Year : 1974 | Volume
: 22 | Issue : 4 | Page : 19--21
Effect of lignocain hydrochloride and ocular massage on intraocular tension and its consequent effect on cataract surgery
MR Jain, RL Argarwal, HR Sharma
Department of Ophthalmology, Ravindra Nath Tagore Medical College, Udaipur, India
M R Jain
Department of Ophthalmology, Ravindra Nath Tagore Medical College, Udaipur
|How to cite this article:|
Jain M R, Argarwal R L, Sharma H R. Effect of lignocain hydrochloride and ocular massage on intraocular tension and its consequent effect on cataract surgery.Indian J Ophthalmol 1974;22:19-21
|How to cite this URL:|
Jain M R, Argarwal R L, Sharma H R. Effect of lignocain hydrochloride and ocular massage on intraocular tension and its consequent effect on cataract surgery. Indian J Ophthalmol [serial online] 1974 [cited 2020 Apr 10 ];22:19-21
Available from: http://www.ijo.in/text.asp?1974/22/4/19/31348
Vitreous prolapse has always been a most dreaded complication of cataract surgery. Various therapeutic, anaesthetic and surgical methods have been devised to reduce its incidence. It is established beyond doubt that the basic factors which decrease the incidence of loss of vitreous are proper akinesia and adequate reduction of intraocular pressure and vitreous volume. Ocular hypotensive drugs like acetazolamide and others have proved quite effective but at times they are not well tolerated and some times they fail to produce adequate effect. Oral glycerol is an effective hypotensive agent, but quite often leads to nausea and vomiting and hence is rather contraindicated. Intravenous use of mannitol invariably leads to excellent hypotension, but it is costly and its administration is quite cumbersome.
With hopes to improve the results of cataract surgery, a study on intraocular tension after facial akinesia, retrobulbar block with added ocular massage and its consequent effect on the result of cataract surgery was undertaken at the ophthalmic department of Ravindra Nath Tagore Medical College, Udaipur.
Materials and Methods
Thirty cases of senile cataract who were fit for cataract surgery were selected for the present study. Intraocular tension was recorded by Schiotz tonometer at the time of admission and then in the operation theatre after facial block and five and ten minutes after retrobulbar block with 1 ml. of 4 per cent lignocain hydrochloride and lastly after three minutes of ocular massage at the ciliary region through the upper lid. Operative procedure and its complications were recorded, and the cases were followed for three months for any post operative complications. The patients were not administered acetazolamide or any other drug having effect on intraocular pressure.
It was observed that there was an average fall of 1.3mm. Hg. of intraocular tension after a facial block. Nine cases showed no fall and maximum fall recorded in 4 cases was 4mms. Hg.
Five and ten minutes after retrobulbar block with 1 ml. of 4 per cent lignocain, the average fall was 4.6 mms. Hg. and 5.3 mms. Hg. respectively. Maximum fall recorded after 10 minutes was 11 mms. Hg. in 2 cases while 2 cases did not show any fall.
Ocular massage was given for 3 minutes. It further lowered intraocular tension, total average fall being 8 mms. Hg.; 4 cases showed fall of 15mms. Hg. and the maximum fall in two cases was of 3 mms. Hg.
Operative and post-operative complications and results are given in [Table 1].
Successful facial block produces perfect akinesia of the lids. In addition, it also frequently reduces intraocular pressure to some extent as seen in our series. Such a small reduction of intraocular pressure is of no consequence to the results of cataract surgery, but improper akinesia can lead to a considerable increase in intraocular pressure owing to the squeeze of the lids.
It is, of course, accepted that correctly induced retrobulbar anaesthesia reduces the risk of vitreous extrusion. Maximum fall of intraocular pressure observed by Mathur  after 1.5 ml. of retrobulbar injection of 2 per cent lignocain hydrochloride with adrenaline was 7 mms. Hg., the average fall being 3.9 mms. Hg. In the same study, they reported the average fall of 7 mms. Hg. and maximum of 12 mms. Hg. after retrobulbar injection of 1.5 ml. of 4 per cent lignocain hydrochloride with adrenaline.
Our series too showed an average fall of 5.3 mms. Hg. after 1 ml. of 4 per cent retrobulbar lignocain injection, the maximum fall being 11 mms. of Hg. A further average lowering of 2.7 mms. of Hg. of intraocular pressure was obtained by applying rotary ocular massage for three minutes. This reduction is explained on the basis that deep rotary ocular massage produces comparatively better akinesia of recti muscles which, in turn, decreases the pressure of the muscles on the globe, resulting in increased aqueous outflow and subsequent decrease in intraocular pressure. , The use of adrenaline alongwith lignocain hydrochloride is observed to be more effective, and produces a prolonged action, but there is always a fear of precipitating hypertension in some sensitive patients.
[Table 1] clearly indicates that the operative results were extremely good with above technique of akinesia, anaesthesia and ocular massage. Out of 30 cases, 28 were intracapsular extractions and in only one case capsule ruptured. Not a single case had a vitreous loss. However, in two cases, vitreous showed a tendency to project in the anterior chamber which was successfully pushed back with the introduction of air in the anterior chamber. No distortion or updrawing of pupil was observed in any case.
Post-operatively, no significant complications were noticed. Interestingly enough, four cases developed flat anterior chamber owing to air being sucked in the posterior chamber. Use of 1 to 2 per cent atropine resulted in good mydriasis and within 3 to 5 days the anterior chamber was well formed with airpersisting in the anterior chamber for 5 to 8 days. Sucking in of air in the posterior chamber is a proof of extreme shrinkage of vitreous due to 4 per cent lignocain block. There was no incidence of iris incarceration or iris prolapse and the healing was uneventful in all cases. Striate keratitis persisted in 4 cases for 7 to 8 days, but finally cleared up completely.
The clinical study was undertaken in 30 cases of cataract to assess the degree of fall of intraocular pressure after facial block, 4 per cent retrobulbar lignocain and with added ocular massage. It was found that 4 per cent lignocain led to a better reduction in ocular tension and shrinkage in vitreous volume. Ocular massage further reduced the intraocular pressure and gave perfect akinesia to recti muscles. The hypotension and akinesia gave excellent surgical results, i.e. only two cases out of 30 cases, had vitreous presentation and none had vitreous loss. No other complication worth mentioning occurred in any case.
|1||Atkinson, W.S., 1961, Amer. J. Ophthal 51, 1.|
|2|| Gartner, S.L. 1959, A.M.A. Arch. Ophthal 61, 50. |
|3|| Gundzik, J.D., and Mayer, J.H., 1963, Amer. J. Ophthal. 56, 933.|
|4||Mathur, S.P., Agarwal, R.L., and Sudama 1971, Ind J Ophthal., 19, 24.|