Video-Assisted Patient Education and Eye Fixation Training in Pterygium Surgery

• Video-Assisted Patient Education (Behavioral): An 8-to-10-minute two-stage audiovisual preparation module administered on a standard tablet prior to pterygium surgery. Stage 1 involves ERAS-based cognitive preparation, including 2D animations of pterygium surgery and local anesthesia, audiovisual desensitization to operating room lights and monitor beeps, and postoperative eye care instructions. Stage 2 consists of interactive eye fixation and motor compliance training, where participants follow voice prompts to track a moving red target without moving their heads, followed by static gaze fixation exercises held for 1 to 3 minutes to improve intraoperative surgical compliance.

Primary outcomes

• State Anxiety [Preoperatively (baseline, in the waiting area before surgery) and postoperatively (10 minutes after transfer to the ward following surgery)]: State anxiety is assessed using the State Anxiety Inventory (STAI Form TX-1), developed by Spielberger et al. The scale consists of 20 items designed to measure situational/transient anxiety. Each item is rated on a 4-point Likert scale ranging from 1 ("not at all") to 4 ("very much so"). Total scores range from 20 to 80, with higher scores indicating greater levels of acute anxiety.

Secondary outcomes

• Postoperative Pain [Postoperatively (10 minutes after transfer to the ward following surgery)]: Pain intensity is assessed using the 11-point Numeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("worst possible pain"). Participants select the number that best represents their current pain level. Higher scores indicate greater pain severity.
• Intraoperative Patient Compliance and Surgeon Evaluation Score [Immediately at the end of surgery (before the patient leaves the operating table)]: Evaluated immediately post-surgery by the operating surgeon, who is blinded to participant group allocation, using a 4-item questionnaire on a 5-point Likert scale (1 = most negative to 5 = most positive). The scale assesses speed and accuracy of response to commands, eye fixation quality, involuntary head/eye movements, and overall surgical facilitation/comfort. Total scores range from 4 to 20, with higher scores indicating superior intraoperative compliance and surgical ease.
• Total Operation Duration [At the completion of the surgical procedure (recorded immediately post-surgery)]: Total surgical procedure duration measured objectively in minutes, recorded from the initial incision to the completion of the final surgical suture.
• Systolic and Diastolic Blood Pressure [Baseline (preoperative waiting area), intraoperatively (during surgery), and postoperatively (10 minutes after transfer to the ward)]: Systolic and diastolic blood pressure measured in millimeters of mercury (mmHg) using a calibrated clinical monitor to evaluate hemodynamic stability.
• Heart Rate [Baseline (preoperative waiting area), intraoperatively (during surgery), and postoperatively (10 minutes after transfer to the ward)]: Heart rate measured in beats per minute (bpm) via continuous clinical monitoring to evaluate autonomic response.
• Respiratory Rate [Baseline (preoperative waiting area), intraoperatively (during surgery), and postoperatively (10 minutes after transfer to the ward)]: Respiratory rate measured in breaths per minute via clinical observation/monitoring.
• Peripheral Oxygen Saturation (SpO2) [Baseline (preoperative waiting area), intraoperatively (during surgery), and postoperatively (10 minutes after transfer to the ward)]: Peripheral oxygen saturation measured as a percentage (%) using a pulse oximeter.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Aged between 18 and over
* Diagnosed with primary pterygium scheduled for surgical excision with conjunctival autograft under local anesthesia
* American Society of Anesthesiologists (ASA) physical status class I or II
* Ability to read, understand, and communicate in Turkish
* Voluntary agreement to participate in the study with written informed consent

Exclusion Criteria:

* Requirement for general anesthesia
* History of psychiatric illness or regular use of anxiolytic/psychotropic medications
* Severe visual impairment in the contralateral eye or severe hearing impairment interfering with communication
* History of prior major ocular surgery in the study eye or contralateral eye
* Presence of systemic comorbidities including diabetes mellitus, severe respiratory diseases, or significant cardiovascular diseases
* Cancellation of surgery due to technical or medical reasons
* Withdrawal of consent or request to leave the study at any stage