Combined topical-peribulbar anesthesia for cataract surgery

Purpose: To evaluate the anesthetic effect of single-point low-volume perib ulbar anesthesia supplemented by topical anesthesia. Setting: Private ambulatory ophthalmic practice. Methods: Five hundred consecutive patients received 4 cc of lidocaine 2% wi th 200 units hyaluronidase as 1-point peribulbar anesthesia. This was suppl emented by lidocaine 4%, 1 drop every 3 to 5 minutes for 3 instillations. P hacoemulsification and intraocular lens implantation were performed through a scleral tunnel or dear corneal approach. All patients were evaluated for intraoperative akinesia, lid closure, and anesthesia. One hour after surge ry, the eye patch was removed and patients were evaluated for pain, discomf ort, foreign-body sensation, diplopia, and lid closure. Results: All patients had no pain to mild discomfort during surgery; 34% ha d total and 58% partial akinesia; 78% had poor orbicularis action (lid clos ure); 12% had subconjunctival hemorrhage. Postoperatively, 42% of patients had foreign-body sensation caused by conjunctival coaptation by diathermy o r corneal edema. Diplopia occurred in 32% of patients but resolved within 1 hour after eye-patch removal, and partial ptosis occurred in 58%, resolvin g within 2 hours of patch removal. All patients had normal lid closure when the eye patch was removed. Conclusions: Low-volume 1-point peribulbar anesthesia supplemented by topic al anesthesia was safe and effective and provided early visual recovery. To pical therapy can be started 1 hour postoperatively.