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題名 | Efficacy and Safety of Phacoemulsification with Intraocular Lens Implantation under Topical Anesthesia=局部滴注麻醉劑進行晶體乳化術及人工水晶體植入之效果及安全性 |
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作者 | 莊蘭馨; 賴旗俊; 古婉珍; 楊克仁; 宋湖仙; | 書刊名 | 長庚醫學 |
卷期 | 27:8 2004.08[民93.08] |
頁次 | 頁609-613 |
分類號 | 416.744 |
關鍵詞 | 局部麻醉; 晶體乳化術; 角膜內皮細胞顯微鏡; Topicla anesthesia; Phacoemulsification; Specular microscope; 10-point visual analog pain scale; |
語文 | 英文(English) |
中文摘要 | 背景:為減少球週或球後麻醉引起的併發症及評估局部滴注麻醉劑進行白內障手術。 方法:我們以局部滴注無防腐劑之2% lidocaine來施行經角膜晶體乳化及折疊式人工水晶體植入,術中並未追加前房內麻醉劑注射。凡焦慮性病人,小瞳孔症,基礎內皮細胞少於每平方毫米一千五百個,青光眼控制不佳,其他影響內皮細胞之眼疾,及對相關藥物敏者皆須排除。我們以角膜內皮細胞顯微鏡來分析手術對內皮細胞的影響,並以10-point visual analog pain scale來評估術中的疼痛程度。 結果:此研究包括29位病人之29隻眼睛。平均年齡為71.5±8.5歲。29眼中有23眼其術後3個月之最佳矯正視力大於或等於零點五。大部份(86.5%)病人在術感覺輕微甚至無痛感。術前及術後之角膜內皮細胞分別為2072.6±104 cell/mm2及1927.4±196 cell/mm2。29眼中其中1例在手術時因不自主眼球移動造成vitreous loss。 結論:以局部滴注無防腐劑之2% lidocaine麻醉劑來進行經角膜晶體乳化及折疊式人工水晶體植入是有效且安全的。另一方面,對於小瞳孔症或焦慮性病人,手術可能較費時?僅以局部滴注麻醉劑進行白內障手術對醫師而言則是一項挑戰。 |
英文摘要 | Background: To eliminate complications of peribulbar and retrobulbar anesthesia and to achieve efficacy and safety for topical anesthesia with cataract surgery. Methods: We performed clear corneal phacoemulsification with foldable intraocular lens OIOL) implantation under topical anesthesia using preservative-free 2%lidocaine drops, without intracameral anesthetic supplementation. The exclusion criteria were anxiety, small pupil, baseline endothelial count 1500cells/mm2, uncontrolled glaucoma, other ocular entities affecting corneal endothelium, and allergy to the relevant medications. We used a specular microscope to evaluate the effect on the endothelium and employed a 10-point visual analog pain scale to assess the discomfort experienced during the operation. Results: Totally, 29 eyes of 29 patients were enrolled in this series. The mean age was 71.5±8.5 years. Twenty-three of 29 (79.3) cases achieved a best-corrected visual acuity (BCVA) equal to 20/40 or better at an interval of 3 months post operatively. Most patients (86.5%) felt mild or no pain during surgery. Pre and postoperative endothelial counts were 2072.6±104 and 1927.4±196cell/mm2, respectively. One in 29 cases developed vitreous loss due to involuntary eye movements intraoperatively. Conclusions: Topical anesthesia with preservative-free 2% lidocaine drops is an effective and safe modality for clear corneal phacoemulsification with IOL implantation. On the other hand, for patients with small pupil or those who are anxious, the procedure may be time-consuming, and it is challenging for physicians to perform cataract surgery merely using topical anesthesis. |
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