A comparison of patient comfort during cataract surgery with topical anesthesia versus topical anesthesia and intracameral lidocaine1☆,
Section snippets
Rabbit studies
Approval was received from the Institutional Animal Care and Use Committee at the University of Utah. Twenty-five New Zealand white rabbits were anesthetized with ketamine (50 mg/kg) and xylazine (7 mg/kg) at a mixture of 7 to 1, respectively. A 75-super-sharp blade was used to make a stab incision into the anterior chamber of the right eye. A tuberculin syringe with a 30-gauge cannula was used to inject 0.25 ml of 1% preservative-free lidocaine (pH 6.5) (Abbott Laboratories, North Chicago, IL)
Rabbit studies
Each of the 25 eyes in the 2 groups was successfully treated, harvested, and analyzed. Of the 25 eyes treated with 1% preservative-free intraocular lidocaine for 10 minutes, the average endothelial damage was 8.1 ± 5.6%. The 25 eyes in the BSS control group showed an average endothelial damage of 8.4 ± 6.1%. This difference was not statistically significant (P = 0.43).
Human studies
Sixty-eight patients were entered into each group. The surgical conditions and complications are given in Table 1. The surgeon
Discussion
Our original study comparing topical anesthesia for cataract surgery with traditional retrobulbar injection anesthesia convincingly showed that topical anesthesia provided safe operating conditions and good patient comfort.26 Visual analog intraoperative pain scores for the 69 patients in the topical anesthesia group averaged 1.13, with 57 patients recording a score of 0 or no pain at all.26 This was not significantly different (P = 0.35) from the intraoperative pain scores recorded by the
References (31)
Prospective study of a single-injection peribulbar technique
J Cataract Refract Surg
(1992)- et al.
Comparison of one-injection-site peribulbar anesthesia and retrobulbar anesthesia
J Cataract Refract Surg
(1990) Administration of periocular anesthesia
J Cataract Refract Surg
(1986)Topical anesthesia for small incision self-sealing cataract surgery. A prospective evaluation of the first 100 patients
J Cataract Refract Surg
(1993)- et al.
Pinpoint anesthesiaa new approach to local ocular anesthesia
J Cataract Refract Surg
(1994) Immediate visual capability after cataract surgerytopical versus retrobulbar anesthesia
J Cataract Refract Surg
(1995)Drop, then decide approach to topical anesthesia
J Cataract Refract Surg
(1995)- et al.
Inadvertent globe perforation during retrobulbar and peribulbar anesthesia. Patient characteristics, surgical management, and visual outcome
Ophthalmology
(1991) - et al.
Retrobulbar anesthesia and retinal vascular obstruction
Ophthalmology
(1983) Current concepts in retrobulbar anesthesia
Surv Ophthalmol
(1985)
Needle penetration of the globe during retrobulbar and peribulbar injections
Ophthalmology
Ocular complications associated with retrobulbar injections
Ophthalmology
Brain stem anesthesia after retrobulbar block
Ophthalmology
Ptosis and cataract surgery. A multivariant computer analysis of a prospective study
Ophthalmology
A comparison of topical and retrobulbar anesthesia for cataract surgery
Ophthalmology
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Comparison of changes in blood pressure in phacoemulsification cataract surgery performed via topical and peribulbar anaesthesia: A cohort study
2023, Medical Journal Armed Forces India0.1% Nepafenac reduces pain and increases patient comfort during cataract surgery
2018, Contact Lens and Anterior EyeOcular tolerance in rabbits after intracameral administration of a fixed combination of tropicamide, phenylephrine, and lidocaine with and without rinsing
2017, Journal of Cataract and Refractive SurgeryOral diazepam versus intravenous midazolam for conscious sedation during cataract surgery performed using topical anesthesia
2015, Journal of Cataract and Refractive SurgeryOphthalmic Anesthesia
2015, Glaucoma: Second EditionIntraoperative and postoperative pain in cataract surgery
2018, Survey of OphthalmologyCitation Excerpt :Other studies have also shown it provides increased patient cooperation and reduced sensation of procedure steps when topical modalities are selected as the primary anesthesia choice.20,30,40,103 In comparison studies, intracameral anesthesia has not shown significant benefit in reducing postoperative pain.20,64 An intraoperative adjunctive analgesic modality that was USA Food and Drug Administration–approved May 2014, is Omidria (Omeros, Seattle, WA), a combination intracameral injection of phenylephrine and ketorolac.
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Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York, to the Department of Ophthalmology, University of Utah, Salt Lake City, Utah.
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The authors have no proprietary interests in any product mentioned in this article.