Skip to main content
PMC home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 2000 Jan;84(1):13–15. doi: 10.1136/bjo.84.1.13

Visual experience during phacoemulsification cataract surgery under topical anaesthesia

D Newman 1
PMCID: PMC1723223  PMID: 10611091

Abstract

BACKGROUND/AIMS—Visual awareness during phacoemulsification cataract surgery is an important determinant of patient satisfaction with any anaesthetic technique. Topical anaesthesia could be associated with significant visual awareness because it does not affect optic nerve function.
METHODS—The visual experience during phacoemulsification cataract surgery under topical anaesthesia (without sedation) was assessed for 106 consecutive unselected patients. Patients were interviewed immediately after surgery using a standardised questionnaire that explored specific aspects of their visual experience.
RESULTS—Four patients were excluded because they had poor recollection of their visual experience. The visual awareness of the remaining 102 patients comprised operating microscope light (99), colours (73), flashes of light (7), vague movements (19), surgical instruments or other objects (12), change in light brightness during surgery (49), change in colours during surgery (30), and transient visual alteration during corneal irrigation (25). No patient found their visual experience during surgery unpleasant, though the operating microscope light was uncomfortably bright for two patients. Six patients lost light perception for a short interval during surgery. There was no association between the various visual phenomena reported and patients' age, sex, preoperative visual acuity, cataract morphology, coexisting ocular pathology, or previous experience of cataract surgery under local anaesthesia (p>0.05).
CONCLUSIONS—Patients experience a wide variety of visual sensations during phacoemulsification cataract surgery under topical anaesthesia. Topical anaesthesia does not, however, appear to result in greater visual awareness than regional anaesthesia. Preoperative patient counselling should include information about the visual experience during surgery.



Full Text

The Full Text of this article is available as a PDF (92.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arora R., Verma L., Kumar A., Kunte R. Peribulbar anesthesia and optic nerve conduction. J Cataract Refract Surg. 1991 Jul;17(4):506–508. doi: 10.1016/s0886-3350(13)80860-7. [DOI] [PubMed] [Google Scholar]
  2. Brent B. D., Singh H. The effect of retrobulbar anesthesia on visual acuity in planned extracapsular cataract extraction. Ophthalmic Surg. 1991 Jul;22(7):392–395. [PubMed] [Google Scholar]
  3. Brothers Arbisser L., Wymore J. G. Visual acuity immediately following phacoemulsification with subconjunctival anesthesia. Ophthalmic Surg Lasers. 1996 Jul;27(7):640–642. [PubMed] [Google Scholar]
  4. Chittenden H. B., Meacock W. R., Govan J. A. Topical anaesthesia with oxybuprocaine versus sub-Tenon's infiltration with 2% lignocaine for small incision cataract surgery. Br J Ophthalmol. 1997 Apr;81(4):288–290. doi: 10.1136/bjo.81.4.288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Davis D. B., 2nd, Mandel M. R. Efficacy and complication rate of 16,224 consecutive peribulbar blocks. A prospective multicenter study. J Cataract Refract Surg. 1994 May;20(3):327–337. doi: 10.1016/s0886-3350(13)80586-x. [DOI] [PubMed] [Google Scholar]
  6. Doden W., Bopp M. Optikusblockade durch retrobulbäre Anästhesie. Klin Monbl Augenheilkd. 1984 Apr;184(4):311–312. doi: 10.1055/s-2008-1054474. [DOI] [PubMed] [Google Scholar]
  7. Duguid I. G., Claoué C. M., Thamby-Rajah Y., Allan B. D., Dart J. K., Steele A. D. Topical anaesthesia for phacoemulsification surgery. Eye (Lond) 1995;9(Pt 4):456–459. doi: 10.1038/eye.1995.106. [DOI] [PubMed] [Google Scholar]
  8. Duker J. S., Belmont J. B., Benson W. E., Brooks H. L., Jr, Brown G. C., Federman J. L., Fischer D. H., Tasman W. S. Inadvertent globe perforation during retrobulbar and peribulbar anesthesia. Patient characteristics, surgical management, and visual outcome. Ophthalmology. 1991 Apr;98(4):519–526. doi: 10.1016/s0161-6420(91)32262-0. [DOI] [PubMed] [Google Scholar]
  9. Edge K. R., Nicoll J. M. Retrobulbar hemorrhage after 12,500 retrobulbar blocks. Anesth Analg. 1993 May;76(5):1019–1022. doi: 10.1213/00000539-199305000-00019. [DOI] [PubMed] [Google Scholar]
  10. Esswein M. B., von Noorden G. K. Paresis of a vertical rectus muscle after cataract extraction. Am J Ophthalmol. 1993 Oct 15;116(4):424–430. doi: 10.1016/s0002-9394(14)71399-6. [DOI] [PubMed] [Google Scholar]
  11. Hay A., Flynn H. W., Jr, Hoffman J. I., Rivera A. H. Needle penetration of the globe during retrobulbar and peribulbar injections. Ophthalmology. 1991 Jul;98(7):1017–1024. doi: 10.1016/s0161-6420(91)32164-x. [DOI] [PubMed] [Google Scholar]
  12. Johnston R. L., Whitefield L. A., Giralt J., Harrun S., Akerele T., Bryan S. J., Kayali N., Claoué C. M. Topical versus peribulbar anesthesia, without sedation, for clear corneal phacoemulsification. J Cataract Refract Surg. 1998 Mar;24(3):407–410. doi: 10.1016/s0886-3350(98)80332-5. [DOI] [PubMed] [Google Scholar]
  13. Levin M. L., O'Connor P. S. Visual acuity after retrobulbar anesthesia. Ann Ophthalmol. 1989 Sep;21(9):337–339. [PubMed] [Google Scholar]
  14. Maclean H., Burton T., Murray A. Patient comfort during cataract surgery with modified topical and peribulbar anesthesia. J Cataract Refract Surg. 1997 Mar;23(2):277–283. doi: 10.1016/s0886-3350(97)80354-9. [DOI] [PubMed] [Google Scholar]
  15. Mandelcorn M. S., Mandelcorn E., Ananthanarayan C., Fleming I. M. Some observations concerning visual perception during vitrectomy after retrobulbar anesthesia. Can J Ophthalmol. 1997 Jun;32(4):255–256. [PubMed] [Google Scholar]
  16. Manners T. D., Burton R. L. Randomised trial of topical versus sub-Tenon's local anaesthesia for small-incision cataract surgery. Eye (Lond) 1996;10(Pt 3):367–370. doi: 10.1038/eye.1996.75. [DOI] [PubMed] [Google Scholar]
  17. Murdoch I. E., Sze P. Visual experience during cataract surgery. Eye (Lond) 1994;8(Pt 6):666–667. doi: 10.1038/eye.1994.164. [DOI] [PubMed] [Google Scholar]
  18. Nicoll J. M., Acharya P. A., Ahlen K., Baguneid S., Edge K. R. Central nervous system complications after 6000 retrobulbar blocks. Anesth Analg. 1987 Dec;66(12):1298–1302. [PubMed] [Google Scholar]
  19. Nielsen P. J., Allerød C. W. Evaluation of local anesthesia techniques for small incision cataract surgery. J Cataract Refract Surg. 1998 Aug;24(8):1136–1144. doi: 10.1016/s0886-3350(98)80110-7. [DOI] [PubMed] [Google Scholar]
  20. Nielsen P. J. Immediate visual capability after cataract surgery: topical versus retrobulbar anesthesia. J Cataract Refract Surg. 1995 May;21(3):302–304. doi: 10.1016/s0886-3350(13)80137-x. [DOI] [PubMed] [Google Scholar]
  21. Patel B. C., Burns T. A., Crandall A., Shomaker S. T., Pace N. L., van Eerd A., Clinch T. A comparison of topical and retrobulbar anesthesia for cataract surgery. Ophthalmology. 1996 Aug;103(8):1196–1203. doi: 10.1016/s0161-6420(96)30522-8. [DOI] [PubMed] [Google Scholar]
  22. Rainin E. A., Carlson B. M. Postoperative diplopia and ptosis. A clinical hypothesis based on the myotoxicity of local anesthetics. Arch Ophthalmol. 1985 Sep;103(9):1337–1339. doi: 10.1001/archopht.1985.01050090089038. [DOI] [PubMed] [Google Scholar]
  23. Roman S., Auclin F., Ullern M. Topical versus peribulbar anesthesia in cataract surgery. J Cataract Refract Surg. 1996 Oct;22(8):1121–1124. doi: 10.1016/s0886-3350(96)80129-5. [DOI] [PubMed] [Google Scholar]
  24. Ropo A., Ruusuvaara P., Setälä K. Visual evoked potentials after retrobulbar or periocular anaesthesia. Br J Ophthalmol. 1992 Sep;76(9):541–544. doi: 10.1136/bjo.76.9.541. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Schimek F., Steuhl K. P., Fahle M. Retrobulbar blockade of somatic, motor, and visual nerves by local anesthetics. Ophthalmic Surg. 1993 Mar;24(3):171–180. [PubMed] [Google Scholar]
  26. Scott R. A., Acharya P. A., Jakeman C. M., Perry S. R. Peribulbar anaesthesia. Br J Ophthalmol. 1994 Jul;78(7):592–592. doi: 10.1136/bjo.78.7.592. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Shammas H. J., Milkie M., Yeo R. Topical and subconjunctival anesthesia for phacoemulsification: prospective study. J Cataract Refract Surg. 1997 Dec;23(10):1577–1580. doi: 10.1016/s0886-3350(97)80032-6. [DOI] [PubMed] [Google Scholar]
  28. Steinert R. F., Oster J. G., Francis J. M. Postoperative retinal ischemia with self-sealing cataract surgery incisions. Am J Ophthalmol. 1997 Jan;123(1):124–125. doi: 10.1016/s0002-9394(14)71004-9. [DOI] [PubMed] [Google Scholar]
  29. Talks S. J., Chong N. H., Gibson J. M., Francis I. R. Visual acuity and pupillary reactions after peribulbar anaesthesia. Br J Ophthalmol. 1994 Jan;78(1):41–43. doi: 10.1136/bjo.78.1.41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Verma L., Arora R., Kumar A. Temporary conduction block of optic nerve after retrobulbar anesthesia. Ophthalmic Surg. 1990 Feb;21(2):109–112. [PubMed] [Google Scholar]
  31. Zehetmayer M., Radax U., Skorpik C., Menapace R., Schemper M., Weghaupt H., Scholz U. Topical versus peribulbar anesthesia in clear corneal cataract surgery. J Cataract Refract Surg. 1996 May;22(4):480–484. doi: 10.1016/s0886-3350(96)80046-0. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES