Dear Editor

As cataract surgeons move toward toward less invasive procedures including topical anesthesia, Friedman et al.[1] have done a research on the patient's perspective.

Their results surprisingly showed that patients preferred retrobulbar blockade anaesthesia over topical anaesthesia in preparing for cataract surgery, raising the question whether ophthalmologists are moving in the proper direction. However, for informed consent patients need to be told not only the risks and benefits of the cataract surgery itself but also the risk and benefits of the alternative anesthesia modalities.[2] While rare, complications of retrobulbar anesthesia injection can be devastating; for example, inadvertent globe perforation,[3] blindness from the injection into the optic nerve,[4] or apnea resulting from subarachnoid injection of the anaesthetic agent.[5-6] Had the patients been informed of these uncommon but serious complications, their preferences might have been altered and the study results might have been different.

References

1. Friedman DS, Reeves SW, Bass EB, Lubomski LH, Fleisher LA, Schein OD. Patient preferences for anaesthesia management during cataract surgery. Br J Ophthalmol 2004;88:333-5.

2. Elder MJ, Suter A. What patients want to know before they have cataract surgery. Br J Ophthalmol 2004;88:331-2.

3. Duker JS, Belmont JB, Benson WE, Brooks HL Jr, Brown GC, Federman JL et al. Inadvertent globe perforation during retrobulbar and peribulbar anesthesia. Patient characteristics, surgical management, and visual outcome. Ophthalmology 1991;98:519-26.

4. Pautler SE, Grizzard WS, Thompson LN, Wing GL. Blindness from retrobulbar injection into the optic nerve. Ophthalmic Surg 1986;17:334-7.

5. Javitt JC, Addiego R, Friedberg HL, Libonati MM, Leahy JJ. Brain stem anesthesia after retrobulbar block. Ophthalmology 1987;94:718-24.

6. Ruusuvaara P, Setala K, Tarkkanen A. Respiratory arrest after retrobulbar block. Acta Ophthalmol (Copenh) 1988;66:223-5.