Is second eye phacoemulsification really more painful?

To demonstrate a numerical data set for intraoperative pain during phacoemulsification and compare the pain scores for first and second procedures.

From 200 consecutive cases requiring bilateral cataract removals 187 were enrolled into this prospective, observational, single-surgeon, single-centre study. To evaluate the pain a 10-point visual analogue scale was used. The pain scores for both eyes of each patient were collected perioperatively (T) as well as 2-4 weeks (mean: 2.43 weeks) later, at the follow-up visit (C). Data were pooled and the four groups were compared by ANOVA All Pairweise Multiple Comparison Procedures.

Median C-score was 1 for both eyes, T-score was 1 and 0 for the first and second eye, respectively. There wasn't any difference between the first and second eyes either in T- (1.50 ± 1.43 vs 1.51 ± 1.36) or in C-scores (0.71 vs 1.10). C-values were lower than T-values for either eye (0.71 vs 1.50 and 1.10 vs 1.51), indicating that patients recalled less pain 2-3 weeks after the surgery than that they indicated on the day of the procedure

Consecutive phacoemulsifications do not differ in the perceived pain nevertheless, patients may believe the second eye surgery more painful because they practically compare it with the lower remembered pain for the first eye procedure. In order to avoid any disappointment we suggest warning patients before their second eye operations that they are likely to experience more pain or discomfort.