Effectiveness of Topical Anesthesia in Patients Undergoing Phacoemulsification Cataract Surgery versus Femtosecond...

To assess the effectiveness of topical anesthesia in patients undergoing phacoemulsification cataract surgery (PCS) and femtosecond laser-assisted cataract surgery (FLACS), and investigate an efficient anesthesia protocol for FLACS.

Non-randomized, prospective cohort study. In this study, patients undergoing cataract surgery self-selected their preferred technique (PCS or FLACS; n = 100 eyes per cohort) and received three topical anesthesia applications prior to phacoemulsification. Those opting for FLACS were randomized to receive the laser phase using either the Catalys (Johnson and Johnson Vision) or LenSx (Alcon Laboratories, Inc.) system, with one topical anesthesia administration before the laser step and two prior to phacoemulsification. Outcome measures included visual analogue scale pain scores, total surgical, anesthesia, and phacoemulsification durations, and anesthesia efficacy.

There was no significant difference in pain perception between the PCS and FLACS groups (P = 0.835). No statistically significant difference was observed in the total surgical duration between the PCS and FLACS groups (P = 0.736). After a single application of topical anesthesia, most patients achieved excellent cooperation during laser procedure with no pain. No significant difference in anesthetic efficacy was observed between the Catalys and LenSx laser systems.

Both PCS and FLACS appeared safe and comfortable under topical anesthesia in this selected cohort. A single application of topical anesthesia was sufficient for the laser step in most FLACS patients, and the protocol of administering additional anesthesia between steps may offer a feasible strategy for workflow optimization. Anesthetic efficacy did not differ between the Catalys and LenSx systems, despite their different patient interface docking mechanisms.