Phacoemulsification procedures performed with topical anesthesia - Ophthalmic Surgery Update

AORN Journal, August, 1997 by Deborah Delaney Garbee

[Figures 4 - 8 ILLUSTRATION OMITTED]

The surgeon injects sodium hyaluronate 0.4 mL into the surgical eye and folds and inserts the IOL (Figure 9). He or she then uses the irrigation and aspiration hand piece to remove the viscoelastic material. He or she uses a 27-g cannula to seal the surgical wound with BSS, checks for a watertight seal, and measures the patient's intraocular pressure (IOP). An uncomplicated cataract extraction procedure with topical anesthesia lasts an average of 13.5 minutes (range seven to 33 minutes), and most patients do not require sutures or postoperative eye patches.

[Figure 9 ILLUSTRATION OMITTED]

When the surgical procedure is complete, the circulating nurse removes the operating microscope, surgical drapes, monitoring equipment, and wrist rest and assists the patient to a sitting position. He or she transports the patient on the gurney to a step-down recovery area used for patients who have undergone ophthalmic surgical procedures. The circulating nurse gives an intraoperative patient report to the recovery area nurses.

POSTOPERATIVE PATIENT CARE

The recovery area nurse assesses the patient, removes the IV line if the patient is stable and alert, and assists the patient into a reclining chair. If the patient has diabetes, the nurse provides a full meal to the patient; otherwise, the patient receives a light meal. The recovery area nurse administers prescribed oral acetazolamide or methazolamide to lower the patient's IOP and instills rimexolone 1% eyedrops to reduce inflammation and ciprofloxacin hydrochloride eyedrops to prevent infection.

Family members usually visit the patient in the recovery area, and the nurse takes this opportunity to provide discharge teaching. The nurse reinforces oral discharge instructions with written handouts. There are few postoperative restrictions; however, the recovery area nurse reminds the patient not to rub the surgical eye, lift objects that weigh more than 15 pounds, or engage in strenuous activity. Although the patient does not need to use an eye patch while awake, he or she must wear an eye shield during sleep.

The recovery area nurse teaches the patient and family members proper technique for instilling the eyedrops that the patient will require for the first three weeks after surgery (Table 3). The nurse also describes potential side effects of these medications (eg, postural hypotension, drowsiness related to acetazolamide or methazolamide; local burning, discomfort from ciprofloxacin hydrochloride ophthalmic solution; blurred vision from rimexolone 1% solution). The recovery area nurse gives the patient a pair of ultraviolet screening sunglasses to wear when he or she is outdoors for comfort and protection from the sun.

Table 3
POSTOPERATIVE MEDICATIONS FOR CATARACT EXTRACTION WITH
TOPICAL ANESTHESIA

Medication                      Dosage and route of administration

Acetazolamide                   500 mg orally
   or

Methazolamide                   100 mg orally

Ciprofloxacin hydrochloride     Instill 1 drop before discharge and
0.3% ophthalmic solution        then 4 times per day x 7 cloys

Rimexolone 1% ophthalmic        Instill 1 drop before discharge and
solution                        then 4 times per day x 3 weeks

Medication                      Procedure

Acetazolamide                   Decrease intraocular pressure (IOP)
                                by reducing aqueous humor production
  or

Methazolamide                   Decrease IOP by reducing aqueous
                                humor production

Ciprofloxacin hydrochloride     Prevent postoperative infection
0.3% ophthalmic solution

Rimexolone 1% ophthalmic        Prevent or reduce inflammation
solution