Author(s): Samyakta Ashok Shetti1, Rekha Mudhol2
To study the efficacy of peribulbar anaesthesia versus topical with intracameral anaesthesia in manual small incision cataract surgery and to compare surgeon’s experience as well as surgical outcome under both techniques.
In a randomised controlled trial conducted at KLES Dr. Prabhakar Kore Hospital and MRC Belgaum from January 2012 to December 2012; 120 patients who met inclusion criteria were randomised into peribulbar group or topical with intracameral group (60 in each). Parameters studied in both the groups were akinesia, analgesia and complications occurring during administration of anaesthesia; surgeon’s experience was evaluated in terms of patient’s cooperation, difficulty while doing surgery due to ocular movements, anterior chamber stability, time taken to complete surgery; surgical outcome was studied with regards to any complications during surgery, best corrected visual acuity at 6 weeks.
Lid akinesia (96.66%) and globe akinesia (100%) was seen only in peribulbar anaesthesia which obviously lacked in topical anaesthesia which was both statistically and clinically significant. Patients in topical group mainly had pain during scleral incision (18.33%), sclera-corneal tunnelling (10%), cortical wash (13.33%) which were statistically and clinically significant compared to peribulbar group. Button holing (3.33%) and posterior capsular rent (3.33%) occurred in topical group due to unexpected eye movement which was clinically significant. Pain scale between both the groups showed no difference during surgery. Most of patients had mild pain 61.66% in peribulbar group and 51.66% patients in topical group. Pain scale was significant in peribulbar group after 4 hrs. of surgery (p<0.001).
Patient cooperation and lesser ocular movements during surgery was better in peribulbar group and also clinically significant. Anterior chamber stability was similar in both the groups. Unwanted ocular movements and lid squeezing were common difficulties faced by surgeon in topical group. Time taken to complete surgery was longer under topical anaesthesia. Best corrected visual acuity 6 weeks postoperatively showed no statistical significant difference in both the groups.
Topical with intracameral anaesthesia can be an alternative to peribulbar anaesthesia for MSICS provided the patient is very cooperative.