title: Topical anesthesia in posterior vitrectomy.
abstract: OBJECTIVE
  To evaluate the efficacy of topical anesthesia as an alternative to peribulbar or retrobulbar anesthesia in posterior vitrectomy procedures.
  
  
  METHODS
  Posterior vitrectomy using topical anesthesia (4% lidocaine drops) was performed prospectively in 134 eyes (134 patients) with various vitreoretinal diseases, including severe proliferative diabetic retinopathy (n = 69), vitreous hemorrhage (n = 12), rhegmatogenous retinal detachments (n = 11), epiretinal membranes (n = 10), macular holes (n = 7), dislocated crystalline lens or intraocular lens (n = 6), giant retinal tears (n = 5), intraocular foreign bodies (n = 3), trauma (n = 3), endophthalmitis (n = 3), subfoveal choroidal neovascular membrane (n = 3), and neovascular glaucoma (n = 2). In 26 (19.4%) eyes, posterior vitrectomy was combined with a scleral buckling procedure, and in 84 (62.6%) eyes, argon laser photocoagulation was performed. Preoperative and intraoperative sedation of varying degrees was necessary. Subjective pain and discomfort were graded from 1 (no pain or discomfort) to 4 (severe pain and discomfort).
  
  
  RESULTS
  All patients had grade 1 pain and discomfort during most of the procedure. All patients had grade 2 (mild) pain and discomfort during pars plana sclerotomies, external bipolar cautery, and conjunctival closure. The average amount of 4% lidocaine drops needed during each procedure was 0.5 mL. No patient required additional retrobulbar, peribulbar, or sub-Tenon anesthesia.
  
  
  CONCLUSIONS
  This technique avoids the risk of globe perforation, retrobulbar hemorrhage, and prolonged postoperative akinesia of the eye. With appropriate case selection, topical anesthesia is a safe and effective alternative to peribulbar or retrobulbar anesthesia in three-port pars plana vitrectomy procedures.
authors.affiliation: Clinica de Ojos de Maracaibo, Clinica Oftalmologica Centro Caracas, Venezuela.
authors.forename: J
authors.initials: J
authors.lastname: Yepez
authors.forename: J
authors.initials: J
authors.lastname: Cedeño de Yepez
authors.forename: J F
authors.initials: JF
authors.lastname: Arevalo
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007267:Injections; D007906:Lens Subluxation / Q000601:surgery; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D011446:Prospective Studies; D012164:Retinal Diseases / Q000601:surgery; D012449:Safety; D012827:Silicone Oils / Q000008:administration & dosage; D016896:Treatment Outcome; D014821:Vitrectomy / Q000379:methods*; D014823:Vitreous Hemorrhage / Q000601:surgery
chemical_list: D000779:Anesthetics, Local; D009883:Ophthalmic Solutions; D012827:Silicone Oils; D008012:Lidocaine