Changing trends of ocular anaesthesia in phaco-emulsification surgery

This study was undertaken prospectively to assess the safety and effectiveness of topical anaeshthesia over sub-tenon and peribulbar anaesthesia during routine phaco-emulsification surgery. One hundred and fifty eyes undergoing clear corneal phaco-emulsification were randomly divided into 3 groups. Pain was assessed subjectively by the patients during introduction of anaesthetic agent, also intra-operatively and 2 hours postoperatively on a visual analogue scale of 0 to 4 by the visual descriptive method. Ocular akinesia at the beginning and during the surgery was recorded by the operating surgeon. Any intra-operative complication was also noted at the end of the surgery. This analysis showed that topical anaesthesia caused no pain at all in 98% and sub-tenon anaesthesia caused minimum or no pain in 92% during introduction of anaesthetic agent as opposed to peribulbar (42%) and two values were also statistically significant. Sub-tenon and peribulbar anaesthesia provided significantly more intra-operative akinesia as compared to topical, the rate of intra-operative complications was comparable in all the 3 groups. So the recent trend of topical anaesthesia in phacosurgery is a safe and efficient alternative to sub-tenon and peribulbar anaesthesia.