RESUMEN
PURPOSE: To evaluate the efficacy of topical anesthesia with oxybuprocaïne 0.4% without intracameral lidocaïne as an alternative to peribulbar or retrobulbar anesthesia in cataract surgery. METHODS: Fifty-eight patients (eighty-two eyes) were included in this study. All patients received topical anesthesia with oxybuprocaïne 0.4%. No intracameral lidocaïne was used at the start of the intervention. Seventy-five per cent of patients received oral sedation with lorazepam 2.5 mg. All surgery was done using a superior corneal incision and phacoemulsification followed by a foldable IOL implantation. Subjective pain was assessed at 4 intervals during surgery using a 4-point pain scale. All patients were evaluated for intraoperative eye motility and blepharospasm. Patient and surgeon satisfaction was measured with a 4-point satisfaction scale. RESULTS: 15% of patients experienced mild pain during phaco and 43% had mild pain during corneal suturing. No patient had severe pain during the operation. In 4% of patients, intracameral lidocaïne was used to relieve pain. The surgeon and patient satisfaction was high. No eye movements or blepharospasm were recorded in 75% and 62% of cases respectively. No serious complications occurred. CONCLUSION: Topical anesthesia is a safe and effective alternative to peribulbar and retrobulbar anesthesia in corneal cataract surgery for the experienced surgeon.
Asunto(s)
Anestésicos Locales/administración & dosificación , Extracción de Catarata/métodos , Procaína/análogos & derivados , Procaína/administración & dosificación , Anciano , Anciano de 80 o más Años , Blefaroespasmo/prevención & control , Humanos , Hipnóticos y Sedantes/administración & dosificación , Periodo Intraoperatorio , Lidocaína , Lorazepam/administración & dosificación , Persona de Mediana Edad , Dolor/prevención & control , Dimensión del Dolor , Satisfacción del Paciente , Resultado del TratamientoRESUMEN
The aim of this study was to examine the vitreomacular interface in symptom-free fellow eyes of macular holes using optical coherence tomography (OCT) to add information to the pathogenesis of macular holes and to refine prognostic factors for bilateral involvement. Sixty-six patients with a full thickness macular hole in one eye and a symptom-free fellow eye were included in the study between 01/98-05/99. The finding on OCT that a perifoveal vitreous detachment can result in a foveal cyst and subsequently a macular hole confirms the theory of Gass of vitreous traction. Symptom-free fellow eyes with a foveal cyst on OCT represent an elevated risk (55%) for macular hole development. Vitreofoveal separation is probably a good prognostic sign.