Abdul Hye.
Trabeculectomy under topical anesthesia.
Pak J Med Health Sci Jan ;4(2):123-6.

Purpose of study: To evaluate the efficacy of topical anesthesia as a method of choice for trabeculectomy procedure, in terms of pain during surgery and patient’s satisfaction and comfort. Patients and methods: Twenty patients undergoing trabeculectomy were included in the study. Trabeculectomy was performed. No sedation was used. No superior rectus muscle suture or corneal suture for exposure of surgical area was used. The degree of pain experienced during the operation was assessed by asking the patients to score on a numerical scale (0-10), having a written grades of pain as well (no pain=0, mild discomfort=2.5, moderate pain=5, severe pain=7.5, and unbearable pain=10). Surgeon (Hye.A) also graded the patient’s overall cooperation during surgical procedure, the grades being 10=excellent, 7.5=good, 5=fair 2.5=poor and extremely poor=0. Results: There were no intra-operative complications except sub-conjunctival hemorrhage during sub-conjunctival anesthesia. The overall cooperation as assessed by surgeon was excellent in majority i.e. 70% of the patients and good in the remaining 30%.The overall score showed a mean of 9.25. Patient’s assessment of pain during delivery of first dose of topical anesthesia, during surgery and in the post operative period, on written and numerical pain scale, was almost similar, the mean score of 0.3, 0.425,and 0.35 respectively. No supplementary topical or injectable anesthesia and intravenous sedation was required. Squeezing of eyes and inadvertent eye movements were observed only in 20% i.e. 4 patients and these did not significantly interfere with the surgery. Conclusion: The topical anesthesia is safe and effective method in providing a painless surgical procedure in patients undergoing trabeculectomy. This method has an additional advantage of avoiding serious complications related to other methods.

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