Topical anesthesia with sedation in phacoemulsification and intraocular lens implantation combined with 2-port pars plana vitrectomy in 105 consecutive cases.
OBJECTIVE
To evaluate the efficacy of topical anesthesia as an alternative to peribulbar or retrobulbar anesthesia in phacoemulsification and intraocular lens implantation combined with our modified 2-port pars plana vitrectomy technique (phacovitrectomy).


METHODS
Phacovitrectomy using topical anesthesia (4% lidocaine drops) was prospectively performed in 105 eyes with cataract and varied vitreoretinal pathology. In 75 eyes (71.4%), phacovitrectomy was combined with argon laser photocoagulation (endolaser). 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. No patient required additional retrobulbar, peribulbar, or sub-Tenon's 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 phacovitrectomy.
Juan B
JB
Yepez
Jazmin Cedeno
JC
de Yepez
Oly
O
Azar-Arevalo
J Fernando
JF
Arevalo
D000368:Aged; D000772:Anesthesia, Local / Q000592:standards*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007432:Intraoperative Period; D019654:Lens Implantation, Intraocular; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D018918:Phacoemulsification; D014821:Vitrectomy / Q000379:methods*
D006993:Hypnotics and Sedatives