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Is second eye phacoemulsification really more painful?

Ist die zweite Phakoemulsifikation wirklich schmerzhafter?

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Summary

Aim

To demonstrate a numerical data set for intraoperative pain during phacoemulsification and compare the pain scores for first and second procedures.

Methods

From 200 consecutive cases requiring bilateral cataract removals 187 were enrolled into this prospective, observational, single-surgeon, single-centre study. To evaluate the pain a 10-point visual analogue scale was used. The pain scores for both eyes of each patient were collected perioperatively (T) as well as 2–4 weeks (mean: 2.43 weeks) later, at the follow-up visit (C). Data were pooled and the four groups were compared by ANOVA All Pairweise Multiple Comparison Procedures.

Results

Median C-score was 1 for both eyes, T-score was 1 and 0 for the first and second eye, respectively. There wasn’t any difference between the first and second eyes either in T- (1.50 ± 1.43 vs 1.51 ± 1.36) or in C-scores (0.71 vs 1.10). C-values were lower than T-values for either eye (0.71 vs 1.50 and 1.10 vs 1.51), indicating that patients recalled less pain 2–3 weeks after the surgery than that they indicated on the day of the procedure

Conclusions

Consecutive phacoemulsifications do not differ in the perceived pain nevertheless, patients may believe the second eye surgery more painful because they practically compare it with the lower remembered pain for the first eye procedure. In order to avoid any disappointment we suggest warning patients before their second eye operations that they are likely to experience more pain or discomfort.

Zusammenfassung

Ziel

Es wird ein intraoperatives numerisches Schmerzbewertungssystem während der Phakoemulsifikation vorgestellt, welches dann die Schmerzbewertung der ersten und zweiten Prozedur vergleicht.

Methodik

In die prospektive Beobachtungsstudie wurden 200 Patienten einbezogen, die von einem Chirurgen an einem Standort aufeinanderfolgende Katarktoperationen (bilateral) erhielten. Für die Schmerzbewertungsmessung wurde eine 10 Punkte messender visueller analoger Maßstab genutzt.

Die Schmerzbewertung für beide Augen eines jeden Patienten wurden perioperativ (T) und 2–4 Wochen (Median: 2,43 Wochen) postoperativ (C) im Rahmen der Nachkontrolle erhoben. Die nach Zusammenfassung der Daten entstandenen vier Gruppen wurden mittels ANOVA All Pairweise Muliple Comparison Procedures verglichen.

Ergebnisse

Der Median C-Wert betrug 1 für beide Augen, T-Wert 1 für das erste und 0 für das zweite Auge. Es gab keine Unterschiede in den T- (1,50 ± 1,43 vs 1,51 ± 1,36) oder C-Werten zwischen erstem und zweitem Auge.

Für beide Augen waren die C-Werte geringer als die T-Werte (0,71 vs 1,50 and 1,10 vs 1,51). Die Patienten bewerten demnach den Schmerz der Operation 2–3 Wochen postoperativ geringer.

Schlussfolgerungen

Der wahrgenommene Schmerz einer jeden Kataraktoperation im Rahmen der bilateralen Phakoemulsifikation unterscheidet sich nicht, obwohl die Patienten glauben könnten, dass die zweite Prozedur schmerzhafter ist. Eine Erklärung dafür könnte das verminderte Schmerzerinnerungsvermögen bezüglich der ersten Operation sein.

Um einer solchen Fehleinschätzung vorzubeugen, sollten wir die Patienten über die annähernd gleichen Schmerzschwellen aufklären.

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The authors declare that there is no actual or potential conflict of interest in relation to this article.

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Correspondence to Andras Hari-Kovacs MD.

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Hari-Kovacs, A., Lovas, P., Facsko, A. et al. Is second eye phacoemulsification really more painful?. Wien Klin Wochenschr 124, 516–519 (2012). https://doi.org/10.1007/s00508-012-0205-2

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  • DOI: https://doi.org/10.1007/s00508-012-0205-2

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