A comparison of topical and retrobulbar anesthesia for cataract surgery.
OBJECTIVE
To evaluate and compare the efficacy of topical and retrobulbar anesthesia for cataract extraction with intraocular lens implantation.


METHODS
One hundred thirty-eight patients prospectively were assigned to the topical (group 1; n = 69) or retrobulbar (group 2; n = 69) anesthesia groups by permuted block restricted randomization. Group 1 received topical 0.75% bupivacaine and intravenous midazolam and fentanyl for anesthesia. Group 2 received intravenous methohexital followed by retrobulbar block with an equal mixture of 2% lidocaine and 0.75% bupivacaine plus hyaluronidase (150 U). A visual pain analogue scale was used to assess the degree of pain during the administration of anesthesia, during surgery, and post-operatively. The degree to which eye movement, touch, and light caused patient discomfort was assessed. Complications and surgical conditions were recorded.


RESULTS
There was no difference in the surgical conditions (P = 0.5) or pain during surgery (P = 0.35) between the two groups. There was more discomfort during administration of topical anesthesia (P < 0.0001) and postoperatively (P < 0.05) in the topical group. Chemosis, subconjunctival hemorrhage, and eyelid hemorrhage were seen almost exclusively in the retrobulbar group. One patient in group 2 had a retrobulbar hemorrhage. Although eyeball movement and squeezing of the eyelids were present more frequently in the topical group, neither was a problem to the surgeon.


CONCLUSIONS
Topical anesthesia can be used safely for cataract extraction. The degree of patient discomfort is only marginally higher during administration of the anesthesia and postoperatively. However, surgical training and patient preparation are the keys to the safe use of topical anesthesia.
Patel
B C
BC
John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City 84132, USA.
Burns
T A
TA
Crandall
A
A
Shomaker
S T
ST
Pace
N L
NL
van Eerd
A
A
Clinch
T
T
D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001340:Autonomic Nerve Block / Q000379:methods; D002045:Bupivacaine / Q000008:administration & dosage; D002387:Cataract Extraction; D004338:Drug Combinations; D005133:Eye Movements; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage; D007431:Intraoperative Complications; D007910:Lenses, Intraocular; D008012:Lidocaine / Q000008:administration & dosage; D008875:Middle Aged; D009883:Ophthalmic Solutions; D009915:Orbit / Q000187:drug effects; D010147:Pain Measurement; D011183:Postoperative Complications; D011446:Prospective Studies
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D004338:Drug Combinations; D009883:Ophthalmic Solutions; D008012:Lidocaine; D006821:Hyaluronoglucosaminidase; D002045:Bupivacaine