Subjective visual experience during phacoemulsification cataract surgery under sub-Tenon's block

Prasad, Niraj K.; Kumar, Chandra M.; Patil, Basavaraj; Dowd, T C

doi:10.1038/sj.eye.6700370

Cited by 51 publications

(38 citation statements)

References 7 publications

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“…Although the scale of visual perceptions is well documented during cataract surgery, [1][2][3][4][5][6] the extent of these experiences during vitreoretinal surgery is less well known. 7,8 As vitreoretinal procedures are increasingly being performed under LA, 9 and appear well tolerated by the patient, 10 it is vital that we adequately and appropriately inform patients of what they might experience during the surgery.…”

Section: Introductionmentioning

confidence: 99%

Subjective visual perceptions during vitreoretinal surgery under local anaesthesia

Vohra

Anya

Farooq

et al. 2008

Eye

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Purpose To evaluate the visual experiences of patients during vitreoretinal surgery under local anaesthesia (LA). Methods Prospective questionnaire survey of 80 patients within 30 min of completion of vitreoretinal surgery under LA. Preoperative visual acuity, surgical procedure and its duration, efficacy of the local block, as well as intraoperative perceptions of flashes, colours, movements, and seeing instruments were documented. Results A sub-Tenon's block was performed in 62/80 (77.5%) and a peribulbar block in the remainder. Overall, 72 (90%) of patients perceived light at some stage during their surgery. Of these, 51 (70.83%) observed movements, 45 (62.5%) saw colours, 38 (52.77%) saw instruments, and 24 (33.33%) saw flashes. The commonest observations were colourful swirls, black pipes, and the colour red. Most patients found these experiences pleasant or bearable; two found them frightening, and four would like to have been warned preoperatively about them. Preoperative visual acuity, diagnosis, gender of the patient, degree of akinesia, and the duration of surgery did not associate with visual perceptions. Logistic regression analysis showed that younger people were more likely to experience flashing lights (P ¼ 0.03) and to see instruments (P ¼ 0.04), patients having a sub-Tenon's block to perceive light (P ¼ 0.005), and those who did not receive awake sedation were more likely to see instruments (P ¼ 0.04). Conclusions Visual experiences are common during vitreoretinal surgery undertaken under LA. Where appropriate, patients should be forewarned about these experiences and reassured that they are not normally frightening.

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Section: Introductionmentioning

confidence: 99%

Subjective visual perceptions during vitreoretinal surgery under local anaesthesia

Vohra

Anya

Farooq

et al. 2008

Eye

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“…[10][11][12][13][14][15][16][17] We report that flashing lights and floaters are commonly experienced by patients immediately following an IVT injection, and that flashes are experienced by almost two-thirds of patients within the first 2 weeks following the procedure. Preinjection VA, clinical indication for the IVT injection, and the nature of the pharmacological agent injected did not influence the visual experiences of patients, although the authors concede that subgroups analysis was limited because of its small size.…”

Section: Discussionmentioning

confidence: 99%

“…3 Indeed, some authors are even using IVT therapeutic agents for relatively rare disorders, such as central serous chorioretinopathy. 3 Patients' visual perceptions and experiences induced by frequently performed ophthalmic surgical procedures, such as cataract surgery (under topical [10][11][12][13][14][15] and regional anesthesia [11][12][13][14]16,17 ), glaucoma filtration surgery, 18 and vitreoretinal surgery, [19][20][21][22] are well documented. Indeed, the beneficial effect of preoperative counseling with respect to known and anticipated visual experiences during phacoemulsification cataract surgery, under topical anesthesia, in terms of reducing patients' fear, has been described.…”

Section: Introductionmentioning

confidence: 99%

Visual perceptions induced by intravitreous injections of therapeutic agents

Charalampidou¹,

Nolan

Ormonde³

et al. 2011

Eye

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Purpose The purpose of this study was to conduct a questionnaire-based survey of subjective visual perceptions induced by intravitreous (IVT) injections of therapeutic agents. Patients and methods Patients undergoing an IVT injection of ranibizumab, pegaptanib sodium, or triamcinolone acetonide were administered a questionnaire in the immediate post-injection period and at 2 weeks of follow-up. Results In the immediate post-injection period (75 IVT injections, 75 eyes, 75 patients), lights and floaters were reported after 20 (27%) and 24 (32%) IVT injections, respectively. In comparison, at the 2-week follow-up, the incidence of reported lights (11; 15%) was similar (P40.05), but the incidence of reported floaters was higher (48; 64%; P ¼ 0.00). Subgroup analysis for various injection subgroups (no previous injection vs previous injection(s) in the study eye; injections in study eyes with good VA (logarithm of minimal angle of resolution [logMAR] r0.3) vs moderate VA (0.7 ologMAR40.3) vs poor VA (logMAR Z0.7); injections according to pharmacological agent (ranibizumab vs pegaptanib vs triamcinolone acetonide); injections in study eyes with choroidal neovascularization (of various causes) vs study eyes with macular edema (of various causes); and injections in phakic vs pseudophakic eyes) did not reveal any statistically significant associations. Visual perceptions experienced following 15% of IVT injections gave cause for concern to the patient (mean visual analog scale score ( ± SD): 4.5 ( ± 1.7)), and in 64% of cases, the patients believed that preoperative counseling would have averted the concern. Conclusions Lights and floaters are frequent visual perceptions following IVT injections of therapeutic agents. They can give rise to concern that could be alleviated with preinjection counseling.

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“…17 Many patients have retained visual sensations under local anaesthesia. In one survey, 16% found this distressing 18,19 ; anxiety results in catecholamine release. Furthermore, the majority of cataract patients are elderly and have co-morbidities like diabetes and cardiovascular disease.…”

Section: Assessment and Preparation Of Patients Before Loco-regional mentioning

confidence: 99%

Ophthalmic loco-regional anaesthesia: Reducing discomfort during injection

Zundert

Kumar

2008

Southern African Journal of Anaesthesia and Analgesia

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Loco-regional anaesthesia is commonly used for both intraocular and extraocular surgical procedures, although the provision and use of the anaesthetic technique varies worldwide. Injection techniques (retrobulbar, peribulbar and sub-Tenon's blocks) are associated with significant pain; indeed, many patients have a fear of pain. Discomfort during injection can, however, be reduced and patients can be made comfortable through reassurance, careful performance of the technique and the provision of sedation and/or analgesia. In this article, the authors describe common loco-regional anaesthetic techniques and measures to reduce discomfort during injection, thus improving patient satisfaction.

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Subjective visual experience during phacoemulsification cataract surgery under sub-Tenon's block

Cited by 51 publications

References 7 publications

Subjective visual perceptions during vitreoretinal surgery under local anaesthesia

Subjective visual perceptions during vitreoretinal surgery under local anaesthesia

Visual perceptions induced by intravitreous injections of therapeutic agents

Ophthalmic loco-regional anaesthesia: Reducing discomfort during injection

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