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Abstract
Topical anaesthesia avoids serious complications of orbital injectable anaesthesia and it is effective in small incision phacoemulisification. The aim of this thesis was to assess the safety and the efficacy of topical or cicumcorneal perilimbal anaesthesia versus peribulbar anaesthesia (Control group) in patients undergoing cataract surgery by phacoemulsification. 100 cases were selected out of patients presenting with senile cataract at the Ophthalmic Out patients Clinics of Zagazig University Hospitals with exclusion of patients unsuitable for local anaesthesia and for phacoemulisification. Preoperative assessment included assessment of ocular motility, IOP measurement, slit lamp examination, visual acuity testing, fundus examination, ultrasonography and general examination. The patients were assigned randomly to have either topical anaesthesia (group A) or peribulbar anaesthesia (group B). Each group included 50eyes. group A was subdivided into group A1 (which included 25 eyes received topical anaesthesia by oxybuprocaine HCL 0.4% eye drops) and group A2 (which included 25 eyes received topical anaesthesia by soaked sponge in 2% lidocaine to obtain cicumcorneal perilimbal anaesthesia). Of the patients included in this study 42 were women (42%) and 58 were men (58%). Their ages ranged from 45 to 72 (mean=57.74 years). The mean IOP in group B increased after the injection by 10.92 mmHg which was highly significant but after compression by Honan’s Balloon, the mean IOP showed significant decrease by 13.76mmHg. While in group A1 and A2, no changes in IOP was recorded after using of the anaesthesia. No intraoperative pain was reported at any step of operation (P6) in 68% of cases in group A1, 72% in group A2 versus 90% of cases of group B, with difference between the three groups was statistically significant. The difference between the three groups was not statistically significant in relation to the total number of patients recorded in the three scores of pain (P>0.05). The unwanted ocular motility was recorded in 56% of cases in group A1, 52% in group A2 and 8% in group B, the difference between the three groups was statistically significant (X2=24.82) (P<0.001)*. The difference was not statistically significant between the three groups in the total number of patients scored according to cooperation. The intraoperative complications were minimal, with no statistical significant difference found between the three groups. The intracameral lidocaine was needed for 5 patients (20%) in group A1 and 5 patients (20%) in group A2. The intracameral lidocaine with intravenous fentanyl was needed for 2 patients (8%) in group A1 and 1 patient (4%) in group A2. While 5 patients (20%) in group B needed intravenous fentanyl. The results of supplementation either by intracameral lidocaine or intravenous fentanyl were excellent in improved cooperation of the patient and increase comfort of the patient by reducing pain. Pain two hours after the operation was reported in 64% of cases of group A1, 60% of group A2 and 42% of group B. The difference was not significant. Patient comfort and surgery related complications did not differ between topical anaesthesia and peribulbar anaesthesia. Thus, from this study we conclude that the advantages of topical anaesthesia is high efficacy without the use of sophisticated technique of anaesthesia, shorter patient preparation times, faster visual rehabilitation and low incidence of complications. Also topical anaesthesia reduces anxiety from needle injection. Topical anaesthesia are effective, safe and comfortable for the patients comparably with peribulbar anaesthesia. Surface anaesthesia and circumcorneal perilimbal anaesthesia are sufficient to perform safety surgery without patient discomfort or pain. We observed that the results of circumcorneal anaesthesia were slightly superior to the results of surface anaesthesia.