PROSPECTIVE EVALUATION OF TOPICAL VERSUS RETROBULBAR ANESTHESIA - A CONVERTING SURGEONS EXPERIENCE

Purpose: To evaluate and compare the efficacy of topical versus retrob ulbar anesthesia for cataract surgery performed by a surgeon newly con verting to the top cal technique. Setting: Department of Ophthalmology , Moran Eye Center, University of Utah, Salt lake City. Utah, USA. Met hods: Ninety patients were prospectively assigned by permuted block re stricted randomization to receive topical (Group 1, n = 45) or retrobu lbar (Group 2; n = 45) anesthesia. Group 1 received topical bupivacain e 0.75% and intravenous midazolam and fentanyl for anesthesia. Group 2 received intravenous methohexital followed by retrobulbar block with an equal mixture of lidocaine 2% and bupivacaine 0.75% plus hyaluronid ase 150 units. A visual pain analog scale was used to assess the degre e of pain during anesthesia administration and surgery and postoperati vely. The degree to which eye movement, touch, and light caused patien t discomfort was assessed. intraoperative conditions and complications were recorded. Results: Intraoperative operating conditions were sign ificantly better in Group 2 (P = .05). There was a small but statistic ally significant difference in the degree of discomfort during anesthe sia administration and surgery (P < .05). There was no difference in p ostoperative discomfort. Chemosis, subconjunctival hemorrhage, and eye lid hemorrhage occurred only in Group 2, in which there was one retrob ulbar hemorrhage. Although eyelid squeezing and ocular motility were p resent more frequently in Group 1, neither was a problem to the surgeo n.Conclusion: Cataract surgery was safely performed by a surgeon conve rting to topical anesthesia. After a distinct learning curve, the proc edure was performed with minimal patient discomfort. Surgical training and patient preparation are the key to safe use of topical anesthesia .