title: Topical plus subconjunctival anaesthesia: foldable intraocular lens implantation in eyes without capsule support through a self-sealing incision.
abstract: OBJECTIVE
  To evaluate the clinical outcomes of topical plus subconjunctival anaesthesia for secondary implantation of foldable intraocular lens (IOL) (Ophtec PC 425Y) in eyes without capsule support through a self-sealing incision.
  
  
  METHODS
  We reviewed the medical records of 22 patients (22 eyes) who received topical plus subconjunctival anaesthesia for scleral fixation of a foldable IOL through small incision. The scleral incision technique was used for IOL scleral fixation. Twelve eyes had traumatic cataract, seven had postphacoemulsification complications and three were aphakic. We studied visual outcome, intraoperative complications and perioperative pain. Autorefractometry and keratometry measurements and central endothelial cell counts were evaluated 1 day preoperatively and 4 months postoperatively. The level of intraoperative pain was scored on a scale of 1-10, where 1 = no pain and 10 = severe pain.
  
  
  RESULTS
  Nineteen patients (86%) tolerated the procedure well, giving pain scores of 1-3, and none required supplemental anaesthesia. The mean age of the patients was 60 years. The postoperative best-corrected visual acuity (BCVA) ranged between 20/100 and 20/25. Four months postoperatively, the mean myopic shift by autorefractometry was -1.25 dioptre (D) and the mean postoperative astigmatism was 1.75 D. The mean central corneal endothelial loss at 4 months was 12.24% (range 4.5-17.2%). Five microscopic hyphaema occurred intraoperatively. Four cystoid macular oedema and four peripheral anterior synechia were the only complications, each occurring at the final follow-up.
  
  
  CONCLUSIONS
  Topical plus subconjunctival anaesthesia and scleral fixation of foldable IOL (Ophtec PC 425Y) was safe, quick, required a small incision, led to favourable visual outcomes and minimized the risk of intraoperative and postoperative complications in eyes without capsule support. However, a long-term study of a large population is required to confirm these findings.
authors.affiliation: Department of Ophthalmology, San João University Hospital, Porto, Portugal. manuelmp@portugalmail.pt
authors.forename: Manuel
authors.initials: M
authors.lastname: Monteiro
authors.forename: António
authors.initials: A
authors.lastname: Marinho
authors.forename: José
authors.initials: J
authors.lastname: Salgado-Borges
authors.forename: Lucas
authors.initials: L
authors.lastname: Ribeiro
authors.forename: J
authors.initials: J
authors.lastname: Castro Correia
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D000777:Anesthetics / Q000008:administration & dosage*; D002387:Cataract Extraction; D003228:Conjunctiva; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006988:Hyphema / Q000209:etiology; D007431:Intraoperative Complications; D007903:Lens Capsule, Crystalline / Q000601:surgery*; D019654:Lens Implantation, Intraocular / Q000009:adverse effects / Q000379:methods*; D007910:Lenses, Intraocular; D008269:Macular Edema / Q000209:etiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011183:Postoperative Complications; D012590:Sclera / Q000601:surgery; D013536:Suture Techniques; D000267:Tissue Adhesions / Q000209:etiology
chemical_list: D000777:Anesthetics