Approaching a 100% success rate using topical anesthesia with mild intravenous sedation in phacoemulsification procedures
Dinsmore, S.C.
Ophthalmic Surgery and Lasers 27(11): 935-938
1996
ISSN/ISBN: 1082-3069 PMID: 8938802 Document Number: 469018
Phacoemulsification with topical anesthesia has been accepted by some ophthalmologists as a minimally invasive alternative technique for cataract surgery. This study approaches a 100% success rate using topical anesthesia with mild intravenous (i.v.) sedation in phacoemulsification procedures. Two hundred consecutive patients underwent clear-corneal phacoemulsification. Patients were not preselected. Lidocaine hydrochloride topical anesthesia was supplemented with small-dose i.v. midazolam hydrochloride and/or fentanyl citrate. Patients underwent meticulous preoperative counseling. Those with dementia, deafness, movement disorders, or hyperanxiety, or those who spoke a foreign language or who were young required special management. Additional techniques were employed for ophthalmologic problems such as small pupil, mature cataract, and strong blink/Bell's phenomenon. Patient comfort was noted intraoperatively and postoperatively. Ninety-seven percent of the patients did well, with only 3% requiring regional block or general anesthesia. Using nucleofractis phacoemulsification with special techniques in more difficult situations, most patients were successful with topical anesthesia plus i.v. sedative anesthesia.