Major reviewIntraoperative and postoperative pain in cataract surgery
Introduction
Cataract is the world's leading cause of blindness according to the most recent data collected by the World Health Organization, and cataract surgery is arguably the most common surgical procedure performed globally.81 Worldwide estimates as of 1999 were 10 million cataract cases per year, which underestimate current rates.31, 35 With advances in technology, there are greater expectations for better visual outcomes and minimal intraoperative and postoperative pain.
There are several proposed mechanisms of physiologic pain in cataract surgery, along with many pain control methods. Severe pain can be a sign of a complication, and ruling out uncommon, but serious, adverse causes should be a priority in initial management. We review the current literature regarding the mechanisms, risk factors, and management of intraoperative and postoperative pain in cataract surgery.
Section snippets
Risk factors for experiencing cataract surgery pain
Recent studies have identified at least 3 key variables that may predispose patients to experience more pain. These are eye dominance, prior cataract surgery, and high myopia.
Insight on the possible contribution of eye dominance to pain has been recorded by work from Aslankurt et al.5 In this study, the authors evaluated a cohort of 76 initial cataract patients and identified a significant increase in mean pain scores on the dominant eye of patients undergoing cataract extraction when compared
Neuroanatomy of ocular sensory innervation
Nociceptive sensations of ocular structures are conducted through bundles of primary myelinated (A-delta fibers) and unmyelinated (C fibers) afferent neurons that run within the ophthalmic (V1) branch of the trigeminal nerve to the trigeminal brainstem nuclear complex.10, 77, 85 The cell bodies of these primary pseudounipolar afferent bundles reside within the trigeminal ganglion.11, 85 From synaptic sites in the brainstem, second order afferent neurons then decussate to join contralateral
Categorization of cataract surgery pain
There are two broad categories of pain: nociceptive (physiologic) and neuropathic (pathologic). We will primarily focus on the nociceptive causes of pain, as they are better characterized in the literature for treatments in the operative and postoperative periods of cataract surgery.
Addressing pain in cataract surgery
This section will summarize anesthetic and analgesic options available for cataract surgery, as well as discuss their utility as presented in the literature. In organizing the discussion, we have stratified options into preoperative, intraoperative, and postoperative periods.
Conclusion
There are many mechanisms for physiologic pain in cataract surgery, along with a number of anesthetic and analgesic modalities available to help minimize it. Future studies may further investigate the discomfort of each procedure step of cataract surgery and evaluate the most suitable methods of minimizing pain.
Method of literature search
In this narrative review, the authors used a PubMed and ScienceDirect search for English or English-translated articles on humans, from January 1, 1981 through November 1, 2016. Keywords used in various orders included “localization of pain receptors in the eye,” “intraoperative pain cataract surgery,” “postoperative pain cataract surgery,” “pain in phacoemulsification,” “analgesics in cataract surgery,” “dry eye after cataract surgery,” “TASS and pain in cataract surgery,” “intracameral
Disclosures
The authors declare no proprietary or commercial interests in any product mentioned or any concept discussed in this article.
Acknowledgments
We would like to recognize Dr. Derek Sakata, MD for his invaluable insights and expertise contributed during the development of this article.
This work was supported in part by an Unrestricted Grant from Research to Prevent Blindness, Inc., New York, NY, to the Department of Ophthalmology & Visual Sciences, University of Utah. This source of financial support had no role in the study design; the collection, analysis, or interpretation of data; in the writing of the report; or the decision to
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