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Anterior Subconjunctival Anesthesia for Manual Small Incision Cataract Surgery: A Randomized Controlled Trial.

K Ajay¹, Revuru Kanaka Subhasree², Avinash Poka²

¹Department of Ophthalmology, The Oxford Medical College Hospital and Research Center, Bengaluru, Karnataka, India.

Journal of Current Ophthalmology

|November 12, 2021

Summary

Anterior subconjunctival anesthesia (ASCA) is effective for manual small incision cataract surgery (MSICS), offering adequate pain relief. However, it does not ensure akinesia, particularly in patients with deep-set eyes.

Keywords:

Anesthesia Cataract Clinical trial

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Area of Science:

Ophthalmology
Anesthesia
Surgical Techniques

Background:

Cataract surgery requires effective anesthesia for patient comfort and surgical success.
Manual small incision cataract surgery (MSICS) is a common procedure.
Comparing different anesthesia techniques is crucial for optimizing surgical outcomes.

Purpose of the Study:

To compare anterior subconjunctival anesthesia (ASCA) with sub-tenon's anesthesia (STA) for MSICS.
Evaluate differences in pain, akinesia, surgeon comfort, and complications between ASCA and STA.

Main Methods:

A randomized trial involving 164 patients undergoing MSICS.
Patients were assigned to either ASCA (Group 1) or STA (Group 2).
Anesthesia complications, ocular motility, patient-reported pain, and surgeon discomfort were assessed.

Main Results:

ASCA induced chemosis and persistent ocular motility in all patients but did not impede MSICS.
Both ASCA and STA provided good pain control, with 94% and 96.4% of patients reporting mild or no pain, respectively.
Surgeon discomfort was higher with ASCA (17.2%) compared to STA (3.6%), particularly in patients with deep-set eyes or excessive movement.

Conclusions:

Anterior subconjunctival anesthesia (ASCA) is a safe and effective option for MSICS.
ASCA provides adequate anesthesia but does not achieve akinesia.
STA may be preferred for patients with deep-set eyes or those exhibiting anxiety during cataract surgery.