Main Article Content
comparative, Sub tenon’s, Anesthesia, Incision, Cataract Surgery
Objective: - To compare patient and surgeon comfort during SICS under sub tenon’s anesthesia (STA) and under anterior subconjunctival anesthesia (ASCA).
Material and method: - A prospective, longitudinal study was conducted from 1st January 2023 to 31st July 2023 in the patients attending Ophthalmology OPD. Patients undergoing small incision Cataract surgery were randomly divided into two groups- anterior subconjunctival anesthesia (ASCA) group and sub tenon’s anesthesia (STA) group. Ocular motility, duration of surgery, pain experienced by patient and surgeon’s discomfort during surgery was recorded.
Result: - A total of 130 patients were included in the study out of which 65 underwent SICS under ASCA and 65 underwent SICS under STA. 68(52%) were females and 62(48%) males. All patients in ASCA group had total ocular motility while in STA group 39 patients had no ocular motility, 12 each had grade 1 and grade 2 motility and 3 had grade 3 motility(p=0.001). In ASCA group in 19 cases surgeon had grade 1 discomfort, in 9 cases grade 2 while in 3 cases grade 3 discomfort in performing the surgery. In STA group only in 4 cases surgeon had grade 1 discomfort in performing the surgery with no patient with grade 2 or grade 3 discomfort. In STA group 13 patients had mild pain during the surgery while in ASCA group 35 patient had mild pain. More patients in ASCA group experienced mild pain than STA group (p<0.001) but none of the patient in any of the group had pain significant enough to need to convert to other mode of anesthesia administration.
Conclusion: - ASCA is a feasible option in expert hands in SICS cases where patient insists on topical surgery. It obliviates the chances of needle related injury during anesthesia.
2. Ruit S, Tabin G, Chang D, Bajracharya L, Kline DC, Richheimer W, et al. A prospective randomized clinical trial of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery in Nepal. Am J Ophthalmol. 2007;143:32–8. [PubMed] [Google Scholar]
3. Gogate P, Deshpande M, Nirmalan PK. Why do phacoemulsification? Manual small-incision cataract surgery is almost as effective, but less expensive. Ophthalmology. 2007 May;114(5):965-8. doi: 10.1016/j.ophtha.2006.08.057. Epub 2007 Feb 12. PMID: 17296230.
4. Rho CR, Kim JH, Chung IK, Kim EC, Han YK, Han SY, Eom Y, Chung TY, Lee DH. Cataract Surgery Practice in the Republic of Korea: A Survey of the Korean Society of Cataract and Refractive Surgery 2020. Korean J Ophthalmol. 2021 Aug;35(4):272-279. doi: 10.3341/ kjo.2020.0001. Epub 2021 Jun 21. PMID: 34162191; PMCID: PMC8357609.
5. Behndig A, Cochener-Lamard B, Güell J, Kodjikian L, Mencucci R, Nuijts R, Pleyer U, Rosen P, Szaflik J, Tassignon MJ. Surgical, antiseptic, and antibiotic practice in cataract surgery: Results from the European Observatory in 2013. J Cataract Refract Surg. 2015 Dec;41(12):2635-43. doi: 10.1016/j.jcrs.2015.06.031. PMID: 26796444.
6. Singh SK, Winter I, Surin L. Phacoemulsification versus small incision cataract surgery (SICS): which one is a better surgical option for immature cataract in developing countries? Nepal J Ophthalmol. 2009 Jul-Dec;1(2):95-100. doi: 10.3126/nepjoph.v1i2.3682. PMID: 21141000.
7. Gogate P, Optom JJ, Deshpande S, Naidoo K. Meta-analysis to Compare the Safety and Efficacy of Manual Small Incision Cataract Surgery and Phacoemulsification. Middle East Afr J Ophthalmol. 2015 Jul-Sep;22(3):362-9. doi: 10.4103/0974-9233.159763. PMID: 26180478; PMCID: PMC4502183.
8. Ajay K, Subhasree RK, Poka A. Anterior Subconjunctival Anesthesia for Manual Small Incision Cataract Surgery: A Randomized Controlled Trial. J Curr Ophthalmol. 2021 Oct 22;33(3):266-271. doi: 10.4103/2452-2325.329083. PMID: 34765813; PMCID: PMC8579797.
9. Nwosu SNN, Nwosu VO, Akudinobi CU, Uba-Obiano CU, Nnubia CA, Ubaka CO, Okpala NE, Onyiaorah AA. Sub-tenon Versus Sub-conjunctiva Anaesthesia for Intraocular Surgery. J West Afr Coll Surg. 2022 Oct-Dec;12(4):27-30. doi: 10.4103/jwas.jwas_175_22. Epub 2022 Nov 23. PMID: 36590781; PMCID: PMC9802597.