Patients' preferences for positioning during phaco-emulsification under topical-intracameral anaesthesia

In many eye departments it is routine to ask patients to lie completely flat for cataract surgery. However, many patients prefer not to lie completely flat, if given the choice. It is our practice to ensure patients are in a comfortable position before commencing surgery. We conducted a prospective observational study of our routine practice comprising 125 consecutive cataract operations conducted by a single surgeon with local anaesthesia (occasional phaco under general anaesthetic was not included). All patients were initially positioned lying flat on the reclining chair and were given the option of staying in that position throughout the operation or having the chair-back raised until they were comfortable. Only 27% (34 patients of 125 total) were happy to lie flat (angle between 0 degrees and 5 degrees ). The majority of our patients (62%--78 patients) preferred to sit up slightly, with the chair-back 10 degrees to 25 degrees above the horizontal; 8% (10 patients) of the patients were sited at an angle of 30 degrees to 35 degrees and 2% (three patients) needed to be sited at 35 degrees or more. Patients who sat up above 30 degrees generally had a medical reason such as orthopnoea (3%--four patients), back pain (5%--six patients), anxiety (2%--two patients), Meniere's disease (1%--one patient). Patients who sat up below 25 degrees chose this position for comfort or preference. Our results show that patient preferences for positioning during cataract phaco-emulsification under topical-intracameral anaesthesia should increase overall patient satisfaction without the need to compromise safety.