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Abstract

We thank Bellini et al for their comments relating to phacoemulsification complication rates in their practice. Their results add to the body of evidence that demonstrates low complication rates with the use of topical anesthetic.Bellini et al's practice differs from ours in that they use topical anesthesia without intracameral anesthetic for most cases, and needle anesthetic techniques are used for cases of small pupil or dense nuclear cataract, with sedation. In our practice, topical intracameral anesthesia was used for almost all cataract surgeries, including hard nuclear cataracts and those with small pupils. In a recent metaanalysis of randomized controlled trials, the addition of intracameral anesthetic has been shown to minimize intraoperative discomfort,1Ezra D.G. Nambiar A. Allan B.D. Supplementary intracameral lidocaine for phacoemulsification under topical anesthesia A meta-analysis of randomized controlled trials.Ophthalmology. 2008; 115: 455-463Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar and we believe this effect is likely to be more beneficial to these patients. Although we did not perform a subanalysis for patients with small pupil or dense cataract, our low overall rate of complications suggests that topical intracameral anesthesia is appropriate for the vast majority of cataract cases.We have been using intracameral lidocaine as standard for 10 years and have not detected endothelial toxicity. We believe that topical intracameral anesthesia obviates the need for sedation. Difficulties such as dose–effect variability (particularly in the elderly population), possible oversedation, intraoperative sleep–wake cycles with potential for sudden movement, and the need for postoperative monitoring therefore are avoided. We believe that topical intracameral anesthesia without sedation is a safe and efficient technique that is beneficial for the great majority of our patients.Again, we thank the authors for their comments and contribution to this topic. We thank Bellini et al for their comments relating to phacoemulsification complication rates in their practice. Their results add to the body of evidence that demonstrates low complication rates with the use of topical anesthetic. Bellini et al's practice differs from ours in that they use topical anesthesia without intracameral anesthetic for most cases, and needle anesthetic techniques are used for cases of small pupil or dense nuclear cataract, with sedation. In our practice, topical intracameral anesthesia was used for almost all cataract surgeries, including hard nuclear cataracts and those with small pupils. In a recent metaanalysis of randomized controlled trials, the addition of intracameral anesthetic has been shown to minimize intraoperative discomfort,1Ezra D.G. Nambiar A. Allan B.D. Supplementary intracameral lidocaine for phacoemulsification under topical anesthesia A meta-analysis of randomized controlled trials.Ophthalmology. 2008; 115: 455-463Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar and we believe this effect is likely to be more beneficial to these patients. Although we did not perform a subanalysis for patients with small pupil or dense cataract, our low overall rate of complications suggests that topical intracameral anesthesia is appropriate for the vast majority of cataract cases. We have been using intracameral lidocaine as standard for 10 years and have not detected endothelial toxicity. We believe that topical intracameral anesthesia obviates the need for sedation. Difficulties such as dose–effect variability (particularly in the elderly population), possible oversedation, intraoperative sleep–wake cycles with potential for sudden movement, and the need for postoperative monitoring therefore are avoided. We believe that topical intracameral anesthesia without sedation is a safe and efficient technique that is beneficial for the great majority of our patients. Again, we thank the authors for their comments and contribution to this topic. Cataract Surgery Complication RatesOphthalmologyVol. 115Issue 8PreviewWe read with interest the article by Shaw et al1 regarding phacoemulsification complication rates. In their article, the authors argued that phacoemulsification under topical-intracameral anesthesia can be performed by experienced surgeons and less experienced trainees with low complication rates. Full-Text PDF