von Jagow B, Wirbelauer C, Häberle H, Pham D-T
Klinik für Augenheilkunde, Vivantes-Klinikum Neukölln, Berlin, Germany.
Klin Monbl Augenheilkd. 2007 Jul;224(7):585-9. doi: 10.1055/s-2007-963358.
Topical anaesthesia in cataract surgery permits early visual rehabilitation due to the reduced impact on the optic nerve function. In this prospective study, we evaluated the course of visual improvement after surgery.
45 consecutive patients with senile cataract and no concomitant eye disease were included in the study. Cataract surgery by clear corneal phacoemulsifaction was performed with insertion of a foldable IOL in the capsular bag under topical anaesthesia. For anaesthesia topical lidocaine gel (2 %) and intracameral injection of 0.15 ml lidocaine (1 %) was used. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were measured in decimal fractions within 4 hours after surgery and 1 day postoperatively.
The average preoperative UCVA was 0.23 +/- 0.39 and BCVA was 0.38 +/- 0.23 SD. Four hours postoperatively UCVA and BCVA improved significantly to 0.48 +/- 0.24 and 0.68 +/- 0.18, respectively. One day after surgery, the average UCVA was 0.65 +/- 0.15 and the BCVA was 0.89 +/- 0.07. 75 % (34) of the patients improved to a UCVA of 0.5 or better. The visual acuity improved in all patients one day after surgery, with 60 % (27) of the patients achieving a BCVA of 0.9 or better one day postoperatively. The postoperative corneal function had a significant influence on visual recovery (p = 0.01).
A significant visual improvement was observed immediately after cataract surgery using the combination of topical and intracameral anaesthesia. 75 % of the patients reached a UCVA, which permitted sufficient visual function for mobility and orientation. Thus, the rapid recovery of visual function suggests an increased safety, particularly for out-patient surgery.
白内障手术中的局部麻醉由于对视神经功能影响较小，可使患者早期视觉康复。在这项前瞻性研究中，我们评估了手术后视力改善的过程。
本研究纳入了45例连续的老年性白内障患者，且无合并眼部疾病。在局部麻醉下，通过透明角膜超声乳化术进行白内障手术，并将可折叠人工晶状体植入囊袋内。局部麻醉使用2%利多卡因凝胶，前房内注射0.15毫升1%利多卡因。分别在术后4小时和术后1天，以小数记录法测量未矫正视力（UCVA）和最佳矫正视力（BCVA）。
术前平均UCVA为0.23±0.39，BCVA为0.38±0.23标准差。术后4小时，UCVA和BCVA显著改善，分别为0.48±0.24和0.68±0.18。术后1天，平均UCVA为0.65±0.15，BCVA为0.89±0.07。75%（34例）患者的UCVA提高到0.5或更好。所有患者术后1天视力均有改善，60%（27例）患者术后1天BCVA达到0.9或更好。术后角膜功能对视力恢复有显著影响（p = 0.01）。
使用局部和前房内联合麻醉进行白内障手术后，视力立即有显著改善。75%的患者达到了UCVA，足以满足移动和定向所需的视觉功能。因此，视觉功能的快速恢复提示安全性增加，尤其对于门诊手术。
