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Subconjunctival long ciliary nerve anaesthesia for phacoemulsification requiring iris manipulation and Malyugin ring

Poster Details

First Author: P.Chiam UK

Co Author(s):    V. Sung              

Abstract Details


The primary objectives were to assess pain during surgery and patient satisfaction. The secondary objective was to evaluate adverse events attributed to the anaesthesia.


Birmingham and Midland Eye Centre, United Kingdom


Patients with poorly dilated pupil requiring iris stretching and/or insertion of Malyugin to proceed with phacoemulsification were recruited. Subconjunctival lignocaine 2% of 0.2 to 0.3ml was injected at the nasal and temporal quadrants on the operating table at the beginning of the operation. This was intended to anaesthetise the long posterior ciliary nerves, which innervates the iris and cornea. A 10-point visual analog scale (VAS) was used for patients to score their pain during the operation. This was completed anonymously on the recovery ward in the absence of the operating surgeon. Adverse effects due to the anaesthesia were also noted.


Eight eyes (8 patients) underwent uncomplicated phacoemulsification by a single surgeon (PJC). All patients had Malyugin ring 6.25mm inserted. Six patients had iris stretching and/or posterior synechiae broken manually prior. Four patients had anterior chamber maintainer inserted (shallow anterior chamber). One patient required corneal stitch. The mean intraoperative pain score on the VAS was 0.9 (out of 10). The range was 0 to 2. All patients would have the same type of anaesthesia for the fellow eye. The mean surgical time was 16.2 minutes. No additional anesthesia was required. Two patients had subconjunctival haemorrhage. There were no other adverse events.


Subconjunctival long ciliary nerve anaesthesia is an effective way to provide adequate anaesthesia for pupillary manipulation during phacoemulsification. FINANCIAL DISCLOUSRE: NONE

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