Systematic Use of Topical Anaesthesia for Cataract Surgery: A Long Term Study About 3000 Consecutive Cases

Abstract

Abstract: : Purpose: the authors try to demonstrate that topical anaesthesia can be systematically used for cataract surgery.They give the results of a retrospective study about 3000 consecutive cases of cataract surgery using simple topical anaesthesia, with tetracaine eyedrops. Methods: it's a retrospective study from January 2002 to November 2004, including 3000 cases of only cataract surgery. The surgeon was the same for all the procedures, and all patients underwent clear corneal phacoemulsification and implantation of a foldable intraocular lens. The method of anaesthesia was systematically a topical one using 1 oxybuprocaine 0.4% preserved eyedrop 10 minutes before corneal incision, and 3 tetracaine 1% unpreserved eyedrops 5 minutes before incision. The authors relate the cases of patients needed complementary intravenous sedation or additional peribulbar injection. We relate also the mean characteristics of the 3000 procedures and the observed complicatons. Results: the mean age of the patients was 78.4 years old (range from 29 to 98 years old). The sex ratio was 0.45 with 68.8 % of women, and the procedure was performed in a mean time of 12.8 minutes. Only 52 peribulbar additional injections (1.73 %) and 105 intravenous sedation (3.5 %) were necessary, essentially for bad cooperation, difficulties of language comprehension or big stress. General anaesthesia was indispensable in 6 cases (0.2%)(patients presenting a 21 trisomia). The complications related where: 1 postoperatory endophtalmis (0.03%), 12 capsule breakings (0.4 %), 2 corneal superficial ulcerations (0.06 %) and 32 superficial keratitis (1 %). All these complications were without concequence for the final visual acuity. Conclusions: topical anaesthesia can be proposed for nearly all the patients undergoing cataract surgery apart for the ones suffering from diseases limiting their cooperation.The topical eyedrops anaesthesia seem to be a safety, reproductible and simply method, without important risk of endophtalmis or great complications, to manage simple cataract surgery, with minimal discomfort for patients in experimented hands.

Keywords: cataract • small incision cataract surgery • clinical (human) or epidemiologic studies: systems/equipment/techniques