advertisement
Abstract #6273 Published in IGR 2-2
A comparative study of topical versus retrobulbar anesthesia in complicated cataract surgery
Jacobi PC; Dietlein TS; Jacobi FKArchives of Ophthalmology 2000; 118: 1037-1043
OBJECTIVES: To evaluate and compare levels of patient discomfort and perioperative complications during phacoemulsification and implantation of a foldable intraocular lens under topical lidocaine hydrochloride and retrobulbar anesthesia in patients with cataract who also had exfoliation syndrome, uveitis, posterior synechia, phacodonesis, or previous intraocular surgery. DESIGN: A prospective, randomized, controlled trial was carried out at two institutions. PARTICIPANTS: A total of 476 eyes of 476 patients with various well-established risk factors fulfilled the inclusion criteria. In 238 eyes, phacoemulsification was performed under retrobulbar anesthesia, while the other 238 eyes received topical anesthesia. INTERVENTIONS: All patients underwent temporal clear corneal phacoemulsification and implantation of a foldable intraocular lens. Patients under retrobulbar anesthesia received a single injection (3.5-5.5 ml) of a combination of 0.75% bupivacaine hydrochloride, 2% lidocaine, and hyaluronidase into the retrobulbar space. Patients in the topical anesthesia group received a minimum of five doses (approximately 40 μl per dose) of 2% topical lidocaine. No intracameral injection of any anesthetic was given. MAIN OUTCOME MEASURES: The number of complications and adverse events. The intraoperative conditions were judged by the surgeon (PCJ or FKJ), and a ten-point visual analogue scale was used immediately after surgery to assess each patient's overall severity of intraoperative pain. RESULTS: The overall intraoperative complication rate was 1.9% for capsular tear, 3.8% for zonular tear, 1.5% for vitreous loss, and 1.0% for iris prolapse. Apart from the incidence of vitreous loss, which was significantly lower (p = 0.041) in the topical anesthesia group, no statistically significant differences in intraoperative and early postoperative complications were found between the groups. A supplemental posterior sub-tenon space injection was required in 1.3% of the topical anesthesia group, and in 0.8% of the retrobulbar anesthesia group. Chemosis (2.5%), subconjunctival hemorrhage (1.7%), and periorbital hematoma (0.8%) were seen in only the retrobulbar anesthesia group. The mean ± SE pain scores estimated by the patients were 0.84 ± 1.30 in the topical anesthesia group and 0.73 ± 1.50 in the retrobulbar anesthesia group (p = 0.41). Patient preference for topical anesthesia (91%) appeared to be significantly higher (p = 0.01) than for retrobulbar anesthesia (62%). The surgeons found anesthesia-related intraoperative difficulty to be slightly lower in the retrobulbar anesthesia group (8%) than in the topical anesthesia group (14%). CONCLUSIONS: Surgery-related complications and patient discomfort were similar for the two methods of anesthesia. Topical anesthesia is justified as a means of improving safety without causing discomfort to the patient, even in complicated cases of cataract surgery.
Dr. P.C. Jacobi, Department of Ophthalmology, University of Cologne, Cologne, Germany
Classification:
12.12 Cataract extraction (Part of: 12 Surgical treatment)
