MAR 2014

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/276058

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Page 68 of 210

FINAL_EyeWorld_March.indd 1 E W CATARACT 66 March 2014 by Vanessa Caceres EyeWorld Contributing Writer Help patients relax for better cataract surgery cooperation Education, positive imagery techniques quelled anxiety in recent study T o cataract surgeons, per- forming surgery can seem like a routine task. How- ever, to patients, it's surgery they have only once or twice in their life—and that could bring on nervousness and anxiety. Surgical anxiety can affect a patient's pain sensitivity, blood pressure, heart rate, compliance, and even IOP. A study published recently in the journal Patient Education and Counseling identified a way to help cataract surgery patients reduce their perioperative anxiety. 1 Investigators, led by Zoltán Kekecs, Eotvos Loránd University, Faculty of Education and Psychol- ogy, Department of Affective Psychology, Budapest, found that listening to an audio CD that in- cluded patient education as well as positive therapeutic suggestions to help manage anxiety made patients feel calmer and be more cooperative during their cataract operation. Study details In this randomized, controlled, sin- gle-blind study, 84 patients slated for cataract surgery were divided into two groups—one group (34 patients) received a 15-minute audio CD and were instructed to listen to the CD four times at home, including once during the night before the opera- tion. They were told that listening to it four times would help get them f amiliar with the relaxation and im- agery techniques. The script on the CD was designed with the help of a hypnotherapist experienced with the use of positive suggestions in the medical field and was read by the cataract surgeon whom the patients were already familiar with. The CD script explained the p hases of the operation and the re- covery period but also used positive suggestions and imagery techniques, such as focusing attention on breathing and imagining a safe place during the operation. Some of the script from the text included: "When you arrive in the forefront of the operating room you'll get a number of eye drops. … It'll be good to know that with every drop your pupil will be more dilated and dilated and your eye will get more and more anesthetized as long as it's needed. … First your eye will be cleaned with a disinfectant solution. … Some imagine this like a pleasant cool breeze that washes away not only bacteria but the remaining tension as well." The 50 patients in the control group did not listen to the audio CD. As part of standard procedure, all patients received the anti-anxiety medication alprazolam 0.25 mg in the perioperative room after an initial medical exam. Upon return to the clinic the following day, investigators asked the intervention group patients how many times they had listened to the C D at home. In addition to the usual clinical measures, investigators measured anxiety with the State-Trait Anxiety Inventory. With use of the Pain Affect Faces Scale, patients measured their happiness or discomfort during various times before and after sur- gery. Patients also provided informa- t ion on their sleep quality during the night before surgery. A study assistant assessed calmness based on the patients' behavior before and after surgery and during the first postoperative follow-up, while the surgeon (who was blind to the group allocation) assessed cooperativeness during the operation. Investigators also assessed blood pressure and heart rate before, during, and after surgery. Delving into the results The study found that the interven- tion group patients were more coop- erative and appeared to be calmer than patients in the control group, particularly during the postoperative visit. Investigators found no differ- ence in heart rate, sleep quality, or subjective well-being. There was one finding surpris- ing to Mr. Kekecs. "Although our in- tervention decreased intraoperative and postoperative anxiety, it did not decrease preoperative anxiety. In retrospect, this might be because our intervention was focused on continued on page 68 similar IOL designs) located in the ciliary sulcus. Furthermore, as de- scribed in other cases, the highly flexible haptics of the lens make it prone to decentration when placed in the sulcus. Also, because the optic edges can lead to irritation, the cap- sulorhexis should ideally be small enough to cover any exposed square edges, eliminating the possibility of IOL edge-related pigment dispersion. Single-piece hydrophobic acrylic lenses (and other similar IOL de- signs) should not be placed in the ciliary sulcus, but should be im- planted only in the capsular bag as recommended by the manufacturer. Differential diagnosis 1. Cell deposits may be observed on the IOL surface after cataract sur- gery as part of a foreign body re- action, and usually are composed of giant cells, macrophages, and fibroblast-like cells. They usually degenerate and detach from the IOL surface in the postoperative period. If necessary, they can be "dusted off" the IOL surface by using a Nd:YAG laser. 2. Cellular deposits on the IOL sur- face may be related to previous episodes of uveitis; however, the patient in the case described here had no previous history of uveitis. 3. Iris transillumination defects may be found in pseudoexfoliation cases, but these defects are usually located near the pupillary border and not clearly related to the IOL haptics. EW References 1. LeBoyer RM, Werner L, Snyder ME, Mamalis N, Riemann CD, Augsberger JJ. Acute haptic- induced ciliary sulcus irritation associated with single-piece AcrySof intraocular lenses. J Cataract Refract Surg 2005; 31:1421–1427. 2. Micheli T, Cheung LM, Sarma S, et al. Acute haptic-induced pigmentary glaucoma with an AcrySof intraocular lens. J Cataract Refract Surg 2002; 28:1869–1872. 3. Chang DF, Masket S, Miller KM, et al, ASCRS Cataract Clinical Committee. Complications of sulcus placement of single-piece acrylic in- traocular lenses: recommendations for backup A case continued from page 65 IOL implantation following posterior capsule rupture. J Cataract Refract Surg 2009;35: 1445-58. 4. Kirk KR, Werner L, Jaber R, et al. Pathologi- cal assessment of complications with asym- metric or sulcus fixation of square-edged hydrophobic acrylic intraocular lenses. Ophthalmology 2012;119:907-13. Editors' note: Drs. Cole, Werner, and Mamalis are affiliated with the John A. Moran Eye Center, University of Utah, Salt Lake City. They have no financial interests related to this article. Contact information Cole: scott.cole@hsc.utah.edu Mamalis: nick.mamalis@hsc.utah.edu Werner: liliana.werner@hsc.utah.edu 64-75 Cataract_EW March 2014-DL2_Layout 1 3/6/14 3:10 PM Page 66

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