Converting to topical anesthesia in cataract surgery

converting from paraocular to topical anesthesia in cataract surgery and to evaluate patient pain and satisfaction with each procedure. Setting: Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. Methods: Three hundred eyes of 245 consecutive patients were prospectively assigned by permuted block-restricted randomization to receive topical (bup ivacaine 0.75%) (Group 1; n = 136) or paraocular (Group 2; n = 163) anesthe sia. The intraoperative conditions were judged by the surgeon. A numerical scale (0 to 10) was used to assess the degree of pain during administration of anesthesia, during surgery and 1 and 24 hours postoperatively. Outcome measures were the number of complications and adverse events registered per ioperatively and 4 months postoperatively as well as Snellen visual acuity and surgically induced astigmatism (SIA) measured I week and 4 months after surgery. Results: The success of posterior chamber intraocular lens (IOL) implantati on through a self-sealing clear corneal incision was very high (99.3% and 9 6.9% in Groups 1 and 2, respectively). One case (0.7%) in the topical group required vitrectomy and implantation of an anterior chamber IOL. Anesthesi a-related difficulties were reported in about 40% of patients in Group 1 an d 4% in Group 2 (P < .001). Supplemental paraocular anesthesia was required in 4 cases (2.9%) in the topical group. Sedative/analgesic medication give n perioperatively was required significantly more often in Group 1 (13.2%) than in Group 2 (2.4%) (P < .01). Significantly more pain during surgery (P < .001) and 1 hour after surgery (P < .001) was reported in the topical gr oup. In Group 1 69.9% and in Group 2 93.3% reported no pain during surgery (P < .001). Chemosis (1.8%), subconjunctival hemorrhage (1.2%), and periorb ital hematoma (1.2%) were seen only in the paraocular group. Perioperativel y, no severe complications occurred in Group 1 and the number of adverse ev ents was less than in Group 2. Postoperatively, 2 cases of endophthalmitis developed in the topical group and none in the paraocular group. There was no between-group difference in outcome measures; a visual acuity of 20/40 o r better was found in 87.8% of eyes in Group 1 and 84.9% in Group 2 4 month s postoperatively, and the percentages of eyes with SIAs within 1.0 diopter of preoperative values were similar (78.8% and 73.3%, respectively). Patie nt preference for topical anesthesia appeared to be higher than for paraocu lar anesthesia. Conclusion: Paraocular anesthesia gave better analgesia than topical, but t opical anesthesia provided acceptable analgesia during surgery and showed t hat intraocular procedures can be performed without akinesia. The surgeon c onverting to topical anesthesia may expect slight difficulty in 40% of case s and more severe difficulty in 7%. Surgically related complications were s imilar with both methods.