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Query: UMLS:C0086543 (cataract)
 29,165 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients often say that they can see the surgical instruments with the operated eye during intraocular surgery. We examined 26 consecutive patients for visual acuity, ocular motility, and pupillary response before, during, and after retrobulbar anesthesia for cataract extraction. Twenty minutes after the anesthetic was injected, 19% of these patients had visual acuities better than 6/200, and 73% of patients described the movements of the instruments during surgery. Two patients (8%) recognized details on the ceiling after insertion of the intraocular lens. An afferent pupillary defect was found in 31% of patients. Although retrobulbar anesthesia results in a marked decrease in ocular motility and visual acuity, total akinesia and blindness do not occur. An incidental result of retrobulbar anesthesia may be a transient afferent pupillary defect.
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PMID:Visual acuity after retrobulbar anesthesia. 281 60

Complications of retrobulbar anesthesia are rare but significant. Periocular anesthesia has been advocated as an alternative to retrobulbar injections. In a prospective, randomized, masked study of 79 consecutive cataract extractions with intraocular lens implantations, 40 patients received retrobulbar injections and 39 patients received periocular injections. In every instance, the volume of the injection was 5 mL. No significant difference in surgeon's assessment of akinesia and anesthesia was found. Supplemental anesthesia was required in eight (21%) of the patients who received retrobulbar injections and in 11 (28%) of the patients who received periocular injections. A significant increase in chemosis was found with periocular injections. There was one complication with retrobulbar anesthesia and none with periocular anesthesia. No significant difference in patient assessment of comfort was found. The efficacy of periocular anesthesia appears to be comparable to that of retrobulbar anesthesia.
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PMID:A comparison of retrobulbar and periocular anesthesia for cataract surgery. 291 Feb 93

A double-blind trial demonstrates the effectiveness of adding hyaluronidase to lignocaine with adrenaline in producing ocular akinesia and anaesthesia in retrobulbar nerve blocks. 92% of the blocks in which hyaluronidase was used for intracapsular cataract surgery were judged successful compared with 56% of those without added hyaluronidase (p less than 0.01).
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PMID:Addition of hyaluronidase to lignocaine with adrenaline for retrobulbar anaesthesia in the surgery of senile cataract. 305 72

We developed a prospective clinical study to determine the effectiveness of a new method of retrobulbar anesthesia and akinesia of the levator and orbicularis muscles. This study involved 50 patients who underwent extracapsular cataract extractions (ECCE) with intraocular lens implant (IOL). We found levator and orbicularis muscle akinesia was achieved in 49 of 50 eyes. One reblock was necessary. We also wish to point out the advantages of this technique as a means of reducing the rare but serious complications associated with retrobulbar anesthesia.
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PMID:A modified Gills' block and its effectiveness for lid muscle akinesia. 356 32

This paper describes an assisted local anaesthetic technique which we have used almost exclusively for extracapsular cataract extraction and posterior chamber intraocular lens implant surgery over the last 12 months. This ALACS technique was developed from a combined neurolept-local anesthetic into an assisted local anaesthetic suitable for day-stay cataract surgery. The technique combines the advantages of purely local (retrobulbar and facial) anaesthesia with the advantages usually inherent in a good general anaesthetic. Thus the patient is in a state of general quiescence and psychic indifference throughout the procedure. ALACS provides excellent and long-lasting akinesia and analgesia, with adequate proptosis of the eye which facilitates surgical access. ALACS is suitable for almost all adult cataract and implant surgery. Our results in 104 cases of ALACS are reviewed in terms of visual results and complications both ocular and anaesthetic; the results appear good and the complications minimal. The results of blood gas estimations done intraoperatively in a small number of patients are also presented, and suggest that the technique is systemically safe.
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PMID:Assisted local anaesthesia for cataract surgery (ALACS). 367 10

Retrobulbar anaesthesia in cataract surgery is advocated so as to decrease anaesthetic risk. The technique of anaesthesia was studied in 100 patients. The study was based on two principles: firstly, it was the anaesthetist who performed the retrobulbar anaesthesia; secondly, retrobulbar anaesthesia was a matter of deliberate choice and not done upon contra-indication of general anaesthesia. After describing the means used in obtaining anaesthesia, akinesia and efficient hypotonia of the eye, the results of the series are reported. The advantages of retrobulbar anaesthesia are discussed. The absence of noxious side-effects is stressed. This anaesthetic technique should be used more often regardless of the patient's condition.
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PMID:[Retrobulbar anaesthesia in cataract surgery revisited]. 377 70

Bupivacaine 0.5% when used as a local anaesthetic for ocular cataract surgery does not give absolute ocular akinesia but provides adequate and prolonged pain relief. In comparison lignocaine provides good ocular akinesia at operation but pain relief is short lived. The mixture of the two local anaesthetics in equal volumes eliminated the disadvantages of their individual use.
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PMID:Bupivacaine and lignocaine for ophthalmic surgery. 381 73

Simplified manual forms of extracapsular cataract extraction appear to be more economical, yet as safe and simple as techniques employing more complex instrumentation. The following method, employed in 40,000 cases, seems to the author to be an efficient and effective way of performing cataract extraction. One hour prior to surgery, modified retrobulbar anesthesia alone is employed using the technique described, and provides adequate akinesia as well as anesthesia. Positive pressure is applied to the eye preoperatively to assure softness of the globe at the time of surgery. An anterior capsulectomy is made with scissors, using the open-sky technique. Following the delivery of the lens nucleus and as much cortex as possible with a lens loop, the remaining cortex is removed with an angled, 23-gauge, double irrigation-aspiration cannula. Filtered balance salt solution, containing gentamycin flows into the eye through the side port (inflow) and a 3-cc syringe with 2 cc BSS for irrigation-aspiration is connected to the other (aspiration) port. A single, 25-gauge, angled irrigation cannula is used to clean up the finger cortical remains. A firm-loop intraocular lens is inserted into the capsular bag. The posterior capsule is left intact.
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PMID:My method of extracapsular cataract extraction with implantation of a posterior chamber intraocular lens. 402 61

Three groups of 15 patients each were randomly assigned to receive a retrobulbar anesthetic block with 0.5% bupivacaine, 0.5% bupivacaine/2% lidocaine or 0.5% bupivacaine/2% lidocaine/1:100 000 epinephrine for unilateral cataract surgery. Hyaluronidase was added to each of the preparations, which were used in double-blind fashion. Lid and globe akinesia and corneal anesthesia were graded after 4 minutes of ocular massage and 36 minutes later (at the end of the procedure) to assess the rapidity of onset and the duration of action of the anesthetics. Overall, bupivacaine/lidocaine/epinephrine was the most effective in producing akinesia of the lids and globe. Bupivacaine alone was more effective than bupivacaine/lidocaine without epinephrine in producing akinesia, although it was slower in producing anesthesia. There was no difference between the groups in the frequency of pain or of the need for analgesia 6 hours postoperatively.
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PMID:Retrobulbar anesthesia for cataract surgery: comparison of bupivacaine and bupivacaine/lidocaine combinations. 405 61

A method of controlled retrobulbar anesthesia was used in 20 patients undergoing extracapsular cataract extraction with intraocular lens implantation. The method includes: leaving the pupil undilated before anesthesia; applying topical anesthetic to the conjunctiva; injecting about 0.25 ml of anesthesia through the non-sensitive conjunctiva into the muscle cone, then waiting until the pupil becomes dilated before injecting an additional 1.5 ml; injecting 0.25 ml anesthesia under the conjunctiva and into the tendon of the superior rectus muscle; and applying short-acting mydriatics after the injection. This method is almost painless and does not result in increased intraocular pressure after injection. Massage or compression to soften the eye is not required, and there is excellent anesthesia and akinesia.
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PMID:Controlled retrobulbar anesthesia for ECCE and IOL implantation. 405 44


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