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Comparison of pain tolerance during phacoemulsification surgery under topical anaesthesia and combined topical anaesthesia with intracameral preservative free lignocaine

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First Author: L.Mohan INDIA

Co Author(s):    P. Krishnan   R. Bhat                 

Abstract Details


Routine phacoemulsification surgery is being more or less universally done under topical anaesthesia with or without supplementation with intracameral lignocaine or subtenon injections.Purpose was to study the effect of topical anaesthesia vs topical anaesthesia with intracameral preservative free lignocaine 1% among uncomplicated cataract surgery cases.


This study was conducted in Comtrust Charitable Trust Eye Hospital, Calicut, Kerala,a superspeciality eye hospital in South India with a daily outpatient turnover of 1000 patients.


A prospective study was done in 200 patientswith bilateral cataract who underwent phacoemulsification surgery during the period from January 2019 to June 2019 .All complicated cases like small pupil,nuclear sclerosis grade4,subluxated ,traumatic,pseudoexfoliation ,deaf patients ¬ cooperative excluded.Preoperative Nepafenac&Moxifloxacin drops on previous day,topical tropicamide+phenylephrine drops twice1hour before surgery.After dialatation,counselled well regarding the procedure and a bright light shown into the eye to see if they can tolerate the light and look steadily into lightTopical proparacaine0.5%applied before and afterbetadine cleaning,A wickplaced on temporal cunjunctiva.!00 patients in each group randomly seletected with or without intracameral.Scoring of pain 1-4during and after the procedure.


There were 200 patients, 100 in group A who had only topical proparacaine and 100in group B who had topical with intracameral preservative free 1%lignocaine(Oculan, Sunways Pharma)There were 123 males and 77 females.In group A,47% patients had pain score 1 ie nopain. 34% had score2 ie mild tolerable pain 13 % had moderate(score3)and 7had moderately severe pain(score4). In group B,52% had score1,36%had score 2 ,9% had score3 and 3% had score 81%of patients in group A and 88%of patients in group B had no pain or only mild tolerable pain.Moderately severe pain in 20 % and 12% in group A and b respectively.89% in group A and 95%patients in group B said they would opt for the same procedure for the second eye


Topical anaesthesia by itself is a good option for routine cataract surgery if properly counselled beforehand.Intracameral use of lignocaine can be avoided in most ofthe cases.

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