Phacoemulsification under Topical Anesthesia in a Tertiary Care Hospital

Abstract

Introduction: The use of topical anaesthesia for cataract surgery dates back to 1884 when Knapp used 5% cocaine to anaesthetize cornea. The advancement in cataract surgery techniques like small stepped, self-sealing corneal incisions, phacoemulsification and advanced intraocular lenses has allowed the use of topical anaesthesia thus reducing surgical time and need of akinesia. Materials and Methods: Prospective non-comparative evaluation of patients’ and surgeon’s satisfaction under topical anaesthesia. All patients received topical anesthesia with proparacaine 0.5%. A 10-point visual analogue scale was given to patients to rate the level of pain felt during the operation. Also, the level of patient satisfaction, the need for supplemental anaesthesia, level of ocular motility, surgical complications and postoperative visual acuity were recorded. Results: Total number of cases were 156 out of which 86 (55.1%) were males and 70 (44.9%) were females. Nuclear sclerosis was most common type of cataract followed by mixed opacities. Majority of patients had no intraoperative movement and 30.8% of patients had some movement. Surgeon was dissatisfied in only 12.2% cases who had disturbing movements during surgery. Although majority of patients felt no pain (68%) or mild pain (23.7%) during surgery 8.3% cases had moderate to severe pain which required supplemental intracameral lidocaine. Conclusion: Topical anaesthesia is cost effective, provides high patient comfort during surgery, is less stressful for the patient, saves considerable time and complications compared to regional anaesthesia. Keywords: topical anaesthesia, phacoemulsification, pain assessment, surgeon`s satisfaction.