Topical versus Retrobulbar Anesthesia in Clear Corneal Cataract Surgery

Lee, J S; Chung, S K; Baek, N H

Abstract

To evaluate the effect of topical anesthesia we compared the efficacy of topical anesthesia with retrobulbar anesthesia in clear corneal cataract surgery. In this prospective, double-blind clinical trial, 20 patients had bilateral cataract surgeries performed 3 days apart. Half of the patients had topical anesthesia for the first surgery and retrobulbar anesthesia for the second surgery. The other half had retrobulbar first and then topical. All surgery was performed by one surgeon using superior clear corneal approach and phacoemulsification followed by in-the-bag intraocular lens implantation. Subjective pain was assessed using a visual analog scale of no pain[0] to worst pain imaginable[10] at each time of anesthesia, operation, and post operation. Surgeon's operating condition was assessed using similar visual analog scale of worst[0] to best[10]. There were no significant carry-over effects in all 4 comparisons[P>0.70] between two groups of different anesthetic order, and no differences in operating condition and post operative pain between retrobulbar and topical anesthesia[mean 8.03 versus 7.15, P>0.08, mean 2.20 versus 2.95, P>0.05]. There was more discomfort during administration of retrobulbar anesthesia[mean 6.65 versus 2.90, P<0.0001], and less discomfort during surgery[mean 3.00 versus 4.75, P<0.0025] in the retrobulbar group. There was no complication reported. Though retrobulbar anesthesia has a better pain subsiding effect during surgery, it has a serious complication possible and much pain during anesthesia, topical anesthesia is a safe, effective alternative to retrobulbar anesthesia in clear corneal cataract surgery.