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Jae, Ji, Kyoung, Eung, and Tae: Relationship between Cataract Maturation and Pain Scale during Cataract Surgery under Topical Anesthesia
Original Article

J Korean Ophthalmol Soc 2007;54(3):437-442.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.3.437

Relationship between Cataract Maturation and Pain Scale during Cataract Surgery under Topical Anesthesia

Sang Ko Jae, MD1, Min Ahn Ji, MD2, Yul Seo Kyoung, MD, PhD1, Kweon Kim Eung, MD, PhD1, Im Kim Tae, MD, PhD1,

1The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine=, Seoul, Korea

2Siloam Eye Hospital, Seoul, Korea

Address reprint requests to Tae Im Kim, MD, PhD Department of Ophthalmology, Severance Hospital #50 Yonsei-ro, Seodaemun-gu, Seoul 120-749, Korea Tel: 82-2-2228-3570, Fax: 82-2-312-0541, E-mail: tikim@yuhs.ac

Received 26 July 2006       Accepted 8 May 2007

Copyright © 2007 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the relationship between maturity of a cataract and the pattern of pain during cataract surgery under topical anesthesia.

Methods

This study comprised 105 eyes of 75 patients undergoing cataract surgery under topical anesthesia. The pain scale during each procedure was scored from 0 to 10 in numeric pattern and analyzed with the cataract maturation degree. Additionally, pain scores were compared between the first and the second eye in 14 consecutive cataract patients.

Results

The average pain score during cataract surgery was 0.86 ± 0.55, and the average maximal pain experience score during surgery was 3.24 ± 1.51, which was generally tolerable. Phacoemulsification was marked as the most painful step among cataract surgery procedures (1.93 ± 1.64), followed by the removal of the surgical draping (1.31 ± 1.53) and the initial instillation of topical anesthetic (1.29 ± 1.28). Progression and cataract typing was not related to pain either during overall cataract surgery procedures or when separately analyzed during procedures. There was no significant difference between the pain scores reported in consecutive cataract surgeries. However, in subjective comparison of consecutive surgeries, more patients reported greater pain in the second operation.

Conclusions

The pain score reported during cataract surgery procedures under topical anesthesia was within a generally tolerable range. Cataract progression does not appear to be related to pain during the operation. In consecutive surgeries, pain measured by a numerical scale and subjective pain experience showed different results.

Keywords: Cataract surgery, Pain, Topical anesthesia

References

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Figure 1.
Mean value of pain scale during procedures of cataract surgery. CCC = continuous curvilinear capsulorhexis.
jkos-54-437f1.tif
Figure 2.
Comparison average pain experience in consecutive cataract surgeries within a week.
jkos-54-437f2.tif
Table 1.
Comparison of mean pain scale during cataract surgeries
Gender Side Age Total (n = 105)
Male (n = 38) Female (n = 67) Right eye (n = 57) Left eye (n = 48) Age < 60 (n = 31) Age ≥ 70 (n = 39)
Anesthetic instillation 1.29 ± 1.39 1.3 ± 1.22 1.39 ± 1.36 1.19 ± 1.18 1.13 ± 1.20 1.38 ± 1.37 1.30 ± 1.28
(p = 0.97) (p = 0.42) (p = 0.43)
Corneal incision 0.13 ± 0.34 0.15 ± 0.5 0.12 ± 0.38 0.17 ± 0.52 0.16 ± 0.37 0.10 ± 0.31 0.14 ± 0.45
(p = 0.83) (p = 0.63) (p = 0.47)
CCC 0.13 ± 0.34 0.13 ± 0.46 0.16 ± 0.49 0.10 ± 0.31 0.16 ± 0.37 0.18 ± 0.56 0.13 ± 0.42
(p = 0.97) (p = 0.50) (p = 0.73)
Hydro-dissection 0.24 ± 0.71 0.36 ± 0.79 0.39 ± 0.88 0.23 ± 0.59 0.19 ± 0.40 0.44 ± 0.94 0.31 ± 0.76
(p = 0.42) (p = 0.30) (p = 0.54)
Phaco-emulsification 1.66 ± 1.60 2.09 ± 1.66 1.88 ± 1.60 2.00 ± 1.70 2.03 ± 1.76 1.95 ± 1.50 1.93 ± 1.64
(p = 0.19) (p = 0.71) (p = 0.98)
Irrigation and aspiration 1.13 ± 1.8 0.88 ± 1.61 0.79 ± 1.42 1.19 ± 1.93 1.58 ± 2.23 0.51 ± 1.07 0.97 ± 1.68
(p = 0.48) (p = 0.24) (p = 0.01)†
IOL implantation 0.53 ± 1.01 0.79 ± 1.32 0.44 ± 0.89 1.00 ± 1.47 0.71 ± 1.04 0.67 ± 1.20 0.70 ± 1.22
(p = 0.25) (p = 0.02)* (p = 0.59)
Antibiotic instillation 1.11 ± 1.69 0.9 ± 1.45 0.98 ± 1.47 0.96 ± 1.62 0.87 ± 1.67 0.92 ± 1.40 0.97 ± 1.53
(p = 0.52) (p = 0.94) (p = 0.67)
Drap removal 0.89 ± 1.18 1.55 ± 1.67 1.47 ± 1.69 1.13 ± 1.33 0.90 ± 1.37 1.79 ± 1.78 1.31 ± 1.54
(p = 0.03)* 　 (p = 0.24) 　 (p = 0.02)†
Mean 0.79 ± 0.62 0.91 ± 0.50 0.85 ± 0.51 0.88 ± 0.59 0.86 ± 0.65 0.88 ± 0.44 0.86 ± 0.55
(p = 0.33) (p = 0.73) (p = 0.24)
Max 2.92 ± 1.51 3.43 ± 1.48 3.26 ± 1.43 3.23 ± 1.60 3.35 ± 1.68 3.44 ± 1.39 3.25 ± 1.50
(p = 0.10) (p = 0.91) (p = 0.46)

Values are presented as mean ± SD.

CCC = circumferential curvilinear capsulorhexis.

* p < 0.05, paired t-test;

† p < 0.05, Mann-Whitney U test.

Table 2.
Mean value of pain scale during cataract surgery compared by types and severity of cataract
Cortical opacity Nuclear opacity PSCO
Mild (n = 74) Advanced (n = 31) Mild (n = 71) Advanced (n = 34) Mild (n = 88) Advanced (n = 17)
Mean typing 1.52 ± 1.24 4.19 ± 0.40 2.14 ± 0.88 4.21 ± 0.41 0.80 ± 1.11 4.35 ± 0.49
Anesthetic instillation 1.22 ± 1.30 1.48 ± 1.23 1.34 ± 1.35 1.21 ± 1.12 1.25 ± 1.21 1.53 ± 1.62
(p = 0.32) (p = 0.60) (p = 0.51)
Corneal incision 0.14 ± 0.34 0.16 ± 0.64 0.13 ± 0.44 0.18 ± 0.46 0.15 ± 0.47 0.12 ± 0.33
(p = 0.83) (p = 0.60) (p = 0.75)
CCC 0.18 ± 0.48 0.03 ± 0.18 0.13 ± 0.44 0.15 ± 0.36 0.14 ± 0.43 0.12 ± 0.33
(p = 0.11) (p = 0.80) (p = 0.84)
Hydro- dissection 0.39 ± 0.82 0.13 ± 0.56 0.37 ± 0.83 0.21 ± 0.59 0.35 ± 0.82 0.12 ± 0.33
(p = 0.11) (p = 0.26) (p = 0.25)
Phaco-emulsification 1.88 ± 1.65 2.06 ± 1.65 1.87 ± 1.72 2.06 ± 1.48 1.89 ± 1.61 2.18 ± 1.85
(p = 0.60) (p = 0.57) (p = 0.55)
Irrigation and aspiration 1.1 ± 1.80 0.55 ± 1.26 1.03 ± 1.79 0.85 ± 1.44 0.88 ± 1.56 1.47 ± 2.18
(p = 0.09) (p = 0.59) (p = 0.18)
Intraocular lens implantation 0.82 ± 1.29 0.39 ± 0.99 0.82 ± 1.23 0.44 ± 1.16 0.61 ± 1.09 1.12 ± 1.73
(p = 0.09) (p = 0.13) (p = 0.12)
Antibiotic instillation 0.96 ± 1.55 1.00 ± 1.53 0.70 ± 1.38 1.53 ± 1.71 0.97 ± 1.46 1.00 ± 1.94
(p = 0.90) (p = 0.01)* (p = 0.95)
Drap removal 1.32 ± 1.58 1.29 ± 1.47 1.14 ± 1.42 1.68 ± 1.74 1.27 ± 1.54 1.53 ± 1.55
(p = 0.92) (p = 0.12) (p = 0.54)
Mean 0.89 ± 0.59 0.79 ± 0.41 0.84 ± 0.56 0.92 ± 0.52 0.83 ± 0.49 1.02 ± 0.78
(p = 0.36) (p = 0.44) (p = 0.20)
Maximum 3.24 ± 1.52 3.26 ± 1.48 3.17 ± 1.59 3.41 ± 1.33 3.16 ± 1.4 3.71 ± 1.76
(p = 0.96) (p = 0.41) (p = 0.17)

Values are presented as mean ± SD.

PSCO = posterior subcapsular opacity; CCC = circumferential curvilinear capsulorhexis.

* p < 0.05, paired t-test.

Table 3.
Association of pain scale with typing and advancement of cataract by Pearsons's correlation coeffiecnt
Cortical opacity Nuclear opacity PSCO
Pearson's coefficient p-value Pearson's coefficient p-value Pearson's coefficient p-value
Anesthetic instillation 0.108 0.272 0.054 0.582 0.065 0.509
Corneal incision -1.290 0.190 0.050 0.614 0.006 0.956
CCC -0.191 0.051 -0.025 0.801 0.025 0.802
Hydro- dissection -0.127 0.195 0.013 0.894 -0.092 0.349
Phaco-emulsification 0.156 0.112 0.013 0.898 0.125 0.205
Irrigation and aspiration -0.244 0.012* -0.128 0.193 0.165 0.093
Intraocular lens implantation -0.219 0.025 -0.122 0.214 0.089 0.365
Antibiotic instillation -0.108 0.272 0.216 0.027* 0.030 0.758
Drap removal -0.052 0.601 0.234 0.016* 0.010 0.917
Mean -0.088 0.374 0.090 0.363 0.138 0.160
Maximum 0.122 0.216 0.072 0.464 0.162 0.099

Values are presented as mean ± SD.

PSCO = posterior subcapsular opacity; CCC = circumferential curvilinear capsulorhexis.

* p < 0.05 pearson's correlation coefficient.

Table 4.
Comparison of mean pain experience in consecutive eye surgeries
Consecutive eyes (n = 14)
First eye Second eye
Anesthetic instillation 1.29 ± 1.38 1.00 ± 1.04
(p = 0.64)
Corneal incision 0.00 ± 0.00 0.00 ± 0.00
(p = 1.00)
CCC 0.00 ± 0.00 0.00 ± 0.00
(p = 1.00)
Hydro- dissection 0.57 ± 1.02 0.36 ± 0.93
(p = 0.67)
Phaco-emulsification 1.64 ± 1.15 1.93 ± 1.38
(p = 0.48)
Irrigation and aspiration 0.57 ± 0.76 0.79 ± 1.53
(p = 0.94)
Intraocular lens implantation 0.21 ± 0.58 0.50 ± 1.16
(p = 0.46)
Antibiotic instillation 1.07 ± 1.38 1.50 ± 1.56
(p = 0.12)
Drap removal　 1.43 ± 1.60 1.07 ± 1.54
　 (p = 0.43)
Mean 0.75 ± 0.29 0.79 ± 0.48
(p = 0.83)
Maximum 3.07 ± 1.00 3.14 ± 1.29
(p = 0.80)

Values are presented as mean ± SD.

Wilcoxon sign rank test.

CCC = circumferential curvilinear capsulorhexis.

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