Comparison of topical versus peribulbar anaesthesia for manual small incision cataract surgery with intraocular lens implantation

Biby Joseph, Bindu Thampi, Antony Joosadima, Jayaprasad Bhaskaran, Remya Raghavan


Background: Manual small incision cataract surgery (MSICS) is an alternative to phacoemulsification for high volume cataract surgery especially in developing countries. Aim of this study is to compare patient and surgeon satisfaction, anaesthesia related and post-operative complications following topical (TA) versus peribulbar anaesthesia (PA) for MSICS with intraocular lens (IOL) implantation.

Methods: Observational study was done over a period of six months. Patients who underwent MSICS under TA and PA were prospectively evaluated for satisfaction with anaesthesia intraoperatively and four hours after surgery through a questionnaire. Any intraoperative or post-operative complications were also assessed. Surgeon satisfaction was also assessed by a questionnaire.

Results: Out of 62 patients 28 underwent MSICS under TA and 34 patients under PA. There was no significant difference in age and co-morbidities between two groups. 88.24% had mild pain and 11.76% had moderate pain during PA which was statistically significant (P<0.05). 17.9% patients in TA group had mild pain at 4 hours while only 2.9% patients in PA group had pain (p<0.05). The intra operative complications were not significant. There was no statistically significant difference in post-operative complications and surgeon satisfaction between two groups.

Conclusions: Although the administration of PA is painful compared to TA, the patient satisfaction was more post operatively in PA group. TA is a safe and effective alternative to PA in MSICS with proper selection and education of patient.


Manual small incision cataract surgery, Peribulbar anaesthesia, Topical anaesthesia

Full Text:



Dole K, Kulkarni S, Shisode KD, Deshpande R, Kakade R, Khanderkar R, et al. Comparison of clinical outcomes, patient and surgeon satisfaction following topical versus peribulbar anaesthesia for phacoemulsification and intraocular lens implantation: A randomised, controlled trial. Indian J Ophthalmol. 2014;62:927-30.

Nauman A, Zahoor A, Saeed AM, Saba J, Waleed R. satisfaction level with topical vs peribulbar anesthesia experienced by same patient for phacoemulsification: Saudi J Anesthesia. 2012;6:363-6.

Canavan KS, Dark A, Garrioch MA. Sub-Tenon’s administration of local anaesthetic: a review of the technique. Br J Anaesth. 2003;90:787-93.

Kershner RM. Topical anesthesia for small incision self-sealing cataractsurgery. A prospective evaluation of the first 100 patients. J Cataract Refract Surg. 1993;19: 290-2.

Ahmad N, Zahoor A, Motowa SA, Jastaneiah S, Riad W. Satisfaction level with topical anaesthesia experienced by same patient for phacoemulsification. Saudi J Anaest. 2012;6:363-6.

Zhao LQ, Zhu H, Zhao PQ, Wu QR, Hu YQ. Topical anaesthesia versus regional anaesthesia for cataract surgery: A meta-analysis of randomized controlled trials. Ophthalmology. 2012;119:659-67.

Kallio H, Uusitalo RJ, Maunuksela EL. Topical anesthesia with or without propofol sedation versus retrobulbar/peribulbar anesthesia for cataract extraction: Prospective randomized trial. J Cataract Refract surgery. 2001;1372-9.

Gills JP, Cherchio M, Raanan MG. Unpreserved lidocaine to control discomfort during cataract surgery using topical anesthesia. J Cataract Refract Surg. 1997;23:545-50.

Pablo LE, Ferreras A, Perez-Olivan S, Polo V, Honrubia FM. Comparison of the efficacy and safety of contact versus peribulbar anaesthesia in combined eye surgery. Ophthalmologica. 2009;223:60-7.

Sauder G, Jonas JB. Topical versus peribulbar anaesthesia for cataract surgery. Acta Ophthalmol Scand. 2003;81:596-9.

Fukasaku H, Marror JA. Pinpoint anesthesia; a new approach to local ocular anaesthesia. J Cataract Refract surg. 1994;20:468-71.

Syed Z, Malik TM, Malik AM, Khan DA, Ejas U, Farooq A. Peribulbar versus topical anaesthesia for cataract surgery;Patient’s satisfaction. Pak J Ophthalmol. 2014;30(2).

Pablo LE, Ferreras A, Perez-Olivan S, Larrosa JM, Gomez ML, Honrubia FM. Contact-topical plus intracameral lidocaine versus peribulbar anesthesia in combined surgery.A randomized clnical trial.J Glaucoma. 2004;13:510-5.

Johnston RL, Whitefield LA, Giralt J, Harrun S, Akerele T, Bryan SJ, et al. Topical versus peribulbar anesthesia, without sedation, for clear corneal phacoemulsification. J Cataract Refract Surg. 1998;24:407-10.

Heurmann T, Anders N, Rieck P, Hartmann C. Peribulbar anaesthesia versus topical anaesthesia in cataract surgery: comparison of the post-operative course. Ophthalmologe. 2000;97:189-93.

Malik A. Efficacy and Performance of Various Local Anaesthesia Modalities for Cataract Surgery. J Clinic Experiment Opthalmol. 2013. S1:007. doi:10.4172/2155-9570.S1-007.

Jacobi PC, Dietlein TS, Jacobi FK. A comparative study of topical vs retrobulbar anesthesia in complicated cataract surgery. Arch Ophthalmology. 2000;118:1037-43.

Dannaker CJ, Maibach HI, Austin E. Allergic contact dermatitis to proparacaine with subsequent cross-sensitization to tetracaine from ophthalmic preparations. Am J Contact Dermat. 2001;12:177-9.