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Cataract surgery anaesthesia

Cataract surgery anaesthesia is an important issue for patients. There is strong anecdotal evidence that some patients needlessly avoid having cataract surgery, persisting with inferior vision, because of concerns about the anaesthetic.

Anaesthetic options for cataract surgery include:

  • General
  • Injectional
  • Topical

Some patients still believe general anaesthesia, with possible associated systemic risks in some elderly patients or those with chronic diseases, is required for cataract surgery. This is incorrect. General anaesthesia is now only used for cataract surgery in young children or patients with significant cognitive impairment.

Some patients remain concerned about the risks or potential discomfort of injections of anaesthetic around the eye. These “peribulbar injections” are a form of local anaesthesia of the eye and eye socket. Although rare, problems can arise if the injection occurs into the eye, eye muscles, or into the nerve between eye and brain, or if local blood vessels are severed.

Happily no injections are really needed to achieve local anaesthesia of your eye. A numb eye can be achieved with anaesthetic drops on your eye, with a little anaesthetic placed inside your eye with a cannula before removal of your cataract. This way with topical “no needle”anaesthesia, injections around your eye are not required.

Instead of anaesthetic drops, some practices have used an anaesthetic gel to numb patients’ eyes prior to cataract surgery. The problem with gels is that antiseptic povidine-iodine, which reduces the bacterial count around your eye before and after cataract surgery, may not work so well if the gel prevents povidine-iodine making full contact with your eye and eye lashes and eye lids.

Now a study by Xia et al published in the Journal of Cataract and Refractive Surgery 020, July, pp1047-1050 suggests a combination anaesthetic (lidocaine) and povidine-iodine gel may solve this problem, providing good anaesthesia and antisepsis at the same time, with the discomfort of multiple drops to achieve the same effect.

At this stage only laboratory evidence is available to support this concept and human trials to test the behaviour of the mixture gel on the human eye surface are yet to be undertaken. At Cataract Surgery SA we will watch closely and hope we may use this mixture gel soon to provide an even more comfortable surgical journey for our cataract patients.