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Lying down looking down test: Evaluating patient suitability for small incision cataract surgery using assisted topical anesthesia

PURPOSE: The objective of this study was to evaluate an OPD-based Lying down looking down (LDLD) test for the assessment of patient suitability for assisted topical anesthesia (ATA) during manual small incision cataract surgery (MSICS), and to compare it with assisted local anesthesia (ALA). METHODS...

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Autores principales: Rajput, Vimal K, Bhalsing, Shweta, Bhalsing, Snehal, Raut, Pritish
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933868/
https://www.ncbi.nlm.nih.gov/pubmed/33463571
http://dx.doi.org/10.4103/ijo.IJO_280_20
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author Rajput, Vimal K
Bhalsing, Shweta
Bhalsing, Snehal
Raut, Pritish
author_facet Rajput, Vimal K
Bhalsing, Shweta
Bhalsing, Snehal
Raut, Pritish
author_sort Rajput, Vimal K
collection PubMed
description PURPOSE: The objective of this study was to evaluate an OPD-based Lying down looking down (LDLD) test for the assessment of patient suitability for assisted topical anesthesia (ATA) during manual small incision cataract surgery (MSICS), and to compare it with assisted local anesthesia (ALA). METHODS: The LDLD test was carried out during preoperative assessment of 250 consecutive patients. A standard LED torch was shined in patient's eye after pupil dilation, with the patient in lying down position, while simultaneously elevating the upper eyelid digitally. A positive test was indicated by the ability to maintain downward gaze and the lack of squeezing of eyes or withdrawal. Chi-square and Fisher's exact tests were used to assess the association between LDLD results and suitability for ATA. The positive predictive value and specificity of the test as an indicator of patient suitability for ATA were calculated. Complications (intra- and post-operative) and postoperative inflammation at day 1 and week 6 were compared between the ATA and ALA groups. RESULTS: A total of 250 patients were included in the study, 138 in ALA group and 112 in ATA group. There were 109 males (43.6%) and 141 females (56.4%). Around 7.4% of LDLD- positive patients were converted to ALA during the surgery. Chi-square and Fisher's exact tests demonstrated a significant association of a positive LDLD test with successful ATA (P value 0.002). The positive predictive value and specificity of the test were 92.56% (95% CI86.87-95.9%) and 93.48% (95% CI87.98-96.97%), respectively. Intraoperative complications were similar in both the groups. Congestion and visually significant corneal edema were significantly less in ATA group. CONCLUSION: The LDLD is a simple, highly specific, OPD-based test to determine patient suitability for MSICS under ATA
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spelling pubmed-79338682021-03-08 Lying down looking down test: Evaluating patient suitability for small incision cataract surgery using assisted topical anesthesia Rajput, Vimal K Bhalsing, Shweta Bhalsing, Snehal Raut, Pritish Indian J Ophthalmol Original Article PURPOSE: The objective of this study was to evaluate an OPD-based Lying down looking down (LDLD) test for the assessment of patient suitability for assisted topical anesthesia (ATA) during manual small incision cataract surgery (MSICS), and to compare it with assisted local anesthesia (ALA). METHODS: The LDLD test was carried out during preoperative assessment of 250 consecutive patients. A standard LED torch was shined in patient's eye after pupil dilation, with the patient in lying down position, while simultaneously elevating the upper eyelid digitally. A positive test was indicated by the ability to maintain downward gaze and the lack of squeezing of eyes or withdrawal. Chi-square and Fisher's exact tests were used to assess the association between LDLD results and suitability for ATA. The positive predictive value and specificity of the test as an indicator of patient suitability for ATA were calculated. Complications (intra- and post-operative) and postoperative inflammation at day 1 and week 6 were compared between the ATA and ALA groups. RESULTS: A total of 250 patients were included in the study, 138 in ALA group and 112 in ATA group. There were 109 males (43.6%) and 141 females (56.4%). Around 7.4% of LDLD- positive patients were converted to ALA during the surgery. Chi-square and Fisher's exact tests demonstrated a significant association of a positive LDLD test with successful ATA (P value 0.002). The positive predictive value and specificity of the test were 92.56% (95% CI86.87-95.9%) and 93.48% (95% CI87.98-96.97%), respectively. Intraoperative complications were similar in both the groups. Congestion and visually significant corneal edema were significantly less in ATA group. CONCLUSION: The LDLD is a simple, highly specific, OPD-based test to determine patient suitability for MSICS under ATA Wolters Kluwer - Medknow 2021-02 2021-01-18 /pmc/articles/PMC7933868/ /pubmed/33463571 http://dx.doi.org/10.4103/ijo.IJO_280_20 Text en Copyright: © 2021 Indian Journal of Ophthalmology http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Rajput, Vimal K
Bhalsing, Shweta
Bhalsing, Snehal
Raut, Pritish
Lying down looking down test: Evaluating patient suitability for small incision cataract surgery using assisted topical anesthesia
title Lying down looking down test: Evaluating patient suitability for small incision cataract surgery using assisted topical anesthesia
title_full Lying down looking down test: Evaluating patient suitability for small incision cataract surgery using assisted topical anesthesia
title_fullStr Lying down looking down test: Evaluating patient suitability for small incision cataract surgery using assisted topical anesthesia
title_full_unstemmed Lying down looking down test: Evaluating patient suitability for small incision cataract surgery using assisted topical anesthesia
title_short Lying down looking down test: Evaluating patient suitability for small incision cataract surgery using assisted topical anesthesia
title_sort lying down looking down test: evaluating patient suitability for small incision cataract surgery using assisted topical anesthesia
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933868/
https://www.ncbi.nlm.nih.gov/pubmed/33463571
http://dx.doi.org/10.4103/ijo.IJO_280_20
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