Subjective visual experience during phacoemulsification and intraocular lens implantation using retrobulbar anesthesia

Purpose: To investigate the subjective visual experience of patients during phacoemulsification and intraocular lens (IOL) implantation using retrobul bar anesthesia, Setting: Department of Ophthalmology, Tan Took Seng Hospital, Singapore. Methods: Seventy cataract patients who had routine phacoemulsification and posterior chamber IOL implantation under retrobulbar anesthesia were interv iewed on the day of their surgery regarding their visual experience in the operated eye during surgery. Results: Thirty-nine men (55.7%) and 31 women (44.3%) were included in the study. Their mean age was 65.1 years (range 37 to 87 years). Preoperative b est corrected visual acuity ranged from 6/12 to counting fingers. Sixty eye s (85.74/0) had no ocular pathology other than cataract. Eleven patients (1 5.7%) reported no light perception during the surgery. The rest reported th ey could see light (59 patients, 84.3%), 1 or more colors (39 patients, 55. 7%), flashes (35 patients, 50.0%), movements (34 patients, 48.6%), instrume nts (12 patients, 17.1%), and the surgeon's fingers or hands (11 patients, 15.7%). The colors seen included red (23 patients, 32.9%), blue (17 patient s, 24.3%), yellow (12 patients, 17.1%), green (7 patients, 10.0%), and oran ge (1 patient, 1.4%). Eight patients (11.4%) saw a spectrum of colors simil ar to a rainbow. Thirty-one patients (44.3%) reported that the brightness o f light changed during surgery. Five patients (7.1%) found their visual exp erience frightening. Patients who reported seeing colors (P = .048, Fisher exact test) and flashes of light (P = .027, Fisher exact test) were more li kely to find the experience frightening. There was no statistically signifi cant correlation between those who found the experience frightening and pat ient sex or age, length of surgery, or history of cataract surgery in the f ellow eye. Conclusions: Many patients having phacoemulsification and IOL implantation under retrobulbar anesthesia experienced a variety of visual sensations tha t were frightening in a small proportion of cases. (C) 2000 ASCRS and ESCRS .