Saritha V Krishnankutty

Abstract

Aims: To assess the quality of analgesia, level of comfort of patients and surgeons and incidence of complications after topical anaesthesia with supplemental intracameral lignocaine as compared to peribulbar block in patients undergoing phacoemulsification. Materials and Methods: It was a prospective observational study done in 66 patients having uncomplicated senile cataracts who underwent phacoemulsification with foldable IOL implantation of both eyes. One eye of each patient was operated under peribulbar blockand the other eye under topical anaesthesia with supplemental intracameral lignocaine after 2 weeks. In Group T, topical anaesthesia was achieved by instilling proparacaine hydrochloride 0.5% and preservative free 1% lignocaine was used for intracameral analgesia. Peribulbar block was administered with 5-7 ml of 2% lignocaine with 1:10000 adrenaline. Patient comfort, feeling of pressure during block, quality of analgesia intraop and 4 hours postop, and surgeon’s comfort were documented. Results: Group P patients had significantly higher pain score, discomfort and pressure on eye during administration of block compared to Group T. Both groups had comparable pain scores and patient’s discomfort. Pressure on eye intraop and postop and intraoperative positive pressure were also similar in both groups. Group P had significantly higher incidence of subconjunctival hemorrhage (80% vs 10%) and chemosis of conjunctiva. (80% vs 0%). Conclusion: Topical anaesthesia with supplemental intracameral lignocaine can be considered as a superior anaesthetic technique for phacoemulsification than peribulbar block as it is associated with significantly higher patient comfort and lower complications with comparable surgeon’s comfort. Keywords: Topical anaesthesia, Intracameral, Peribulbar anaesthesia, Phacoemulsification.

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Abstract

Aim: To compare ocular biometric features of chronic angle closure glaucoma patients with normal subjects. Materials and Methods: 35 chronic angle closure glaucoma patients (group A) were compared with 35 normal subjects (group B). Chronic angle closure glaucoma was diagnosed in eyes with peripheral anterior synechiae [PAS] of > 270 degrees with a chronically elevated IOP with disc and field changes. Patients with history of intraocular surgeries or trauma, secondary angle closure, active keratitis or corneal opacities, previous history of Nd Yag laser peripheral iridotomy and those on miotic drops were excluded. Contact ultrasonic biometry was used for measuring ocular biometric parameters like axial length, AC depth, and lens thickness. LAF and RLP were calculated. Statistical analysis: Chi-square test and Independent sample t-test as applicable. Results: Mean age, gender distribution and axial length measurements in both the groups were comparable. Lens thickness and LAF were significantly higher in Group A (p and RLP were significantly lower in group A. Pachymetry, best corrected visual acuity and spherical equivalents were comparable in both groups. Conclusion: It is concluded that the mechanism of chronic angle closure glaucoma can be explained by the ocular biometric parameters with possibility of some additional factors like variations in the iris thickness/ insertion. Keywords: Chronic, Ocular biometry, Primary angle closure glaucoma.

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