• Users Online: 12733
  • Home
  • Print this page
  • Email this page

   Table of Contents      
LETTER TO EDITOR
Year : 2006  |  Volume : 54  |  Issue : 3  |  Page : 211

Author's reply


Department of Pediatric Ophthalmology, H. V. Desai Eye Hospital, Hadapsar, Pune - 411 028, India

Correspondence Address:
Parikshit Gogate
Department of Pediatric Ophthalmology, H. V. Desai Eye Hospital, Hadapsar, Pune - 411 028
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions

How to cite this article:
Gogate P. Author's reply. Indian J Ophthalmol 2006;54:211

How to cite this URL:
Gogate P. Author's reply. Indian J Ophthalmol [serial online] 2006 [cited 2024 Mar 28];54:211. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2006/54/3/211/27084

Dear Editor,

I thank Barikh for the interest shown in our article.[1] She has made many interesting observations and pointed to few of our weaknesses. I shall answer the queries one by one in serial order.

Manual small incision cataract surgery involves more intra-ocular handling than either conventional extracapsular cataract extraction or phacoemulcification. The surgeon has to deal with the iris tissue more closely, in delivering the nucleus into the anterior chamber and in getting it out of the eye. There are claims that it is harder on the endothelium. Both these tissues are pain- sensitive.

1. The patients were taken for surgery after five to ten minutes of giving the injection, as that is the time required for the anesthetic agents to act. In Sub-tenon's, the anesthesia is given on the operating table and the action is almost instantaneous. The method of administration was not different than that used in a real life situation.

2. The sample size needed was 126 and once that was achieved, further randomization was not done. Also, preliminary results showed marked differences in both the techniques. The randomization was done at International Center for the Advancement of Rural Eye Care, L. V. Prasad Eye Institute, Hyderabad, using an epitable.

3. The patients were asked to grade a pain level from 0 to 4, 0 being no pain (0%) and 4 being maximal imaginable pain (100%). Grade 1 (mild, 25%) would be a mild discomfort, grade 2 (moderate, 50%) would be pain just bearable and grade 3 (severe, 75%) would be severe pain. Admittedly, the scale was subjective and there would be a difference in perception of different patients. There was however no difference as regards to age and sex in the two arms of the trial.

4. In hindsight, I feel, we should have kept another independent observer to grade the outcome markers of surgery to eliminate bias.

5. Another observer noted down the movements. I am sorry we did not mention this in the methods.

6. Repetition of the block may have increased the positive pressure thrust in peribulbar anesthesia and there was a fear of nerve toxicity in Sub-tenon's. The anesthesia was to be repeated, only if the patient was feeling the pain on taking the rectus suture or the incision.

7. One of the four surgeons did not like the Sub-tenon's anesthesia, as the akinesia was inadequate. Fastidious surgeons may not be comfortable with a moving eye. So Sub-tenon's anesthesia cannot be recommended to everybody. Because we had four surgeons, this difference could be brought out, making the study more valid. Ultimately, many anesthesia and surgery techniques are about the conflicting demands of surgeon and patient comfort.

Sub-tenon's anesthesia is very comfortable for the patient, but asks for certain fortitude from the surgeon.

 
  References Top

1.
Parkar T, Gogate P, Deshpande M, Adenwala A, Maske A, Verappa K. Comparison of subtenon anaesthesia with peribulbar anaesthesia for manual small incision cataract surgery. Indian J Ophthalmol 2005;53:255-9.  Back to cited text no. 1
    




 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References

 Article Access Statistics
    Viewed2014    
    Printed96    
    Emailed1    
    PDF Downloaded156    
    Comments [Add]    

Recommend this journal