Hypnosis is able to induce a state of total psychological calm in very many subjects, including maintenance or even enhancement of their ability to cooperate. A smaller number of more receptive subjects may even achieve ocular anaesthesia, though this is not suitable for the performance of operations because the Dagnini-Aschner reflex persists and hypotonia is not attained.
Hypnosis is an effective tool in many areas of medicine and surgery. The exacting demands of ophthalmic surgery require good patient cooperation and strict adherence to treatment regimens. Multisystemic diseases compounded by the physiological stress of surgery make it essential that already strained homeostatic mechanisms are interfered with minimally. The cases presented in this report illustrate the beneficial use of hypnosis in the treatment of several high risk patients in unusual situations.
A 73-year-old morbidly obese female patient (weight 125 kg, height 156 cm) was scheduled for cataract surgery of her right eye. Due to a number of severe co-morbidities general anaesthesia was contraindicated. However the patient was very anxious and requested sedation if the procedure was to be undertaken under local anaesthesia. She responded very positively to the proposal of utilising perioperative hypnosis. Hypnotic induction was achieved with the heavy eyelid technique, putting the patient into trance within 30 seconds.
Fifty-three cataract extractions in eyes with pathological myopia effected visual improvement in 47 eyes (89%). The median visual acuity increased from a preoperative level of 20/300 to 20/40 postoperatively. The incidence in this series of vitreous loss (1.9%) and retinal detachment (1.9%), are within the expected range of such complications. Four cases developed aphakic glaucoma which has necessitated continued therapy. All four had both enzyme zonulolysis and topical steroids, postoperatively.
Four eyes underwent cicatricial closure of the filtering bleb within the 6 weeks postoperatively. They failed to respond to digital massage and conventional therapy, resulting in loss of bleb and elevated intraocular pressure. The average pre-YAG laser treatment intraocular pressure was 34.5 mmHg. Three hundred to five hundred applications from the mode-locked Neodymium:YAG laser ( Meditec ) delivered at 3.5 mJ were directed through a goniocontact prism to the surgical area. Prompt vaporization of scar tissue and sclera resulted in a dramatic reversal of the pathology.
Transactions of the American Ophthalmological Society
We used the Honan intraocular pressure reducer, a balloon that applies a constant force, to the eyes in ten subjects with senile cataracts. An initially significant decrease in intraocular pressure after removal disappeared exponentially with a half-time of 9.6 minutes, indicating that the benefits derived from the Honan balloon do not result from a sustained reduction in intraocular pressure. Measurements made on a phantom eye showed both marked variability and unexpectedly high intraocular pressure during typical preoperative digital massage by a group of ophthalmic surgeons.
Couching for cataract is one of the most ancient surgical procedures. Maharshi Sushruta, an ancient Indian surgeon, first described the procedure around 600 BCE in Sushruta Samhita. The procedure, also known as jin pi shu in Mandarin, was introduced to China via the Silk Road during the late West Han Dynasty (206 BCE-9 CE), and it spread throughout China during the Tang Dynasty (618-907 CE). As the procedure was combined with the Chinese concept of acupuncture, jin pi shu was integrated into Chinese medical practice until the founding of the Republic of China in 1911.