title: Combined Topical-Intracameral Anesthesia in Manual Small-Incision Cataract Surgery: A Prospective, Randomized, Double-Masked, Placebo-Controlled Trial.
abstract: OBJECTIVE
  To determine whether intracameral lidocaine plus topical anesthesia could further reduce patients' pain experience during manual small-incision cataract surgery, compared with topical anesthesia alone.
  
  
  METHODS
  A prospective, randomized, double-masked, placebo-controlled clinical trial was conducted.
  
  
  METHODS
  This research was approved by the institutional review board of the Eye Hospital of Wenzhou Medical College in China. All patients gave written, informed consent, and no untoward pressure or coercion was used for the written informed consent. A total of 300 patients were randomly assigned into the placebo group (topical anesthesia plus intracameral balanced salt solution) or the interventional group (combined topical plus intracameral anesthesia). The pains they experienced during the different stages of the operation were evaluated by a visual analog pain scale. At the end of the surgery, the surgeon was given a questionnaire to evaluate the cooperation of the patient. The endothelial cell count was collected preoperatively and 1 month postoperatively.
  
  
  RESULTS
  The patient-reported pain scores were significantly lower in the interventional group at the following stages of the operation: nucleus rotation (P < 0.001), bisection of the nucleus (P < 0.001), and prolapse of the nucleus (P < 0.001). The surgeon assessment showed better patient cooperation in the lidocaine group (P = 0.04). There was no significant difference in endothelial cell loss between the 2 groups.
  
  
  CONCLUSIONS
  Although topical anesthesia alone provides acceptable anesthesia for manual small-incision cataract surgery, combined topical and intracameral anesthesia decreased patients' discomfort and increased their cooperation during the operation.
authors.affiliation: From the *General Hospital of Armed Police Forces, Beijing, China; and †School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, Zhejiang, China.
authors.forename: Lihua
authors.initials: L
authors.lastname: Wang
authors.forename: Jinyang
authors.initials: J
authors.lastname: Li
authors.forename: Guoxing
authors.initials: G
authors.lastname: Li
authors.forename: Xu
authors.initials: X
authors.lastname: Xu
authors.forename: Hai
authors.initials: H
authors.lastname: Tao
authors.forename: Wei
authors.initials: W
authors.lastname: Chen