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Visual experiences during cataract surgery: what anaesthesia providers should know

Published online by Cambridge University Press:  02 June 2005

Colin S. H. Tan ,
Kah-Guan Au Eong  and
Chandra M. Kumar
Colin S. H. Tan
Affiliation:
The Eye Institute, Tan Tock Seng Hospital, National Healthcare Group, Singapore
Kah-Guan Au Eong
Affiliation:
The Eye Institute at Alexandra Hospital; The Eye Institute at Tan Tock Seng Hospital; National University of Singapore, Department of Ophthalmology; and Singapore Eye Research Institute, Singapore
Chandra M. Kumar
Affiliation:
The James Cook University Hospital, Academic Department of Anaesthesia, UK
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Summary

Recently published literature shows that most patients experience a variety of visual sensations during cataract surgery under local anaesthesia. Most patients (80–100%) retain at least some light perception in the operated eye and many also experience a variety of other visual sensations during cataract surgery under regional ophthalmic anaesthesia (retrobulbar, peribulbar and sub-Tenon's blocks) or topical anaesthesia. The visual sensations experienced include perception of movements, flashes, colours, changes in brightness, or the sight of surgical instruments, the surgeon's hands or fingers, or even the surgeon. These findings are clinically significant because 3–16.2% of patients who had cataract surgery under either regional or topical anaesthesia were frightened by their intraoperative visual experience. Fear and anxiety may cause some patients to become uncooperative during the surgery and may also induce a sympathetic stress response that might cause hypertension, tachycardia with myocardial ischaemia, hyperventilation or an acute panic attack. These effects are especially undesirable as the majority of cataract patients are elderly and have concurrent medical problems. Besides increasing the risk of intraoperative complications, a frightening visual experience may decrease patient satisfaction. Appropriate preoperative counselling has been shown to be effective in reducing the patients' fear. As most patients retain some visual function during cataract surgery under local anaesthesia, anaesthesia providers should be mindful of this phenomenon and offer appropriate preoperative information and counselling to their patients.

Keywords

CATARACT SURGERY, intraoperative visual experience, visual sensations, fear, preoperative counsellingLOCAL ANAESTHESIA, topical anaesthesia, peribulbar anaesthesia, retrobulbar anaesthesia, sub-Tenon's anaesthesia
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 6 , June 2005 , pp. 413 - 419
Copyright
© 2005 European Society of Anaesthesiology

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