Commentary
Topical Anaesthesia for Cataract Surgery: A Promising Reality
Rajat Mohan Shrivastava and Sanjiv Kumar Gupta*
Corresponding Author: Dr. Sanjiv Kumar Gupta, Professor, Department of Ophthalmology, King Georges Medical University, UP, India
Received: May 31, 2018; Revised: December 28, 2018; Accepted: June 29, 2018
Citation: Shrivastava RM & Gupta SK. (2018) Topical Anaesthesia for Cataract Surgery: A Promising Reality. Int J Anaesth Res, 1(1): 13.
Copyrights: ©2018 Shrivastava RM & Gupta SK. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Cataract is the commonest cause of reversible blindness and cataract surgery is the commonest ophthalmic surgery performed worldwide. Over the years, cataract surgery has undergone tremendous technical advancements which have made the surgery safe and effective than ever before. Today, with small incision cataract surgery and foldable intra-ocular lens (IOL), not only have patient’s postoperative expectations raised, perioperative experience has improved too. The western ophthalmology practice has observed a shift in the anaesthesia technique during cataract surgery over the last decade. From a predominant peribulbar and retrobulbar anaesthesia, today more and more cataract surgeries are now performed under topical-intracameral anaesthesia. A major cause for such a shift has been a higher associated vision and life threatening complication rate with peri-bulbar and retro-bulbar techniques. Secondly, the need of akinesia during surgery to prevent squeezing of extra-ocular muscles and expulsion of globe contents has been reduced with small incisions. Today, medical literature conclusively points to the safety and efficacy of topical anaesthesia in routine cataract surgery practice.

Overcoming cataract related blindness is a major national prerogative. The Government of India, through the National Program for Control of Blindness (NPCB) aims to reduce the burden of cataract related blindness. Conducting outreach screening programmes for cataract and hospital base surgery is a standard model widely adopted to meet the goals of the program. In India today, manual small incision cataract surgery with IOL implantation under peri or retro-bulbar anaesthesia is the standard procedure for eye camp cataract surgery. Unfortunately, some of the studies have also pointed to additional complications which arise out of the anaesthesia technique during surgery like conjunctival chemosis, lid hematoma, raised intra-ocular pressure (Hard Eye). In the recent past, studies conducted in India have found topical-intracameral anaesthesia to be equally safe and effective while performing phacoemulsification or manual small incision cataract surgery (MSICS). Studies have also shown comparable surgical outcome and patient comfort with topical-intracameral anaesthesia both for MSICS and phacoemulsification in routine elective patients.

With an ever-increasing social outreach programs and related eye surgeries, it is now time for us to consider modifications in our practice which may further reduce the complications. It is time when we should consider topical-intracameral anaesthesia for our outreach program patients. ‘Topical Anaesthesia in High Volume Cataract Surgery: Pain evaluation and feasibility study’ [1] clearly outlines that the benefit of topical anaesthesia can be safely extended to our camp patients. It is time we reconsider our choices and overcome the mental block with topical anaesthesia. With studies highlighting the benefits of small incision and topical-intracameral anaesthesia, is it really worthy to expose our patients to an additional risk of peribulbar or retrobulbar anaesthesia? Well, the answer lies within us. Cataract surgery under topical anaesthesia is a promising reality.

1.  Gupta SK, Kumar A, Sharma AK, Agrawal S, Katiyar V, et al. (2015) Topical anesthesia in high volume cataract surgery: Pain evaluation and feasibility study. J Anesth Clin Res 6: 582.