Pain control, visual sensation, and visual outcome for phacoemulsification using topical anesthesia without sedation

Aim: To study the analgesic effect, subjective visual experience, and visual outcome of phacoemulsification and posterior chamber intraocular lens implantation using topical anesthesia without systemic sedation for uncomplicated cataract. Patients and methods: Eighty one eyes of 81 consecutive patients with uncomplicated cataract undergoing phacoemulsification and posterior chamber intraocular lens implantation were recruited. Xylocaine jelly 2% was used for topical anesthesia. No sedation was used. Analgesic effect was assessed by patients’ pain score, eyelid squeezing, verbal expression of pain, intraoperative elevation of blood pressure and pulse, need for supplementary anesthetic, and postoperative analgesic. The patients were interviewed immediately after operation for their subjective visual experiences of the operated eyes during surgery. Their visual acuities 3 months after operation were recorded. Results: Sixty one patients (75.3%) had pain scores of 0 (no pain). One patient (1.2%) verbally expressed discomfort during operation. Seventy eight patients (96.3%) had no eyelid squeezing. None of the patients had a significant increase in pulse rate and blood pressure. No supplementary anesthetic or postoperative analgesic was needed for any of the patients. Five patients (6.2%) reported absence of visual sensation during the operation. For the remaining 76 patients, 8 (9.9%) saw moving objects or instruments, 2 (2.5%) saw shadow and 2 (2.5%) saw a line or lattice pattern. No patients reported the visual sensation as threatening. All except 2 patients had improved visual acuity 3 months after operation. Conclusions: Xylocaine 2% jelly without the use of sedative provides satisfactory anesthesia with favorable visual outcome for phacoemulsification and posterior chamber intraocular lens implantation for uncomplicated cataract. Patients experience a variety of visual sensations during the operation that are non-threatening.