Shivakumar Hiremath

Abstract

Aim: To compare the efficiency of sub-Tenon`s versus peribulbar anaesthesia in Manual small incision cataract surgery with respect to Pain during administration of block, analgesia intraoperatively, akinesia, effect on intraocular pressure, volume of the anaesthetic agent, surgeon`s comfort during surgery and Complications of block. Materials and Methods: A prospective study of 100 cases who underwent manual small incision cataract surgery (MSICS) divided into two groups namely peribulbar group and sub-Tenon`s group. The two techniques were compared with respect to pain at administration, analgesia, akinesia, intraocular pressure (IOP), volume, surgeon`s comfort and complications. Results: Sub-Tenon`s anaesthesia was relatively less painful at administration, providing good analgesia with incomplete akinesia. It needed significantly lesser volume of anaesthetic agent, with minimal rise in IOP, good comfort to surgeon and had only minor complications in the form of subconjuctival haemorrhage, chemosis. Conclusion: Sub-tenon`s anaesthesia is relatively less painful to deliver, effective and safe technique for MSICS. Keywords: Akinesia, Anaesthesia, Analgesia, Cataract surgery, Lignocaine.

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Abstract

Aim: Pseudoexfoliation (PEX) could alter the tear secretion and unstabilize it by modifying the cell morphology in conjunctiva. Abnormalities of tear secretion and tear film have been assessed that can occur in eyes with PEX syndrome as compared to normal eyes. Materials and Methods: A prospective non-randomized study consisting of Group 1 with 60 eyes of 30 normal subjects without PEX material on lens as controls and Group 2 with 60 eyes of 30 patients with PEX material in both eyes as cases were taken. Exclusion criteria included patients with ocular surface disorders, PEX glaucoma, previous ocular surgeries, long term use of eye drops and adnexal abnormalities. Tear functions were assessed by, Schirmer’s 2 test and tear break-up time (TBUT). Results: The mean age in group 1 was 64 years and group 2 was 62 years. There were 14 males and 16 females in group 1 whereas 20 males and 10 females in group 2. Average of Schirmer’s and TBUT in group 1 were 24.02mm and 15.65s respectively, whereas in Group 2 they were 11.6mm and 7.8s and difference was clinically significant. Among the eyes with PEX, 54.2%of cases had PEX material in both zone 1 and zone 3. 30.8% of cases had only in zone 1 and 15% had only in zone 3.Hence 69.2% of cases had PEX material in zone 3. The average mydriasis in eyes with PEX was 5.2 and in eyes without PEX was 6.5. Conclusion: PEX syndrome alters tear film stability and decreases tear secretion. Keywords: Dry eye, Pseudoexfoliation, Schirmer’s test, Tear function.

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