title: Topical-intracameral anesthesia without preoperative mydriatic agents for Descemet-stripping automated endothelial keratoplasty and phacoemulsification cataract surgery with intraocular lens implantation.
abstract: We describe a technique for a new triple procedure comprising phacoemulsification and intraocular lens (IOL) implantation followed immediately by Descemet-stripping automated endothelial keratoplasty (DSAEK). It is performed under topical anesthesia, with dilation accomplished using methylparaben-free lidocaine 1% with no added epinephrine. In a case series of 32 patients, adequate dilation was achieved and no patient reported significant intraoperative discomfort. No operative or postoperative complications were encountered, and visual rehabilitation was quick and satisfactory. Topical anesthesia eliminated the risks associated with retrobulbar and peribulbar blocks, as well as the risks associated with general anesthesia. Intracameral dilation with preservative-free lidocaine 1% provided adequate and short-lived dilation, alleviating the need for intraoperative pharmacologic constriction when transitioning from IOL implantation to DSAEK.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: John A. Moran Eye Center, University of Utah, Department of Ophthalmology and Visual Sciences, Salt Lake City, Utah 84132, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Oberg
authors.forename: Shameema
authors.initials: S
authors.lastname: Sikder
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Jorgensen
authors.forename: Mark D
authors.initials: MD
authors.lastname: Mifflin
mesh_terms: D000287:Administration, Topical; D000700:Analgesics / Q000008:administration & dosage; D000772:Anesthesia, Local / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000869:Anterior Eye Segment / Q000187:drug effects; D057111:Descemet Stripping Endothelial Keratoplasty; D005283:Fentanyl / Q000008:administration & dosage; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D019654:Lens Implantation, Intraocular; D008012:Lidocaine / Q000008:administration & dosage*; D008874:Midazolam / Q000008:administration & dosage; D009184:Mydriatics / Q000008:administration & dosage; D018918:Phacoemulsification; D011300:Preoperative Care; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055675:Viscosupplements / Q000008:administration & dosage; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D009184:Mydriatics; D055675:Viscosupplements; D008012:Lidocaine; D008874:Midazolam; D005283:Fentanyl