Rajput Vimal K, Bhalsing Shweta, Bhalsing Snehal, Raut Pritish
Department of Pediatric Ophthalmology and Strabismus, Prime Vision Superspeciality Eye Care, Ahmednagar, Maharashtra, India.
Department of Cataract Services, Prime Vision Superspeciality Eye Care, Ahmednagar, Maharashtra, India.
Indian J Ophthalmol. 2021 Feb;69(2):268-273. doi: 10.4103/ijo.IJO_280_20.
The objective of this study was to evaluate an OPD-based Lying down looking down (LDLD) test for the assessment of patient suitability for assisted topical anesthesia (ATA) during manual small incision cataract surgery (MSICS), and to compare it with assisted local anesthesia (ALA).
The LDLD test was carried out during preoperative assessment of 250 consecutive patients. A standard LED torch was shined in patient's eye after pupil dilation, with the patient in lying down position, while simultaneously elevating the upper eyelid digitally. A positive test was indicated by the ability to maintain downward gaze and the lack of squeezing of eyes or withdrawal. Chi-square and Fisher's exact tests were used to assess the association between LDLD results and suitability for ATA. The positive predictive value and specificity of the test as an indicator of patient suitability for ATA were calculated. Complications (intra- and post-operative) and postoperative inflammation at day 1 and week 6 were compared between the ATA and ALA groups.
A total of 250 patients were included in the study, 138 in ALA group and 112 in ATA group. There were 109 males (43.6%) and 141 females (56.4%). Around 7.4% of LDLD- positive patients were converted to ALA during the surgery. Chi-square and Fisher's exact tests demonstrated a significant association of a positive LDLD test with successful ATA (P value 0.002). The positive predictive value and specificity of the test were 92.56% (95% CI86.87-95.9%) and 93.48% (95% CI87.98-96.97%), respectively. Intraoperative complications were similar in both the groups. Congestion and visually significant corneal edema were significantly less in ATA group.
The LDLD is a simple, highly specific, OPD-based test to determine patient suitability for MSICS under ATA.
本研究的目的是评估一种基于门诊检查的躺下向下看（LDLD）测试，以评估患者在手法小切口白内障手术（MSICS）期间是否适合辅助表面麻醉（ATA），并将其与辅助局部麻醉（ALA）进行比较。
对连续250例患者进行术前评估时进行LDLD测试。在瞳孔散大后，让患者仰卧，用标准LED手电筒照射患者眼睛，同时用手指提起上眼睑。能够保持向下注视且没有挤眼或退缩表示测试为阳性。使用卡方检验和费舍尔精确检验来评估LDLD结果与ATA适用性之间的关联。计算该测试作为患者ATA适用性指标的阳性预测值和特异性。比较ATA组和ALA组的并发症（术中及术后）以及术后第1天和第6周的术后炎症情况。
本研究共纳入250例患者，ALA组138例，ATA组112例。男性109例（43.6%），女性141例（56.4%）。约7.4%的LDLD阳性患者在手术期间转为ALA。卡方检验和费舍尔精确检验表明，LDLD测试阳性与成功的ATA显著相关（P值0.002）。该测试的阳性预测值和特异性分别为92.56%（95%CI 86.87 - 95.9%）和93.48%（95%CI 87.98 - 96.97%）。两组术中并发症相似。ATA组的充血和具有视觉意义的角膜水肿明显较少。
LDLD是一种简单、高度特异的基于门诊检查的测试，用于确定患者在ATA下进行MSICS的适用性。
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