Does your hospital has any guideline for preoperative PHARMACOLOGY management of cataract or glaucoma surgery?
I am trying to collect as many opinions from all over the world
simple topical anesthetic 5-6 times in 5 minute intervals prior to cataract surgery will do the work. When it comes to glaucoma surgery, it all depends on the approach. Sometimes, topical anesthetic is quite enough (Ex-Press shunt surgery), and sometimes parabulbar anesthesia has to bee applied (trabeculectomy).
peribulbar and parabubar anaesthetics , xylocain and bupivacaine combination for fast and sustained actions with topical top ups PRN.
as asepsis preparation, we use povidon iodine 5% drop. For anesthesia, it could be topical, peribulbar, retrobulbar and even general anesthesia for uncooperative or young patients.
Local: Topical Paracaine/lignocaine or peribulbar block . Povidone Iodine paint .
Topical broad spectrum antibiotics starting a day before surgery , dilating agent(Tropicamide phenylephrine) on day of surgery with or without flurbiprofen. Antiglaucoma drugs for glaucoma cases ( Stop prostaglandins and pilocarpine atleast 7 days before surgery)
Oral: Minimal dosage of wide spectrum antibiotics in susceptible cases, analgesics as per need, oral acetazolamide as per surgeon and the case
Regards - Dr Lipi Chakrabarty, Director LIPIKA NETRADHAM, Bhilai-Durg, Chhattisgarh, India
For CATARACT surgery: We use tropicamide-phenylephrine eyedrops for dilating, intra-operative 10% povidone paint around the face and 5% eyedrops. For anesthesia it is lignocaine injection or proparacaine eyedrops for surgery under topical anesthesia. In the BSS we also add adrenaline. For GLAUCOMA surgery, intravenous mannitol is sometimes given preop (if IOP is above 30 mmHg). Trabeculectomy is usually done under retrobulbar lignocaine anesthesia.
Cataract surgery: Nepafenac 1 drop every 8 hours, 7 days before surgery. Moxifloxacin: 1 drop every 8 hours, initiate 2 days before surgery. The night before surgery: diazepam 5 mgrs. Tropicamide phenylephrine for pupil dilating. In the OR: Povidone 10%: face. Povidone 5% eye drops. Clean very well the border of the eyelid (before adhering sterile drape). Lidocaine preservative free: intra anterior chamber. Topical anesthesia. Fentanyl: 50 micrograms EV. Midazolam: 1 mgrs. EV
Glaucoma Surgery: Stop prostaglandins and pilocarpine one week before surgery. Stop aspirin. Moxifloxacin: 1 drop every 8 hours, initiate 2 days before surgery. The night before surgery: diazepam 5 mgrs. Tropicamide phenylephrine for pupil dilating. In the OR: Povidone 10%: face. Povidone 5% eye drops. Clean very well the border of the eyelid (before adhering sterile drape). Peribulbar block.