Visual experience during phacoemulsification under topical versus retrobulbar anesthesia: results of a prospective, randomized, controlled trial.
OBJECTIVE
To compare the subjective visual experience of cataract patients during phacoemulsification and intraocular lens implantation under topical anesthesia (TA) vs retrobulbar anesthesia (RA).


METHODS
Prospective, randomized, controlled trial.


METHODS
Three hundred six cataract patients eligible for phacoemulsification and intraocular lens implantation were randomized to receive either TA or RA during surgery by one of three surgeons. The surgeons were familiar with both anesthetic techniques and operated on the patients using the technique to which the patients were randomized. A masked interviewer conducted in-person interviews with the patients using a standardized questionnaire about their intraoperative visual experience and their reaction to their visual experience between 30 minutes and 4 hours after the surgery.


RESULTS
Two patients (one in each group) had intraoperative posterior capsule rupture and were excluded from analysis. There was no statistically significant difference between TA (n = 154) and RA (n = 150) groups, except that more males compared with females had TA (P = .03). More patients who had TA reported perception of light (P < .001) and colors (P < .001) and a change (either increase or decrease) in light brightness during the course of the surgery (P < .001). There was no statistically significant difference in the proportions of patients who saw movements, flashes, instruments, or the surgeon or medical staff during the operation and who found their visual sensations frightening in the two groups. However, 10.4% in the TA group and 9.3% in the RA group found their visual experience frightening.


CONCLUSIONS
More patients undergoing cataract surgery under TA compared with RA reported perception of light, colors, and a change in light brightness. A significant proportion of patients in both groups found the visual experience frightening.
Rengaraj
Venkatesh
V
Aravind Eye Hospitals, Madurai, India.
Radhakrishnan
Muralikrishnan
M
Au Eong
Kah-Guan
KG
Saw
Seang-Mei
SM
Srinivasan
Aravind
A
Mathew
Jacob
J
Ramasamy
Kim
K
Prajna N
Venkatesh
V
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D003118:Color Perception / Q000502:physiology; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D019654:Lens Implantation, Intraocular; D008027:Light; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000187:drug effects; D018918:Phacoemulsification; D011446:Prospective Studies; D012677:Sensation / Q000502:physiology; D011795:Surveys and Questionnaires; D014796:Visual Perception / Q000502:physiology*
D000779:Anesthetics, Local