Topical anesthesia for phacoemulsification, intraocular lens implantation,and posterior vitrectomy

Purpose: To evaluate the efficacy of topical anesthesia as an alternative t o peribulbar or retrobulbar anesthesia in phacoemulsification and intraocul ar lens (IOL) implantation combined with pars plana vitrectomy. Setting: Clinica de Ojos de Maracaibo, Maracaibo, and the Retina and Vitreo us Service, Clinica Oftalmologica Centro Caracas, Caracas, Venezuela. Methods: in this prospective study, phacoemulsification, IOL implantation, and posterior vitrectomy using topical anesthesia (lidocaine 4% drops) were prospectively performed in 45 eyes (45 patients) with varied vitreoretinal pathology including macular holes, epiretinal membranes, subfoveal neovasc ular membranes, proliferative diabetic retinopathy, and vitreous hemorrhage . Preoperative and intraoperative sedation of varying degrees was necessary . Subjective pain and discomfort were graded from 1 (no pain or discomfort) to 4 (severe pain and discomfort). Results: All patients had grade 1 pain and discomfort during most of the pr ocedure. All patients had grade 2 (mild) pain and discomfort during pars pl ana sclerotomies, external bipolar cautery, and conjunctival closure. The m ean amount of lidocaine 4% drops required during each procedure was 0.5 mL. No patient required additional retrobulbar, peribulbar, or sub-Tenon's ane sthesia. Conclusions: This technique avoids the risks of globe perforation, retrobul bar hemorrhage, and prolonged postoperative akinesia of the eye at a lower cost. With appropriate case selection, topical anesthesia was a safe and ef fective alternative to peribulbar or retrobulbar anesthesia in phacoemulsif ication and IOL implantation combined with posterior 3-port pars plana vitr ectomy. (C) 1999 ASCRS and ESCRS.