This study by investigators at the Universities of Manitoba, Ottawa and Calgary 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.

In a retrospective interventional case series of patients visiting the Brandon Regional Health Centre, Brandon, Manitoba, between 2001 and 2003, those 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. A total of 538 eyes of 373 patients were included in the study. Oral sedation was via lorazepam, and an anesthetist was available to manage any medical adverse events. Topical anesthesia was achieved with 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.

No medical adverse events were reported in 454 cases (84.4 percent); 84 patients (15.6 percent) experienced adverse events, classified as mild in 13.5 percent, moderate in 1.1 percent and severe in 0.9 percent (5 cases). The most common adverse event was mild pain, experienced in 69 procedures (12.8 percent). Moderate pain, necessitating use of intracameral 1% lidocaine, occurred in three procedures (0.6 percent).

Based on these results, the authors suggest that topical anesthesia is a safe alternative to injection anesthesia without many of the disadvantages of the latter, and that it may be preferable in carefully selected patients.

A 25-gauge transconjunctival sutureless vitrectomy, visualization of the vitreous with triamcinolone acetonide, protection of the macular hole with autologous whole blood and staining of the ILM using indocyanine green are safe and efficient techniques for macular hole repair, according to a study by researchers in Pisa, Italy.

Eighty-four eyes of 77 consecutive patients with idiopathic macular hole were operated on using a transconjunctival sutureless 25-gauge vitrectomy system. Surgeons performed a complete vitrectomy in each patient using triamcinolone acetonide to visualize the vitreous gel and to remove the posterior vitreous cortex. The macular hole was covered with autologous whole blood, and the internal limiting membrane (ILM) was stained with indocyanine green. The ILM was peeled and a fluid-air exchange performed. The globe was filled with gas, and the patient was kept in a prone position for one week. Surgery-related complications, macular hole closure on optical coherence tomography (OCT) and visual outcome were evaluated.

Results showed no intraoperative or postoperative complications. It was noted in particular that sclerotomies did not require sutures. No postoperative hypotony or endophthalmitis was observed. OCT showed macular hole closure in 93 percent of the cases. The median preoperative best-corrected visual acuity was 20/200 and improved significantly to a median best-corrected visual acuity of 20/67 (median follow-up 6.5 months).