Non-Toxic Anesthesia for Cataract Surgery

Round 1

Reviewer 1 Report

The paper presents the study on patients' data of the minimal localized anesthesia compared with the conventional topical anesthesia for cataract surgeries. The real data is highly improving the paper's significance. However, the writing should be significantly improved because the sentences are too long and the paragraphs also (e.g., page 4-5, the paragraph is more than half of page). Some of the reviewer's advice is highlighted in green in the attachment. The originality and scientific soundness of this work are hard to be evaluated because the paper lacks the state of the art and the bigger picture where this anesthetic method positions in the clinical practice/research. Moreover, the references are too old.

Authors should consult the EQUATOR Network webpage (Enhancing the Quality of and Transparency of Health Research (EQUATOR) Network) for adhering to the applicable statement/guidelines for reporting human subjects research. An important concern is the lack of endpoints, objectives of the study, sample size calculation and many other items required when publishing the results of a clinical trial. The number received by the ethical committee and the one from https://clinicaltrials.gov/ should be included in the paper. 

Comments for author File: Comments.pdf

Author Response

Dear Reviewer

We appreciate your comments on the manuscript and we have edited the addressed parts.

As you mentioned, we have corrected the long sentences and paragraphs. We have included recent published references, especially regarding the ocular surface damage due to topical anesthetics.

Author Response File: Author Response.docx

Reviewer 2 Report

As per attached word document

Comments for author File: Comments.docx

Author Response

We appreciate your comments on the manuscript and we have edited the addressed parts.

1. The authors should provide appropriate background literature about current research and practice. The Introduction should establish the hypothesis of the paper clearly.

The introduction has been changed and current research papers have been added in references.

2. Methods: Considering that grading of the pain by patients is highly subjective method of assessment, a masked observer is crucial to remove bias. While the surgeon cannot be masked to the anesthesia method, a second unbiased masked observer should have recorded pain grades.

Methods section has been edited, explaining how data have been collected.

3. There is no Discussion Section. Section 3 to be appropriately renamed as Results and Discussion or include a separate discussion section.

Discussion section has been changed as required and Statistical analysis has been properly described.

4. Aesthesiometer observations are not reported in results.

Cochet-Bonnet aesthesiometer data have been added in a proper table.

5. The authors observed better OSDI scores and TBUT in group 2 one month post operation. What could be the reason for this? This should be discussed with appropriate references.

Thank you for this important suggestion. The discussion has been edited properly to explain the role of topical anesthetics on the corneal epithelial cells damage and ocular surface changes. Our techniques reduced these damages and the consequent tear film instability and dry eye symptoms. We have included recent references supporting our hypothesis and findings. 

6. The discussion provided by the authors from Pg 4 line 3 onwards would be more appropriate to background literature than to a “discussion”.

The discussion has been expanded.

7. The discussion section would benefit from recent relevant examples of anesthetic procedure and their potential influence on pain scores and ocular surface disease, comparing these to the present study.

The discussion has been edited accordingly to the suggestion.

8. The authors should include background and discussion citing relevant recent literature. At present, almost all references are over a decade old, with only one reference being from 2017. No studies from the last 5 years have been cited.

As mentioned before, recent papers have been included in references

Thorough proof-reading is recommended for grammatical and punctuation errors

Grammar mistakes and typos have been corrected.

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

Proof reading required