Phacoemulsification under peribulbar anesthesia: To patch or not

Abstract

Introduction Anesthesia for cataract surgeries is undertaken in various forms. In cases under peribulbar anesthesia, there exists a practice of patching the eye for varying duration. This study has been conducted to look into the difference in the outcome and comfort of the patient with respect to the use of eye patch in an objective way. Materials and Methods This is a prospective randomized observational study with controls conducted at an Ophthalmology Department of a Tertiary Care Hospital. All patients undergoing uneventful phacoemulsification with posterior chamber intraocular lens implant surgery for age-related cataracts meeting the inclusion criteria were recruited for the study. Results Two hundred and seven patients were included and randomly allotted to the patch and no-patch group. The mean pain score for the no-patch group was 2.930 (standard deviation [SD] =1.4231), while the same for the patch group was 2.879 (SD = 1.3438). The symptom of watering in patch group was significantly lower than the no-patch group with a P = 0.013 by Pearson’s Chi-square test. The mean postoperative day (POD) 1 DVA among the cases was found to be 0.440 LogMAR (SD = 0.3114) and the same for controls was 0.715 LogMAR (SD = 0.2858). On the 2nd POD, the DVA of the cases improved to 0.162 LogMAR (SD = 0.1819) while that of controls were 0.419 LogMAR (SD = 0.2758). However, the visual acuity of both groups was comparable at the end of the 7th POD. The patients without patch demonstrated significantly better visual acuity on the 1st POD. This group of patients also had statistically significant reduction in the conjunctival congestion, aqueous flare, aqueous cells, and corneal edema. The beneficial outcome on the 1st POD is likely due to the early use of topical drugs which is facilitated by the absence of eye patch. However, the final outcome seems independent of the use of patching. Conclusion Using an eye patch for the patient undergoing a routine phacoemulsification surgery under peribulbar block does not seem to have any additional benefit.