Predictors of Patient Cooperation during Phacoemulsification Surgery under Topical Anesthesia

Background: 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. Patient characteristics including sex, age, place of residence (urban or rural), education level (literate and illiterate) and physical examination variables including visual acuity in logarithm of minimum angle of resolution (LogMAR), reaction to eye drop, and cooperation during tonometry before surgery were evaluated. Patient cooperation during surgery was classified into successful (good and satisfactory) or failed (weak) cooperation. The two groups were compared in terms of baseline and clinical examination variables. Results: In this study, 103(64.4%) cases showed a good or satisfactory cooperation, and others had a weak cooperation. There was no association between patient cooperation during surgery and sex (P-value = 0.2), age (P-value = 0.7), place of residence (P-value = 0.3) and education level (P-value = 0.3). The successful group showed a higher rate of non-reaction to eye drop (P-value = 0.0001), good cooperation during tonometry (P-value = 0.0001), non-reaction to press on lacrimal sac (P-value = 0.0001), and lower visual acuity (P-value = 0.045). In the multivariate logistic regression model, non-reaction to eye drop (OR = 66.4), good and satisfactory cooperation during tonometry (OR = 21.2, OR = 7.2, respectively) compared to weak cooperation, lower LogMAR of visual acuity (OR = 7) were significantly associated with the success of TA. Conclusion: This study showed that some ocular examination tests before surgery including visual acuity, reaction to eye drop, cooperation during tonometry and reaction to press on the lacrimal sac can predict patient cooperation during phacoemulsification surgery under TA.