Less Discomfort And Less Pharmacology: Cataract Surgery At Physiologic Intraocular Pressure - The Patient Experience

To investigate whether phacoemulsification at physiologic (low) intraocular pressure (IOP) vs high IOP impacts a patient’s intraoperative experience of pain and their overall satisfaction with anesthesia

Wolfe Surgery Center.  West Des Moines, Iowa.  United States.

Prospective, randomized, paired-eye design of 130 eyes in 65 patients undergoing cataract surgery. First eye randomized to high (65mmHg) or low (24 mmHg) intraoperative IOP setting, contralateral eye received other IOP setting. Patient, surgeon, anesthesiologist and post-operative technicians blinded to study group. Endpoints included comparison of patient reported pain scores at four steps during surgery (phaco, lens insertion, cortex removal and viscoelastic removal; scale of 1 to 10), surgeon’s assessment of patient cooperation, patient satisfaction with anesthesia care using a modified Iowa Satisfaction with Anesthesia Scale (Likert scale of 1 to 6), and patient recollection of details.

Pain scores were significantly lower in the low IOP group compared to the high IOP group during phacoemulsification (0.51 v 1.80, p<0.001), cortex removal (0.52 v 1.88, p<0.001) and viscoelastic removal (1.24 v 2.96, p<0.001). Surgeon assessment of patient cooperation (2.97 v 2.66, p<0.001) were better in the low IOP group compared to the high IOP group. Both groups had high satisfaction and strongly “agreed very much that they were relaxed” with the anesthesia care and reportedly “would have the same anesthesia again”. Additionally, both groups were largely able to recall details of the surgery.

Patients in the lower IOP group experienced less pain at each step of the phacoemulsification procedure involving fluidics which led to better patient cooperation. Postoperative surveys revealed high patient satisfaction and patients were able to recall details of the surgery in both groups.