Abstract
To the Editor.— I would like to respond to the question asked by Dr Silverman regarding a 79-year-old man with bilateral cataracts who requires surgery and has a chronic sneezing problem. 1 Sneezing cannot occur under general anesthesia. For the past 12 years, most cataract patients operated on by me have had general anesthesia unless this was contraindicated by an internist evaluating the patient's condition preoperatively. This has resulted in 99% of patients having general anesthesia. Second, it is possible that the Valsalva effect of sneezing could cause iris prolapse in a larger-incision cataract surgery. This has been seen even with proper closure, and proper closure cannot always be assured. I have never seen an iris prolapse with phacoemulsification. I would strongly recommend that the safest procedure for this man would be a phacoemulsification cataract extraction with posterior chamber lens implantation done under general anesthesia.
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