H. Kallio et al., Topical anesthesia with or without propofol sedation versus retrobulbar/peribulbar anesthesia for cataract extraction - Prospective randomized trial, J CAT REF S, 27(9), 2001, pp. 1372-1379
Purpose: To evaluate the feasibility of intravenous sedation in addition to
topical anesthesia during cataract extraction.
Setting: Helsinki University Eye Hospital, Helsinki, Finland.
Methods: Three hundred seventeen eyes of 291 consecutive patients having ca
taract surgery were prospectively randomized to receive topical (oxybuproca
ine 0.4%, n = 96), combined (topical anesthesia and propofol sedation, n =
107), or retrobulbar/peribulbar (prilocaine 1.5%, n = 114) anesthesia. The
intraoperative conditions were judged by the surgeon. A numerical scale (0
to 10) was used to assess the degree of pain during surgery. Outcome measur
es were the number of complications and adverse events registered periopera
tively and 1 week postoperatively as well as Snellen visual acuity.
Results: The success of posterior chamber intraocular lens (IOL) implantati
on through a self-sealing clear corneal incision was 97.9%, 96.3%, and 98.2
% in the topical, combined, and retrobulbar/peribulbar groups, respectively
. There was no difference among the groups in pain during surgery, frequenc
y of complications, or outcome measures. One week postoperatively, visual a
cuity was 20/40 or better in 81.7%, 78.5%, and 77.5% of eyes in the topical
, combined, and retrobulbar/peribulbar groups, respectively. The surgeon re
ported significantly fewer difficulties in the retrobulbar/peribulbar group
(9.8%) than in the topical (26.0%) (P = .004) or combined (21.0%) (P = .03
6) groups, Additional sedative/analgesic medication given intraoperatively
was required significantly more often in the topical (15.6%) than in the re
trobulbar/peribulbar group (2.6%) (P = .002). Patients with bilateral surge
ry preferred combined anesthesia over retrobulbar/peribulbar anesthesia; ho
wever, there was no significant difference in patient acceptance among grou
ps in patients having unilateral surgery.
Conclusion: Intravenous propofol sedation added to topical anesthesia did n
ot improve the operative conditions or surgical outcome. Retrobulbar/peribu
lbar anesthesia ensured the best surgical conditions. Patients in all anest
hesia groups reported high satisfaction. However, patients having bilateral
surgery seemed to prefer combined anesthesia over retrobulbar/peribulbar a
nesthesia. (C) 2001 ASCPS and ESCRS.