Cataract surgery under topical anesthesia in patients with coexisting glaucoma

Purpose: To evaluate and compare levels of patient discomfort and complicat ions during phacoemulsification with implantation of a foldable intraocular lens (IOL) under topical lidocaine hydrochloride in patients with and with out various forms of chronic open-angle and chronic angle-closure glaucoma. Setting: Two university eye centers In Germany. Methods: This prospective nonrandomized comparative study comprised 176 eye s of 176 patients with various forms of chronic open-angle glaucoma and chr onic angle-closure glaucoma. Eyes with cataract and without a glaucoma diag nosis or history of intraocular surgery served as a control group (n = 212) . All patients received a minimum of 5 doses (2 drops per dose) of topical lidocaine-hydrochloride 2% before standard temporal clear corneal phacoemul sification and foldable IOL Implantation. No Intracameral anesthetic inject ion was given, and no systemic sedatives were used. The main outcome measur es were the number of complications and adverse events. Results. The intraoperative complication rate in all patients (n = 388) was capsule tear, 1.3%; zonule tear, 1.8%; vitreous loss, 1.0%; Iris prolapse, 0.8%. No statistically significant differences in intraoperative or early postoperative complications were found between the glaucoma and control gro ups. The mean pain scores of patients were 0.38 +/- 1.1 (SD) in the glaucom a group and 0.36 +/- 0.8 in the control group (P = .21) Patient preference for cataract surgery under topical anesthesia was similar in both groups. Conclusions. Surgery-related complications and patient discomfort, were sim ilar in patients with and without glaucoma who had phacoemulsification and IOL implantation under topical anesthesia. These results indicate that topi cal anesthesia is safe for routine phacoemulsification with foldable IOL im plantation in patients with glaucoma and does not compromise patient comfor t. J Cataract Refract Surg 2001; 27: 1207-1213 (C) 2001 ASCPS and ESCRS.