Circumferential perilimbal anesthesia for combined cataract glaucoma surgery

A topical-subconjunctival anesthesia technique named circumferential perilimbal anesthesia was tested in a consecutive series of 34 combined cataract and glaucoma cases to determine effectiveness in long duration anterior segment surgery.

The circumferential perilimbal technique for combined surgery involved administration of 4% topical Xylocaine drops and injection of 0.25 cc of 4% Xylocaine subconjunctivally 3-4 mm inferior to the limbus. The inferior subconjunctival anesthesia was then spread 360 degrees around the limbus circumferentially with a smooth forceps. The topical and local anesthetic was supplemented by intravenous preoperative and intraoperative sedative and analgesic medications.

All patients had successful phacoemulsification cataract extraction with intraocular lens combined with trabeculectomy. Medical records and postoperative interviews of the combined cataract-glaucoma cases revealed an average surgery time of 46 minutes (range 35 minutes-60 minutes) and only one incident of patient intraoperative pain.

The circumferential perilimbal technique was an effective anesthesia technique for long duration combined cataract and glaucoma surgery.