Cataract Surgery: Is it Time to Convert to Topical Anaesthesia?

Abstract

Purpose: To evaluate the efficacy and safety of topical anaesthesia for routine uncomplicated phacoemulsification with intraocular lens implantation surgery in Pakistani patients.

Material And Methods: 109 consecutive patients listed for routine cataract surgery were operated under topical anaethesia. Patients received four doses of 0.5% proparacaine eye drops. A 10 point visual analogue pain scoring system was used to score pain just after instillation of drops and pain score during operation was recorded just after completion of surgery. Intraoperative/ postopearive complications and surgeon’s difficulties attributable to operating conditions were recorded as was the incidence of chemosis and subconjunctival haemorrhage.

Results: The pain scores reported by the patients on instillation of drops was zero in 83 patients (76%) and only 26 patients (24%) complained of slight stinging sensation (score 1) with mean score of 0.24 (Fig. 1). Pain score during surgery was zero to 1 in 85 patients (78%), 2 to 5 in 20 patients (18%) and 5 to 7 in 4 patients (4%) with mean score of 1.52 (Fig. 2). Eight patients in the last two groups required supplemental subconjunctival bupivacaine injection above superior limbus. When inquired about choice of anesthesia for another similar operation, 102 patients (93.5%) preferred same technique of anaethesia.

Conclusion: It is right time to convert to topical anaesthesia for small incision cataract surgery which is an efficient and safe anaesthetic technique.