Manage cataract surgery pain to reduce postop discomfort, patient responsibility
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WAIKOLOA, Hawaii — Reducing intraoperative inflammation and anxiety through medications and calming techniques may help reduce intraoperative and postoperative pain, according to a speaker at Hawaiian Eye 2022.
“What I see trending toward the future is maybe that we are getting rid of IV sedation,” Deborah Gess Ristvedt, DO, said. “Maybe we are using something in surgery to address pain and inflammation so that we’re not putting all this responsibility on the patients’ hands.”
Before surgery, nonpharmacological options such as listening to music or hand-holding have been shown to reduce anxiety.
“By just holding a patient’s hand, they calm. You find that they have lower levels of epinephrine release and a decreased need for sedation,” Ristvedt said.
Ristvedt discussed several pharmacological options for pain and inflammation.
“Phenylephrine 1% and ketorolac 0.3% infused in balanced salt solution [Omidria, Omeros/now Rayner] has been around for quite some time, but I am finding that I am using this more and more as time goes on to maintain dilation, reduce inflammation and decrease postoperative pain,” she said.
Administration of intracanalicular dexamethasone 0.4 mg, or Dextenza (Ocular Therapeutix), is intended to treat postoperative pain and inflammation through round-the-clock delivery. The elimination of drops reduces potential for patient error and noncompliance, Ristvedt said.
“Another option that we have for treating inflammation in surgery is dexamethasone intraocular injection, or Dexycu [EyePoint Pharmaceuticals],” Ristvedt said. “This is a wonderful way to address inflammation where the effects start at day 1 and last through day 30.”
“We really have to tailor experience and patient satisfaction by looking at being proactive with pain and inflammation,” she said.
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Ristvedt DG. Controlling pain and inflammation in cataract surgery. Presented at: Hawaiian Eye 2022; Jan. 15-21, 2022; Waikoloa, Hawaii.
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