Waheeda Rahman

Progression of retinopathy during pregnancy in type 1 diabetes mellitus.

Purpose:  The incidence and risk factors for progression of retinopathy during pregnancy in women with type 1 diabetes mellitus were retrospectively evaluated.

Incidence of visual sensations during cataract surgery under regional anaesthesia.

Cataract surgery is performed using various regional, local or topical anaesthetic techniques. Researchers have demonstrated a significant disparity between surgeon awareness of and actual patient experiences during cataract surgery under local anaesthesia. There is an underestimation of the frequency and nature of subjective visual sensations experienced by patients during cataract surgery under both topical and regional anaesthesia. To demonstrate this, we carried out a study to assess subjective visual sensations of patients undergoing phacoemulsification surgery under topical or local anaesthesia by postoperative masked interview. One hundred and forty-four patients undergoing day-case phacoemulsification surgery under local anaesthesia (subtenons/ peribulbar/topical) were enrolled in this study. An interviewer, blinded to the method of anaesthesia, conducted interviews with the patients using a standardized questionnaire. Data were collected about intraoperative visual experiences and reactions to these between 30 min and 4 h following the surgery. All patients with complicated or prolonged surgery (>40 min in duration) were excluded from the study. The patients were specifically asked about colours, lights, changes in light intensities, shadows and moving instruments observed during the surgery. We also enquired whether they had been warned of these sensations and asked them to grade the experience as acceptable, or frightening. The study group interviewed had a mean age of 76 years (range: 70–80) with a male : female ratio of 5:4. The number of patients in the various anaesthetic groups was 115 (subtenons anaesthesia), 19 (peribulbar anaesthesia) and 10 (topical anaesthesia). The various intraoperative visual sensations reported by the patients included colours (39.6%), lights (52 0%) and moving instruments and shadows (26.4%). The percentage of patients who reported two or more of the above visual sensations was 28.5% in the peribulbar group, 46.2% in the subtenons group and 100% in the topical group. To quantify the visual sensations, we awarded one point each for lights, colours and moving instruments, etc. and the total calculated to give the visual sensation score which ranged from 0 (no sensations perceived) to 3. There was a statistically significant difference (P = 0.01, chi-squared test) among the three groups as shown in Table 1. Interestingly, the majority (96%) of patients found these sensations acceptable although only 14% had been warned of them during preoperative counselling. In our study, more patients having cataract surgery under topical anaesthesia reported perception of light, colours and a change in light brightness compared with regional anaesthesia. Visual sensations during cataract surgery are more common than expected even under a peribulbar or subtenons block. Although the majority of patients in our study found the experience acceptable and nonfrightening, all patients should be warned of the possibility of occurrence of visual sensations while undergoing cataract surgery under local anaesthesia.