Comparative Assessment of Pain in Sequential Cataract Surgery with Topical Phacoemulsification - A Prospective Observational Study from a Tertiary Care Hospital in Uttar Pradesh

Abstract

BACKGROUND With the advancement in anaesthetic measures, a safe and effective alternative to peribulbar and retrobulbar anaesthesia for phacoemulsification is provided by topical anaesthesia.1 (Fichman, 1996). Studies highlighting varied pain experiences have been published with some reporting higher pain in second eye surgery,2,3 (Ursea et al. 2011; Tan et al. 2011) while others did not.4,5 (Bardocci, 2011; HariKovacs, 2012). So, we conducted this study to assess and compare pain experienced by patients subjectively as well as objectively in first and subsequent eye following topical phacoemulsification cataract surgery. METHODS A prospective observational clinical study was done for a duration of two years at Institute of Ophthalmology, Jawaharlal Nehru Medical College, AMU Aligarh. Study groups consisted of patients having bilateral cataract, to be operated in both eyes undergoing topical phacoemulsification and placement of an intraocular lens within one-year interval. Subjective as well as objective assessment of postoperative pain was done in the recovery room. RESULTS A total of 60 patients were included in the study with 51 (85 %) patients having higher pain score for second eye surgery as compared to first eye surgery, which was also significant while comparing their mean pain score (0.73 \uf0b1 0.86 vs 2.17 \uf0b1 0.91). Systolic and diastolic blood pressure as well as mean arterial pressure (MAP) were higher in first eye surgery as compared to second eye surgery. CONCLUSIONS In our comparative study, we observed higher pain in second eye surgery. As this subjective assessment of higher pain was not supplemented by objective assessment, we concluded that it may be due to more apprehension and uneasiness because of previous surgery. Patients going for second eye surgery should be prior consulted as well as managed properly. KEYWORDS Cataract, Pain, Topical Phacoemulsification