PERIBULBAR ANESTHESIA VERSUS TOPICAL ANESTHESIA IN CATARACT SURGERY: COMPARISON OF THE POSTOPERATIVE DEVELOPMENT
T. Heuermann, N. Anders, P. Rieck, Chr. Hartmann
Phacoemulsification with topical anesthesia is a proven alternative to peribulbar or retrobulbar anesthesia. Application of Lidocaine in the anterior chamber before surgery is one method to achieve good analgesia. Nevertheless a toxic effect of Lidocaine on the corneal endothelium is documented (1). The purpose of this study was to find out, if there do exist any differences in the postoperative development between patients having peribulbar injection and patients having topical anesthesia.
Method: A total of 140 patients scheduled to undergo elective cataract surgery were included in the study. The mean age of patients enrolled was 72,9 ± 9,5 years. The patients were randomly assigned to receive intraocular injection of 0,15 ml Lidocaine 1% or a peribulbar injection of 6 ml Xylonest 2%. Cataract surgery was always performed by the same surgeon using phacoemulsification technique and IOL implantation in the posterior chamber. Uncorrected visual acuity has been measured 30 minutes after surgery. On the first day cornea, intraocular pressure, ocular inflammation affecting the anterior chamber were examined at the slit lamp, best corrected visual acuity and postoperative complications were documented.
Results: 30 minutes after surgery the uncorrected visual acuity was significantly better in the Lidocain group. At one day we didnt see any differences concerning the visual acuity. In 14%of the peribulbar group there occured mild haematoma at the injection side. Descemet folds occured in 10 % of the peribulbar group but as twice as much in the Lidocain group. They didnt persist on later examination.
Conclusion: Topical anesthesia with intraocular application of 0,15 ml Lidocain 1% circumvents the complications of a peribulbar / retrobulbar injection. The patient profits from a rapid visual rehabilitation.
1.Judge-AJ et al.: Ophthalmology 1997 Sep; 104(9): 1373-9
Dept. of Ophthalmology, Charité, Campus Virchaw-Klinikum, D-13353 Berlin