TOPICAL VERSUS PERIBULBAR ANESTHESIA, WITHOUT SEDATION, FOR CLEAR CORNEAL PHACOEMULSIFICATION

Purpose: To investigate patient and surgeon acceptance of topical anes thesia as an I alternative to peribulbar anesthesia for clear corneal phacoemulsification. Setting: Department of Ophthalmology, Whipps Cros s Hospital, London, England. Methods: All cataract surgery was perform ed using a temporal clear corneal approach, bimanual phacoemulsificati on, and in-the-bag intraocular lens implantation. The results of 51 pa tients having surgery under topical anesthesia (amethocaine) were comp ared with those of 30 patients having peribulbar anesthesia (50:50 mix ture of lignocaine 2% and bupivacaine 0.5% with hyaluronidase). No sed ation was used in either group. Pain perception on administration of t he anesthetic, perioperatively (period immediately surrounding and dur ing surgery), rid postoperatively was assessed using a visual analog s cale from 0 to 10 (0 = no pain; 10 = worst pain imaginable). A questio nnaire was used to assess the degree of patient and surgeon satisfacti on. Results: Administration of topical amethocaine was significantly l ess painful than peribulbar bupivacaine (P = .03). Perioperative pain showed a trend toward being worse in the topical anesthesia group but did not reach statistical significance. There was no difference in the postoperative pain scores of the two groups. The surgical experience was rated very satisfactory by 67% in the topical group and 73% in the peribulbar group. The surgeons reported no difficulties or complicati ons. Conclusion: Topical anesthesia was safe and effective for clear c orneal phacoemulsification and was well tolerated by patients. The sli ghtly greater awareness of ocular discomfort in the topical group peri operatively did not alter patient satisfaction with the surgical exper ience when compared with the peribulbar I group.