Visual perception during phacoemulsification cataract surgery under topical and regional anaesthesia

Tranos, Paris; Wickremasinghe, Sanjeewa; Sinclair, Neil; Foster, Paul J.; Asaria, Riaz; Harris, M. L.; Little, Brian

doi:10.1034/j.1600-0420.2003.00029.x

Cited by 48 publications

(37 citation statements)

References 11 publications

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“…These visual phenomena are mostly independent of comorbidities, sex, age, form of anaesthesia, duration of the operation, mode of cataract surgery, or even sedation. Intraoperative visual illusions can lead to anxiety 2,10,20 or joy. 11,24 This is why patients are counselled about them prior to surgery.…”

Section: Introductionmentioning

confidence: 99%

Which colours are seen by the patient during cataract surgery? Results of an intraoperative interview

Wenzel¹,

Schwering

2015

Eye

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Purpose To discover what cataract patients see during phacoemulsification and if these light phenomena influence their anxiety levels during surgery. Methods In all, 200 patients were interviewed intraoperatively at the Eye Hospital, Petrisberg, Trier, Germany. The quality of the visual experiences was described and if these were pleasant, neutral or unpleasant. Systemic sedation was noted. Results Among 200 patients (209 eyes): 88 were men (91 eyes; 44%) and 112 were women (118 eyes; 56%). Median age (years): men (71), women (70). Mean operating time was 8 min. 49/209 (23%) were not anxious before and during surgery. 110/209 (52%) were more anxious before than during surgery, 50/209 (24%) were still anxious during surgery, 27/209 (13%) got sedation with midazolam (1-5 mg). Colours in descending order seen: blue, red, pink, yellow, green, purple, turquois, and orange. The most dominant colour combination was red/blue. Structures were seen by 162/209 (78%). Most (61%) intraoperative visual experiences were pleasant, 38% were neutral, and 1% found them transiently unpleasant. Three patients felt blinded by the light of the operating microscope. Conclusions The experience of colours and other light phenomena was pleasant for most patients during phacoemulsification under topical anaesthesia. They occur spontaneously when the patient is fixating on the operating light. They are not dependent on the individual or environment. Sedation only in 13%. Direct questioning for visual sensations by the operating surgeon may lead to less need for sedation and lead to less side effects for elderly and multimorbidity people postoperatively. The surgeon can use this knowledge to reassure patients during surgery.

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Section: Introductionmentioning

confidence: 99%

Which colours are seen by the patient during cataract surgery? Results of an intraoperative interview

Wenzel¹,

Schwering

2015

Eye

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“…Another study found that there were no associations between intraoperative visual impression and sex 14 .…”

Section: Discussionmentioning

confidence: 99%

“…The fear is a response to perceived threat which can be minimized by appropriate health education interventions 12 . It is well known that topical anaesthesia preserves optic nerve function 13 and thus patients can experience a vast range of visual stimuli. So, preoperative counselling about possible visual fear could be of value for every patient scheduled to undergo phacoemulsifi cation cataract surgery, in particular, regarding various possible stimuli such as light perception, gush of water and movements e.g.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative visual experience and preoperative counselling during phacoemulsification under topical anaesthesia

Shakya

Pandey

Pokhrel

et al. 2016

J. Kathmandu Med. Coll.

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Background: Phacoemulsifi cation surgery using topical anaesthesia makes patient experience a multitude of visual sensations. However, it makes cataract surgery safe with the quickest visual recovery. Objective: To fi nd the effect of preoperative counselling about potential intraoperative visual experience during phacoemulsifi cation under topical anaesthesia to alleviate fear in patients having cataract surgery. Methods: This non-randomized and non comparative study was carried out in a tertiary care hospital from February 2015 to April 2015. Forty fi ve adult patients underwent cataract surgery (phacoemulsifi cation with foldable intraocular lens implantation) under topical anaesthesia using Proparacaine hydrochloride 0.5 % eye drops by a single surgeon. All patients received counselling on the potential intraoperative visual experience during phacoemulsifi cation. A structured questionnaire was used to collect data on socio-demographics, pain, intraoperative visual experiences and their fear. Participants were asked if they experienced visual sensations such as light perception, gush of water and movements during surgery. Results: Nineteen (42.2%) of them were men and 26 (57.8%) were women. Sixty nine percent of the patients were above 60 years. All of them reported having experienced visual sensations during surgery, the most common being light perception (100%), movements of instruments or surgeon's hands (91.1%) and gush of water (62.2%). One case (4.4%) felt tolerable pain associated with fear (P=0.000) due to these visual experience. Conclusion: Preoperative counselling about the potential intraoperative visual experience during phacoemulsifi cation under topical anaesthesia alleviates the visual experience fear in patients having cataract surgery.

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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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Visual perception during phacoemulsification cataract surgery under topical and regional anaesthesia

Cited by 48 publications

References 11 publications

Which colours are seen by the patient during cataract surgery? Results of an intraoperative interview

Which colours are seen by the patient during cataract surgery? Results of an intraoperative interview

Intraoperative visual experience and preoperative counselling during phacoemulsification under topical anaesthesia

Visual perceptions induced by intravitreous injections of therapeutic agents

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