Randleman J Bradley, Srivastava Sunil K, Aaron Maria M
Department of Ophthalmology, Emory University, Atlanta, GA 30322, USA.
J Cataract Refract Surg. 2004 Jan;30(1):149-54. doi: 10.1016/S0886-3350(03)00491-7.
To evaluate and compare the outcomes in phacoemulsification cases performed by resident surgeons using topical anesthesia or retrobulbar anesthesia.
Department of Ophthalmology, Emory University, Atlanta, and Department of Veterans Affairs Medical Center, Decatur, Georgia, USA.
This was a retrospective review of phacoemulsification cases performed by resident surgeons during 1 academic year. Variables analyzed included patient age and sex, preexisting conditions limiting final acuity, and type of anesthesia used. Outcomes measured included intraoperative and postoperative complications and final visual acuity.
Of the 291 cases analyzed, 119 (40.9%) were retrobulbar and 172 (59.1%) were topical. Residents began using topical anesthesia after a brief introductory period with retrobulbar anesthesia. Vitreous loss occurred in 15 cases (5.1%), 8 retrobulbar (6.7%) and 7 topical (4.1%) (P =.42). Postoperative complications occurred in 30 cases (10.3%), 17 topical (9.9%) and 13 retrobulbar (10.9%) (P =.85). Overall, 245 cases (84.2%) achieved a final best corrected visual acuity (BCVA) of 20/40 or better. When cases with preexisting conditions limiting final acuity were eliminated, 92.1% achieved a final BCVA of 20/40 or better. More topical cases (112, 65.1%) than retrobulbar cases (64, 53.8%) achieved a final BCVA of 20/25 or better (P =.06), and more topical cases (149, 86.6%) than retrobulbar cases (96, 80.7%) achieved a final BCVA of 20/40 or better (P =.19).
Topical anesthesia is safe and efficacious for phacoemulsification performed by resident surgeons early in training after a brief introduction to phacoemulsification using retrobulbar anesthesia.
评估并比较住院医师采用表面麻醉或球后麻醉进行白内障超声乳化手术的效果。
美国佐治亚州亚特兰大市埃默里大学眼科以及迪凯特市退伍军人事务医疗中心。
对住院医师在1个学年内进行的白内障超声乳化手术病例进行回顾性研究。分析的变量包括患者年龄和性别、限制最终视力的既往病症以及所采用的麻醉类型。测量的结果包括术中及术后并发症和最终视力。
在分析的291例病例中，119例（40.9%）采用球后麻醉，172例（59.1%）采用表面麻醉。住院医师在经过短暂的球后麻醉入门期后开始使用表面麻醉。15例（5.1%）发生玻璃体脱出，其中8例（6.7%）为球后麻醉，7例（4.1%）为表面麻醉（P = 0.42）。30例（10.3%）发生术后并发症，其中17例（9.9%）为表面麻醉，13例（10.9%）为球后麻醉（P = 0.85）。总体而言，245例（84.2%）患者最终最佳矫正视力（BCVA）达到20/40或更好。排除存在限制最终视力的既往病症的病例后，92.1%的患者最终BCVA达到20/40或更好。最终BCVA达到20/25或更好的表面麻醉病例（112例，65.1%）多于球后麻醉病例（64例，53.8%）（P = 0.06），最终BCVA达到20/40或更好的表面麻醉病例（149例，86.6%）多于球后麻醉病例（96例，80.7%）（P = 0.19）。
在经过短暂的使用球后麻醉进行白内障超声乳化手术入门期后，表面麻醉对于住院医师早期培训阶段进行的白内障超声乳化手术是安全有效的。
