Topical anesthesia in posterior vitrectomy

Purpose: To evaluate the efficacy of topical anesthesia as an alternative t o peribulbar or retrobulbar anesthesia in posterior vitrectomy procedures. Methods: Posterior vitrectomy using topical anesthesia (4% lidocaine drops) was performed prospectively in 134 eyes (134 patients) with various vitreo retinal diseases, including severe proliferative diabetic retinopathy (n = 69), vitreous hemorrhage (n = 12), rhegmatogenous retinal detachments (n = 11), epiretinal membranes (n = 10), macular holes (n = 7), dislocated cryst alline lens or intraocular lens (n = 6), giant retinal tears (n = 5), intra ocular foreign bodies (n = 3), trauma (n = 3), endophthalmitis (n = 3), sub foveal choroidal neovascular membrane (n = 3), and neovascular glaucoma (n = 2). in 26 (19.4%) eyes, posterior vitrectomy was combined with a scleral buckling procedure, and in 84 (62.6%) eyes, argon laser photocoagulation wa s performed. Preoperative and intraoperative sedation of varying degrees wa s 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 a verage amount of 4% lidocaine drops needed during each procedure was 0.5 mt . No patient required additional retrobulbar, peribulbar, or sub-Tenon anes thesia. Conclusions: This technique avoids the risk of globe perforation, retrobulb ar hemorrhage, and prolonged postoperative akinesia of the eye. With approp riate case selection, topical anesthesia is a safe and effective alternativ e to peribulbar or retrobulbar anesthesia in three-port pars plans vitrecto my procedures.