Can we predict patients’ cooperation during phacoemulsification surgery under topical anesthesia

Purpose: Topical anesthesia (TA) may accompany with more discomfort for some patients during cataract surgery. We aimed to evaluate the potential factors that can be used for predicting patient’s cooperation during phacoemulsification surgery under TA. Methods: One hundred sixty consecutive cases that were candidate for phacoemulsification surgery enrolled in this prospective study. Patients’ sex, age, place of residency (urban or rural), education level (literate and illiterate) and physical examination variables (visual acuity, reaction to eye drop, cooperation during tonometry and reaction to press on the lacrimal sac before surgery) evaluated. Patients’ cooperation during surgery was classified as successful (good and satisfactory) or failed (weak) groups. Results: In this study, 103(64.4%) cases showed a good or satisfactory cooperation, and others had a weak cooperation. There was no correlation between patients’ cooperation during surgery and sex (p=0.2), age (p=0.7), place of residency (p=0.3) and education level (p=0.3). The successful group showed a higher rate of non-reaction to eye drop (p=0.0001), good cooperation during tonometry (p=0.0001), non-reaction to press on lacrimal sac(p=0.0001), and lower visual acuity (p=0.045). In the multi-logistic regression, non-reaction to eye drop (OR=66.4), good cooperation during tonometry (OR=21.2, good vs. bad and OR=7.2, satisfactory vs. bad), lower visual acuity (OR=7, <0.1 vs. 0.1-0.4 d) is the significant predictors for the success of TA. Conclusion: This study showed that some ocular examination tests before surgery (visual acuity, reaction to eye drop, cooperation during tonometry and reaction to press on the lacrimal sac) can predict patients’ cooperationduring phacoemulsification surgery under TA.