathy after phacoemulsification cataract surgery. METHODS: This study was conducted at King Hussein Medical Center during the period between January 2015 and July 2016. Patients attending ophthalmology clinic complaining of decreased vision due to lens opacity were evaluated. Patients were divided into two groups. First group included patients with no medical illness and second group included patients with diabetes mellitus, hypertension or hyperlipidemia. The two groups were further divided into two subgroups. First subgroup included patients who had phacoemulsification surgery and second subgroup did not have surgery. All patients were followed up for 6 months. They were assessed by neuro-ophthalmologist looking for ischemic optic neuropathy. RESULTS: A total number of 568 patients were enrolled. Group 1A included patients with no medical illness who underwent surgery and group 1B did not undergo surgery. The number of patients in these two subgroups was 119 and 103 respectively. Number of patients in group 2A (medical illness and surgery) was 188 and number of patients in group 2B (medical illness and no surgery) was 130. The incidence of ischemic optic neuropathy was 4.3 % in group 2A, 4.2 % in group 1A, 0.8% in group 2B, and 0% in group 1B. CONCLUSION: Phacoemulsification is a risk factor for non arteritic ischemic optic neuropathy independent of the presence of medical risk factors. Suggested mechanisms would be local anaesthesia, intraocular pressure fluctuation and local intraocular inflammation.

Endophthalmitis Reduction with Intracameral Moxifloxacin Prophylaxis: Analysis of 600 000 Surgeries.

PURPOSE: To compare the postoperative endophthalmitis rate before and after initiation of intracameral (IC) moxifloxacin prophylaxis for both phacoemulsification and sutureless, manual small-incision cataract surgery (M-SICS), as well as in patients with posterior capsular rupture (PCR). DESIGN: Retrospective, clinical registry. PARTICIPANTS: All cataract surgeries (617 453) performed during the 29-month period from January 2014 to May 2016 at the 10 regional Aravind eye hospitals were included. METHODS: The electronic health record data for all study eyes were analyzed. Endophthalmitis rates before and after moxifloxaxin were statistically compared for all eyes and separately for both phacoemulsification and M-SICS, and for the eyes complicated by PCR. MAIN OUTCOME MEASURES: The postoperative endophthalmitis rates before and after initiation of IC moxifloxacin prophylaxis. RESULTS: Overall, 302 815 eyes did not receive IC moxifloxacin and 314 638 eyes did, and there was a significant decline in the endophthalmitis rate, from 0.07% (214/302 815) to 0.02% (64/314 638) (P < 0.001), with moxifloxacin. For the 194 252 phacoemulsification eyes, the endophthalmitis rate was 0.07% (75/104 894) without IC moxifloxacin prophylaxis, compared with 0.01% (11/89 358) with moxifloxacin (P < 0.001). For the 414 657 M-SICS eyes, the endophthalmitis rate was 0.07% (135/192 149) without IC moxifloxacin prophylaxis, compared with 0.02% (52/222 508) with moxifloxacin (P < 0.001). Approximately half of the 8479 eyes that had PCR received IC moxifloxacin, and half did not. Without IC moxifloxacin, PCR increased the endophthalmitis rate nearly 7-fold to 0.48% (20/4186); IC moxifloxacin reduced the endophthalmitis rate with PCR to 0.21% (9/4293) (P = 0.034). No adverse events were due to IC moxifloxacin. CONCLUSIONS: Routine IC moxifloxacin prophylaxis reduced the overall endophthalmitis rate by 3.5-fold (3-fold for M-SICS and nearly 6-fold for phacoemulsification). There was also a statistical benefit for eyes complicated by PCR, and IC antibiotic prophylaxis should be strongly considered for this high-risk population. These conclusions are strengthened by the high volume of cases analyzed at a single hospital network over a comparatively short time frame. Considering the association of hemorrhagic occlusive retinal vasculitis with vancomycin and the commercial unavailability of IC cefuroxime in many countries, moxifloxacin appears to be an effective option for surgeons electing IC antibiotic prophylaxis.

Office-Based Cataract Surgery: Population Health Outcomes Study of More than 21 000 Cases in the United States.

PURPOSE: To identify safety and effectiveness outcomes of office-based cataract surgery. Each year, approximately 3.7 million cataract surgeries in the United States are performed in Ambulatory Surgery Center (ASC) and Hospital Outpatient Department (HOPD) locations. Medicare in July 2015 published a solicitation for expert opinion on reimbursing office-based cataract surgery. DESIGN: Large-scale, retrospective, consecutive case series of cataract surgeries performed in Minor Procedure Rooms (MPRs) of a large US integrated healthcare center. PARTICIPANTS: More than 13 500 patients undergoing elective office-based cataract surgery. METHODS: Phacoemulsification cataract surgery performed in MPRs of Kaiser Permanente Colorado from 2011 to 2014. MAIN OUTCOME MEASURES: Postoperative visual acuity and intraoperative and postoperative adverse events (AEs). RESULTS: Office-based cataract surgery was completed in 21 501 eyes (13 507 patients, age 72.6±9.6 years). Phacoemulsification was performed in 99.9% of cases, and manual extracapsular extraction was performed in 0.1% of cases. Systemic comorbidities included hypertension (53.5%), diabetes (22.3%), and chronic obstructive pulmonary disease (9.4%). Postoperative mean best-corrected visual acuity measured 0.14±0.26 logarithm of the minimum angle of resolution units. Intraoperative ocular AEs included 119 (0.55%) cases of capsular tear and 73 (0.34%) cases of vitreous loss. Postoperative AEs included iritis (n = 330, 1.53%), corneal edema (n = 110, 0.53%), and retinal tear or detachment (n = 30, 0.14%). No endophthalmitis was reported. Second surgeries were performed in 0.70% of treated eyes within 6 months. There were no life- or vision-threatening intraoperative or perioperative AEs. CONCLUSIONS: This is the largest US study to investigate the safety and effectiveness of office-based cataract surgery performed in MPRs. Office-based efficacy outcomes were consistently excellent, with a safety profile expected of minimally invasive cataract procedures performed in ASCs and HOPDs.

Outpatient cataract surgery: incident and procedural risk analysis do not support current clinical ophthalmology guidelines.

OBJECTIVE: To evaluate whether an ophthalmologist-led, non-anesthesia-supported, limited monitoring pathway for phacoemulsification/intraocular lens cataract surgery, can be performed safely with only a medical emergency team providing support. DESIGN: Retrospective, observational, cohort study. PARTICIPANTS: All patients who underwent elective phacoemulsification/intraocular lens surgery under topical anesthesia in the ophthalmology outpatient unit between January 1, 2011, and December 31, 2012. METHODS: Cataract surgery was performed by phacoemulsification under topical anesthesia. The intake process mainly embraced ophthalmic evaluation, obtaining a medical history, and proposing the procedure. A staff ophthalmologist performed the procedure assisted by 2 registered nurses in an independent outpatient clinic operating room within the hospital. The clinical pathway was without dedicated presence of or access to anesthesia service. Perioperative monitoring was limited to blood pressure and plethysmography preoperatively and intraoperatively. Patients were offered supportive care and instructed to avoid fasting and continue all their chronic medication. MAIN OUTCOME MEASURES: The primary outcome measure was the incidence of adverse events requiring medical emergency team (MET) interventions throughout the pathway. Secondary outcome measures were surgical ocular complication rates, use of oral sedatives, and reported reasons to perform the surgery in the classical operation room complex. RESULTS: Within the cataract pathway, 6961 cases (4347 patients) were eligible for analysis. Three MET interventions related to the phacoemulsification/intraocular lens pathway occurred in the 2-year study period, resulting in an intervention rate of 0.04%. None of the interventions was intraoperative. All 3 patients were diagnosed as vasovagal collapse and recuperated uneventfully. No hospital admittance was required. Eight other incidents occurred within the general ophthalmology outpatient unit population during the study period. CONCLUSIONS: Cataract surgery can be safely performed in an outpatient clinic, in the absence of the anesthesia service and with limited workup and monitoring. Basic first aid and basic life support skills seem to be sufficient in case of an adverse event. An MET provides a generous failsafe for this low-risk procedure.

Inferior Rectus Muscle Restriction after Sub-Tenon's Anesthesia

No abstract available.

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.