Cataract surgery under topical anesthesia in patients with coexisting glaucoma

Area of Science:

• Ophthalmology
• Surgical Anesthesia

Background:

• Glaucoma patients often have co-existing cataracts requiring surgical intervention.
• Topical anesthesia is increasingly used for cataract surgery, but its safety and efficacy in glaucoma patients require evaluation.

Purpose of the Study:

• To compare patient discomfort and complications during phacoemulsification with foldable intraocular lens (IOL) implantation using topical lidocaine hydrochloride in patients with and without glaucoma.
• To assess the safety and tolerability of topical anesthesia in glaucoma patients undergoing cataract surgery.

Main Methods:

• A prospective, nonrandomized comparative study was conducted at two German university eye centers.
• 176 eyes of patients with chronic open-angle or angle-closure glaucoma and 212 control eyes underwent phacoemulsification and IOL implantation.
• All patients received topical lidocaine hydrochloride 2% anesthesia; no intracameral anesthetic or systemic sedatives were used.

Main Results:

• Intraoperative complication rates (capsule tear, zonule tear, vitreous loss, iris prolapse) were low and not significantly different between glaucoma and control groups.
• Mean pain scores were comparable between the glaucoma (0.38 ± 1.1) and control (0.36 ± 0.8) groups (P =.21).
• Patient preference for topical anesthesia was similar in both groups.

Conclusions:

• Phacoemulsification and IOL implantation under topical anesthesia demonstrate similar complication rates and patient discomfort in patients with and without glaucoma.
• Topical anesthesia is a safe and effective option for routine cataract surgery in patients with glaucoma.
• This approach does not compromise patient comfort or increase surgical risks in the glaucoma population.