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  • Comprehensive Ophthalmology

    This meta-analysis in the April issue of Ophthalmology compared clinical outcomes and pain levels for phacoemulsification procedures during which topical anesthesia (TA) or regional anesthesia, including retrobulbar anesthesia (RBA) and peribulbar anesthesia (PBA), were used. The authors found that TA does not provide the same high level of pain relief during cataract surgery as RBA/PBA, although surgical outcomes were similar. However, they conclude that use of TA reduces injection-related complications and alleviates patients' fear of injection.

    The authors performed a literature search for randomized controlled trials of phacoemulsification under TA or RBA/PBA that report clinical outcomes. They included in the current review 15 studies reporting on 1084 TA eyes and 1121 RBA/PBA eyes.

    Intraoperative and postoperative pain perception was significantly higher in the TA group (P < 0.05), with these patients showing more frequent inadvertent ocular movement (P < 0.05) and a greater intraoperative need for supplementary anesthesia (P = 0.03). However, patients significantly preferred TA (P < 0.00001).

    There was no statistically significant difference between the two groups in surgeon-assessed intraoperative difficulties (P > 0.05). The RBA/PBA group had more frequent anesthesia-related complications, such as chemosis, periorbital hematoma and subconjunctival hemorrhage (P < 0.05), but surgery-related complications were similar (P > 0.05).

    The authors conclude that while TA does not provide pain relief as effectively as RBA/PBA during cataract surgery, its anesthetic effect is reasonably well tolerated by patients. However, they say that TA is not suitable for patients with a higher initial blood pressure or greater pain perception. They advise that there is not one type of anesthesia that is right for all potential cases, with the best choice varying from surgeon to surgeon on the basis of experience and predilection, and from patient to patient.