Safety of cataract surgery under topical anesthesia with oral sedation without anesthetic monitoring

Abstract

Purpose: The current study was conducted to determine whether topical anesthesia with oral sedation and without an anesthetist present in the operating room is a safe and cost-effective strategy for low-risk patients undergoing cataract surgery.

Methods: This retrospective interventional case series included cases conducted between 2001 and 2003 at the Brandon Regional Health Centre in Brandon, Manitoba. Patients with visually significant cataracts were screened for study inclusion by using the following criteria: good general health, good dilation, moderate cataracts, cooperation with in-office tests and procedures, and understanding of cataract surgery. Oral sedation was provided by lorazepam, and an anesthetist was available to manage any medical adverse events. Topical anesthesia was achieved by means of tetracaine drops, lidocaine hydrochloride jelly, and intracameral lidocaine hydrochloride, as necessary. Main outcome measures were heart rate, systolic and diastolic blood pressure, oxygen saturation, intraoperative complications, and medical adverse events necessitating anesthetist intervention.

Results: A total of 538 eyes of 373 patients were included in the cataract surgery case series. No medical adverse events were reported in 454 cases (84.4%); 84 patients (15.6%) experienced adverse events, classified as mild in 13.5%, moderate in 1.1%, and severe in 0.9% (5 cases). The most common adverse event was mild pain, experienced in 69 procedures (12.8%). Moderate pain, necessitating use of intracameral 1% lidocaine, occurred in 3 procedures (0.6%).

Interpretation: Topical anesthesia appears to be a safe alternative to injection anesthesia without many of the disadvantages of the latter and may be preferable in carefully selected patients.