title: No-anesthesia clear corneal phacoemulsification versus topical and topical plus intracameral anesthesia. Randomized clinical trial.
abstract: OBJECTIVE
  To compare the intraoperative pain scores during clear corneal phacoemulsification under no anesthesia, topical anesthesia, and topical plus intracameral anesthesia.
  
  
  METHODS
  Dr. Agarwal's Eye Hospital and Eye Research Center, Chennai, India.
  
  
  METHODS
  Seventy-five patients were randomized to have phacoemulsification under no anesthesia, topical anesthesia, or topical plus intracameral anesthesia. Uncooperative or illiterate patients and those with hard cataract, a shallow anterior chamber, or small pupils were excluded. A protocol was established for supplemental anesthesia in case of breakthrough pain during the surgery. Each patient was asked to grade the overall severity of intraoperative pain immediately after surgery on a 10-point visual analog scale. Also evaluated were the general discomfort during surgery, discomfort from the microscope lights, surgeon stress during surgery, and total surgical time. Comparison among the 3 groups was performed using an analysis of variance.
  
  
  RESULTS
  No supplemental anesthesia was required in any group. No significant difference was noted in the mean scores of the subjective sensation of pain with or without topical anesthesia (P =.610). The mean scores of patient discomfort from the microscope lights and surgical time were also statistically insignificant. Patient discomfort and surgeon stress during surgery were significantly greater in the no-anesthesia group than in the topical and topical plus intracameral groups (P =.0235 and P = 0.0206, respectively).
  
  
  CONCLUSIONS
  No-anesthesia clear corneal phacoemulsification was performed by a highly experienced, skilled surgeon without causing an unacceptable level of pain. However, this technique is not suitable for every cataract surgeon or patient.
authors.affiliation: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina 29425-5536, USA. pandeys@musc.edu
authors.forename: S K
authors.initials: SK
authors.lastname: Pandey
authors.forename: L
authors.initials: L
authors.lastname: Werner
authors.forename: D J
authors.initials: DJ
authors.lastname: Apple
authors.forename: A
authors.initials: A
authors.lastname: Agarwal
authors.forename: A
authors.initials: A
authors.lastname: Agarwal
authors.forename: S
authors.initials: S
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000867:Anterior Chamber / Q000187:drug effects*; D003315:Cornea / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies; D012826:Silicone Elastomers; D011795:Surveys and Questionnaires
chemical_list: D000779:Anesthetics, Local; D012826:Silicone Elastomers; D008012:Lidocaine