Clear cornea extracapsular cataract extraction (ECCE) with intraocular lens(IOL) implantation under topical anesthesia (TA). A report of 3 cases

Poster Details

First Author: N.Qahthani SAUDI ARABIA

Co Author(s):    I. Subhan              

Abstract Details

Purpose:

Many studies have been reported on the surgical procedure of ECCE and Clear Cornea Phacoemulsification (CCP) under various kinds of anesthesia. Studies reported have used various modalities of anesthesia. Osman Nuri Aydin1 has reported use of intravenous (IV) patient-controlled sedation/analgesia with fentanyl during phacoemulsification surgery under topical anesthesia and has reported excellent comfort for the patient and surgeon. Uraiwan Tinnungwattana2, MD reflected that deep topical anesthesia with subconjunctival anesthesia for ECCE/IOL and topical anesthesia for Phaco/IOL provide effective anesthesia for cataract surgery. Ehud I Assia3, MD mentioned the efficacy of lignocain gel. Small-incision manual extracapsular cataract extraction using deep-topical, nerve-block anesthesia was reported by Kaderli B4, Avci R. We report 3 cases posted for phacoemulsification with IOL implantation under topical anesthesia, which were converted to ECCE due to various reasons. The purpose of this presentation was to convey the outcome of complete ECCE with IOL implantation entirely done under TA with no supplementation of local anesthetic (LA) injection, thereby totally avoiding all the related complications of LA.

Setting:

King abdullah medical city, makkah, kingdom of saudi arabia.

Methods:

After complete ophthalmic evaluation and work up, 3 patients, 2 males and a female aged 65yrs, 67 yrs and 70 yrs respectively were posted for elective Clear Cornea Topical Phacoemulsification with IOL implantation. Pre-Operative vision was counting fingers in 2 cases and 20/400 in one. At the immediate start of the 1st case, after hydro dissection, the phaco machine broke down. The incision was extended on either side, and the case was successfully converted to ECCE an IOL implantation. The other 2 cases showed extreme phacodonesis due to more than 270 degrees of zonular dehiscence as a result of psuedoexfoliation syndrome. The procedure was converted to ECCE with visco manipulation and expression of nucleus . Limited Automated Anterior vitrectomy and Simcoe canula was used to clear the Anterior chamber of vitreous and cortical matter. Artisan IOL was implanted under healon in these cases. The wound was closed with 5 interrupted 10-0 ethilon sutures with buried knots. The entire surgical procedure was completed under topical proparacaine 0.5% eye drops.

Results:

During the procedure the patients response was remarkable with no complaints of pain or discomfort. All the 3 surgeries were uncomplicated, and uneventful. Post operative vision was 20/40 in 2 cases and 20/60 in the third with correction at the end of 1st month.

Conclusions:

We share our experience about the remarkable outcome of managing a situation to convert Clear Cornea Topical Phacoemulsification to Clear Cornea Extra Capsular Cataract Extraction with IOL implantation totally under Topical Anesthesia. Thereby avoiding the need to inject local anesthesia in between the procedure and hence saving the patient from the complications of LA. The outcome pertaining to the patient and surgeon’s comfort using least quantity of anesthetic agent and to avoid injection has been encouraging. Though the number of cases is very small, we are encouraged in such conditions to perform surgeries under TA. FINANCIAL DISCLOSURE?: No