[Topical anesthesia as routine procedure in cataract surgery -- evaluation of pain and complications in 1010 cases].
BACKGROUND
The number of cataract surgeries using topical anesthesia has increased continuously in the United States in the last years. Over 60 % of all cataract surgeons accept this form of anesthesia as first choice in cataract surgery. Surgeons in German-speaking countries still prefer injection anesthesia. Patient pain and complications during cataract surgery under topical anesthesia were recorded in 1010 cases to find out if topical anesthesia will become established as a routine procedure in Germany.


METHODS
Cataract surgery was performed as a routine procedure by two surgeons as phacoemulsification with implantation of a foldable posterior chamber lens. Preoperative tetracaine drops were applied three times. Additionally, non-preserved lidocaine 1 % was injected into the anterior chamber. Patients assessed pain intensity by checking off a visual analogue scale 1 to 10. Intra-operative complications were recorded by the surgeons. The level of pain, intra-operative complications, age of patients, duration of surgery and type of implanted intraocular lens were analyzed by descriptive statistical methods.


RESULTS
The evaluation of intra-operative pain showed an overall mean pain score of 1.62. The pain was described as minor and light by 98.8 % of all patients. Complications happened in not more than 0.5 % of the cases related to the single complication. Complications did not necessarily lead to a higher rating of pain.


CONCLUSIONS
Topical anesthesia using tetracaine drops with adjunctive intracameral injection of non-preserved lidocaine 1 % is a safe and efficient form of anesthesia in phacoemulsification and is well tolerated by patients. According to the patients' positive assessment and the low rate of complications, drop anesthesia is well suited for clinical routine.
Irle
S
S
Klinik für Refraktive Chirurgie, Evangelisches und Johanniter Klinikum Duisburg gGmbH, Duisburg.
Lückefahr
M H
MH
Tomalla
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D000867:Anterior Chamber; D005260:Female; D006801:Humans; D007267:Injections; D007431:Intraoperative Complications / Q000209:etiology*; D007910:Lenses, Intraocular; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D010147:Pain Measurement; D017060:Patient Satisfaction; D018918:Phacoemulsification; D013748:Tetracaine
D009883:Ophthalmic Solutions; D013748:Tetracaine; D008012:Lidocaine