Dorado Beach, Puerto Rico—Special
situations sometimes arise in cataract surgery that call for the use of
William W. Culbertson, MD,
described three such techniques: cryoanalgesia, pupil dilation with an
injectable device for the presence or expectation of small pupils, and
sealed capsule irrigation.
Dr. Culbertson also presented some examples of when these techniques might
be utilized in a presentation at the Current Concepts in Ophthalmology
meeting here. The conference was sponsored by The Johns Hopkins University
School of Medicine, Wilmer Eye Institute, Baltimore, and supported by
Cryoanalgesia can be used in cataract surgery for patients with
sensitivity to local anesthetic, situations in which postoperative
inflammation must be prevented, and in patients with endothelial problems,
according to Dr. Culbertson. He is professor of ophthalmology at the
Bascom Palmer Eye Institute, University of Miami.
The cryoanalgesia technique, which was originally proposed by Francisco
Gutierrez-Carmona, MD, of Madrid, calls for precooling of all
irrigation and infusion solutions and viscoelastic agents to 4° C.
Figure 1. In
preparation for cryoanalgesia, an ice bath in a plastic bag is applied
to the lids and globe for 15 minutes, after which topical povidone
iodine is applied.
An ice bath in a plastic bag is applied to the lids and globe for 15
minutes, after which topical povidone iodine is applied. The globe is
irrigated with chilled balanced salt solution (BSS) while the incisions
are being made. The chilled viscoelastic is injected, and phaco is
performed with the chilled BSS. Finally, the IOL is inserted while the
incision is irrigated with chilled BSS. Dr. Culbertson recounted using
this procedure to remove a cataract from a 62-year-old woman who was
allergic to topical and local anesthetic and was not a good candidate for
Figure 2. The
incision site is irrigated with chilled balanced salt solution during
incisions and maneuvers.
The patient felt nothing during the procedure," Dr. Culbertson said. "She
behaved as if we had injected a retrobulbar anesthetic. The phaco
"When we put the acrylic IOL in place it was slow to expand, and we waited
a minute or two before it expanded sufficiently to dial it into the
capsular bag," he said. "The only other problem is that the surgeon's and
assistant's hands get cold. Otherwise, the procedure went normally but
required more in the way of preparation. Importantly, the eye looked very
good the day after the surgery."