title: A comparison of patient pain and visual outcome using topical anesthesia versus regional anesthesia during cataract surgery.
abstract: OBJECTIVE
  The purpose of this study was to compare the level of patient pain during the phacoemulsification and implantation of foldable intraocular lenses while under topical, intracameral, or sub-Tenon lidocaine.
  
  
  METHODS
  This was a retrospective study. Three hundred and one eyes subjected to cataract surgery were included in this study. All eyes underwent phacoemulsification surgery and intraocular lens implantation using topical, sub-Tenon, or intracameral anesthesia. The topical group received 4% lidocaine drops, and the intracameral group received a 0.1-0.2 cc infusion of 1% preservative-free lidocaine into the anterior chamber through the side port combined with topical drops of lidocaine. The sub-Tenon group received 2% lidocaine. Best-corrected visual acuity, corneal endothelial cell loss, and intraoperative pain level were evaluated. Pain level was assessed on a visual analog scale (range 0-2).
  
  
  RESULTS
  There were no significant differences in visual outcome and corneal endothelial cell loss between the three groups. The mean pain score in the sub-Tenon group was significantly lower than that in the topical and intracameral groups (P=0.0009 and P=0.0055, respectively). In 250 eyes without high myopia (< -6D), there were no significant differences in mean pain score between the sub-Tenon and intracameral groups (P=0.1417). No additional anesthesia was required in all groups.
  
  
  CONCLUSIONS
  Intracameral lidocaine provides sufficient pain suppressive effects in eyes without high myopia, while sub-Tenon anesthesia is better for cataract surgery in eyes with high myopia.
authors.affiliation: Department of Ophthalmology, Otsu Red-Cross Hospital, Otsu, Japan.
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Hosoda
authors.affiliation: Department of Ophthalmology, Otsu Red-Cross Hospital, Otsu, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Kuriyama
authors.affiliation: Department of Ophthalmology, Otsu Red-Cross Hospital, Otsu, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Jingami
authors.affiliation: Department of Ophthalmology, Otsu Red-Cross Hospital, Otsu, Japan.
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Hattori
authors.affiliation: Department of Ophthalmology, Otsu Red-Cross Hospital, Otsu, Japan.
authors.forename: Hisako
authors.initials: H
authors.lastname: Hayashi
authors.affiliation: Department of Ophthalmology, Otsu Red-Cross Hospital, Otsu, Japan.
authors.forename: Miho
authors.initials: M
authors.lastname: Matsumoto
keywords: anesthesia; cataract; intracameral; sub-Tenon; topical