A prospective randomized study was done in 79 patients undergoing elective routine cataract surgery in which the Kelman phacoemulsification technique was used with placement of an intraocular lens. In all the patients anesthesia was induced with both a peribulbar and a retrobulbar injection of a large volume (total 10.5 mL) of local anesthetic. The patients were randomly assigned to receive either the peribulbar (39 patients) (group 1) or the retrobulbar (40 patients) (group 2) injection first. The intraocular pressure (IOP) was measured five times during anesthesia. The mean elevation in IOP immediately after the first injection was 0.4 mm Hg in group 1, compared with 2.0 mm Hg in group 2. Twenty minutes after both injections had been given and a Super Pinky pressure device had been placed on the eye, the mean decrease in IOP from the preoperative value was 3.1 mm Hg in group 1 and 4.8 mm Hg in group 2. We conclude that a combined peribulbar and retrobulbar approach is a safe and effective alternative method of regional anesthesia for cataract surgery.