Patient pain during stretching of small pupils in phacoemulsification performed using topical anesthesia

O’Brien, Paul D.; Fitzpatrick, Patricia; Power, William

doi:10.1016/j.jcrs.2005.02.044

Cited by 12 publications

(4 citation statements)

References 16 publications

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“…23,24 Topical anaesthesia does not block all pain fibers from the iris and ciliary body, so manipulation of the iris might be expected to cause pain. 25 As we know, some manipulations performed during phacoemulsification cause significant levels of pain. O'Brien et al 1 showed that hydrodissection, phacoemulsification, lens aspiration, and intraocular lens insertion require the most manipulation of the iris and were associated with higher pain scores during surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparative clinical trial of topical anaesthetic agents for cataract surgery with phacoemulsification: lidocaine 2% drops, levobupivacaine 0.75% drops, and ropivacaine 1% drops

Borazan

Karalezlı

Akova

et al. 2007

Eye

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Purpose To assess the safety and efficacy of topical lidocaine, levobupivacaine, and ropivacaine in cataract surgery with phacoemulsification. Methods One hundred and five patients scheduled for cataract surgery with topical anaesthesia were randomly allocated into 3 groups of 35 patients each to receive eye drops of lidocaine 2%, levobupivacaine 0.75%, or ropivacaine 1% every 5 min starting 30 min before surgery. Patients graded their pain using a 0-10-point verbal pain score (VPS) at different stages of the procedure. The levels of patient and surgeon satisfaction, the duration of surgery, complications, and the need for supplemental anaesthesia were recorded. Results There was no significant difference in duration of surgery and demographic variables among the groups. At the intraoperative period, end of surgery, and postoperative first hour the mean VPS in the lidocaine group was significantly higher than the others (Po0.01), but no significant difference was found between the levobupivacaine and ropivacaine groups. At incision and 24 h after surgery, it was not significantly different among the groups. Surgeon and patient satisfaction scores were significantly better in the levobupivacaine and ropivacaine groups than in the lidocaine group (Po0.01).Conclusions Topical anaesthesia with levobupivacaine and ropivacaine were safe, feasible and more effective than lidocaine in cataract surgery. Levobupivacaine and ropivacaine provided sufficient and long-lasting analgesia without the need of supplemental anaesthesia for each patient.

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Section: Discussionmentioning

confidence: 99%

Comparative clinical trial of topical anaesthetic agents for cataract surgery with phacoemulsification: lidocaine 2% drops, levobupivacaine 0.75% drops, and ropivacaine 1% drops

Borazan

Karalezlı

Akova

et al. 2007

Eye

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“…To ensure that the adult retina forms appropriately during development, RPCs transition through states of developmental competence by coordinating cell cycle exit and cell fate specification to generate an ordered array of uniquely fated cell populations (Dyer and Cepko 2001;Fujita 2003;Pearson and Doe 2004;Zhang et al 2004;Kageyama et al 2005). When these processes are disrupted, as observed in some cases of human microphthalmia and anophthalmia (Zigman and Paxhia 1988;Loosli et al 1998;Fantes et al 2003;Driver et al 2005;Fitzpatrick and van Heyningen 2005;Labadie et al 2005;O'Brien et al 2005;Ragge et al 2005a,b;Xu et al 2005), vision is severely compromised. Identifying the molecular mechanisms that allow some progenitors to continually divide yet promote neighboring cells to stop dividing and differentiate at appropriate times during development is pivotal to the understanding of both normal and defective retinal development.…”

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confidence: 99%

SOX2 is a dose-dependent regulator of retinal neural progenitor competence

Taranova¹,

Magness

Fagan³

et al. 2006

Genes Dev.

508

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Approximately 10% of humans with anophthalmia (absent eye) or severe microphthalmia (small eye) show haploid insufficiency due to mutations in SOX2, a SOXB1-HMG box transcription factor. However, at present, the molecular or cellular mechanisms responsible for these conditions are poorly understood. Here, we directly assessed the requirement for SOX2 during eye development by generating a gene-dosage allelic series of Sox2 mutations in the mouse. The Sox2 mutant mice display a range of eye phenotypes consistent with human syndromes and the severity of these phenotypes directly relates to the levels of SOX2 expression found in progenitor cells of the neural retina. Retinal progenitor cells with conditionally ablated Sox2 lose competence to both proliferate and terminally differentiate. In contrast, in Sox2 hypomorphic/null mice, a reduction of SOX2 expression to <40% of normal causes variable microphthalmia as a result of aberrant neural progenitor differentiation. Furthermore, we provide genetic and molecular evidence that SOX2 activity, in a concentration-dependent manner, plays a key role in the regulation of the NOTCH1 signaling pathway in retinal progenitor cells. Collectively, these results show that precise regulation of SOX2 dosage is critical for temporal and spatial regulation of retinal progenitor cell differentiation and provide a cellular and molecular model for understanding how hypomorphic levels of SOX2 cause retinal defects in humans.[Keywords: SOX2; allelic series; retinal progenitor identity; dosage regulation; anopthalmia, microapthalmia] Supplemental material is available at www.genesdev.org. It has recently been shown that mutations in SOX2 a SOXB1-HMG box transcription factor whose expression universally marks neural stem and progenitor cells throughout the CNS including the neural retina (Collignon et al. 1996;Zappone et al. 2000;D'Amour and Gage 2003;Ellis et al. 2004;Ferri et al. 2004), are associated with retinal and ocular malformations in humans. The resulting haploid insufficiency at the SOX2 locus occurs in ∼10% of human individuals with anophthalmia or severe microphthalmia (Fantes et al. 2003;Fitzpatrick and van Heyningen 2005;Hagstrom et al. 2005; Ragge et al. 2005a,b;Zenteno et al. 2005). Most mutations identified to date are point mutations leading to truncations of SOX2, while a smaller class of mutations includes microdeletions and missense point mutations. Interestingly, all mutations produce hypomorphic conditions, where residual SOX2 expression and function are still preserved, albeit at lower levels, leading to the highly variable severity of the clinical phenotype. In this regard, the SOX2 mutations in humans and the clinical consequence of reduced functional levels of SOX2 suggest a dosage-dependent role for SOX2 during retinal progenitor differentiation.To date, the importance of SOX2 in the nervous system has been highlighted by misexpression and domi-

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“…All procedures were performed using topical anesthesia. 10 , 11 In addition, 0.5% tetracaine hydrochloride (Tetracaine; Cooper Pharmaceutical SA) drops were instilled.…”

Section: Methodsmentioning

confidence: 99%

Safety and efficacy of phacoemulsification and intraocular lens implantation through a small pupil using minimal iris manipulation

Papaconstantinou

Kalantzis

Brοuzas

et al. 2016

CIA

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PurposeThe aim of this study was to compare the results of phacoemulsification through a small pupil using minimal iris manipulation versus phacoemulsification through a well-dilated pupil.MethodsThis prospective randomized control (comparative) study comprised 78 patients (group I) with a maximally dilated pupil size of ≤4.00 mm and 45 patients (group II) with dilated pupil size of ≥7.00 mm. In group I patients, only viscodilation and minimal push-and-pull iris stretching with two collar-button iris-retractor hooks were utilized without iris manipulation. Phacoemulsification was performed by two senior surgeons and the technique used consisted of either stop and chop or quick chop, infusion/aspiration of lens cortex, capsular bag refill with ocular viscoelastic devices, and implantation of an acrylic foldable intraocular lens. Patients were examined on the first day and 1 month postoperatively.ResultsForty-six eyes of group I patients had pseudoexfoliation syndrome, eleven eyes had previous glaucoma surgery, 14 eyes had angle-closure or open-angle glaucoma, and seven eyes had posterior synechiae with iritis. In group I patients, the mean pupil size measured under an operating microscope was 3.2 mm preoperatively, 4.3 mm after viscoelastic and mechanical pupil dilation, and 4.1 mm at the end of a surgical procedure. Rupture of the zonular fibers occurred in six patients of group I and the intraocular lens was implanted in the sulcus. Small iris-sphincter rupture and small hemorrhages occurred in four eyes during pupillary manipulation, but they were not evident at the end of the surgery. In group II patients, no intraoperative complications occurred. Signs of significant corneal edema and iritis were observed more frequently in group I eyes (26 eyes and 20 eyes, respectively) on the first postoperative day in comparison with group II eyes (ten eyes and six eyes, respectively). Intraocular pressure was <20 mmHg in all eyes of both groups. One month postoperatively, the pupil was round and reactive to light, the anterior chamber was quiet, and the cornea was clear in all eyes. The best-corrected visual acuity on Snellen chart was 20/40 (Monoyer’s scale) or better in both groups.ConclusionPhacoemulsification through a small pupil using minimal iris manipulation can be safe and exhibits the same results as those obtained with phacoemulsification through normal pupils.

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Patient pain during stretching of small pupils in phacoemulsification performed using topical anesthesia

Cited by 12 publications

References 16 publications

Comparative clinical trial of topical anaesthetic agents for cataract surgery with phacoemulsification: lidocaine 2% drops, levobupivacaine 0.75% drops, and ropivacaine 1% drops

Comparative clinical trial of topical anaesthetic agents for cataract surgery with phacoemulsification: lidocaine 2% drops, levobupivacaine 0.75% drops, and ropivacaine 1% drops

SOX2 is a dose-dependent regulator of retinal neural progenitor competence

Safety and efficacy of phacoemulsification and intraocular lens implantation through a small pupil using minimal iris manipulation

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