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AG John, T John, J Roig; Easy Topical Anesthesia Technique For Clear Cornea Phacoemulsification . Invest. Ophthalmol. Vis. Sci. 2002;43(13):362.
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Purpose: To describe an easy, intraoperative, three-step, topical anesthesia technique for clear corneal phacoemulsification. Methods: Eight hundred and seventy-six consecutive clear-corneal, single-port, phacoemulsifications were performed using the topical anesthesia technique described here. There were 518 females. The average patient age was 73.11 yr. (range, 36-93 yr). All anesthesia was administered in the operating room, which eliminates the need to administer topical anesthesia to the patient in the holding area. Step 1: Mild intravenous sedation was induced with 1 mg of midazolam and 10 mg of propofol. This is administered by the anesthesiologist when the surgeon enters the operating room and begins to don the surgical gown. Step 2: The surgeon applied a preservative-free-lidocaine (1%)-soaked Weck cell sponge to the peripheral cornea and limbus 360 degrees, under the operating microscope, for local anesthesia. Step 3: Following clear-corneal keratome entry into the anterior chamber, preservative-free lidocaine 1%, 0.75 cc, was injected into the anterior chamber from the temporal quadrant directed at the 7, 9, and 11 o'clock positions for intraocular anesthesia. Surgery is then performed in the usual manner. Results: This technique of topical anesthesia provided effective anesthesia for clear-corneal phacoemulsification in all cases, including for 4-plus, brunescent, mature cataracts. Iris retractors were used when needed without patient discomfort or pain. Conclusion: This reproducible, easy, three-step, simplified, topical anesthesia technique is effective, can be used for all clear-corneal phacoemulsification procedures, and eliminates the need for peribulbar or retrobulbar anesthesia.
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