Anesthesiologist: Pain reduction important for cataract surgery

MIAMI — The technology of cataract surgery has come a long way since the time of couching, but even if surgeons are no longer removing cataractous lenses using sharpened sticks they still need to take care in "reducing the sting" for their patients, according to an anesthesiologist speaking here.

That "sting" — the intra- and postoperative pain experienced by patients — can be reduced with a variety of anesthetic approaches, including topical anesthesia, intravitreal anesthesia injection and general anesthesia, said Steven I. Gayer, MD, an associate professor of clinical anesthesiology at the University of Miami's Leonard M. Miller School of Medicine.

Dr. Gayer spoke about approaches to anesthesia during cataract surgery at the Bascom Palmer Eye Institute's Inter-American Course in Clinical Ophthalmology.

"The advantage of topical anesthesia is that it is quick, simple and noninvasive, and the patient retains the ability to see," Dr. Gayer said. "It is simple for uncomplicated or brief procedures where an experienced ophthalmologist is working in selected cooperative patients."

In most cases, the first drop of topical anesthetic stings, so some surgeons dilute that first drop to reduce anesthesia-related pain for their patients, he said.

General anesthesia may be more appropriate for cataract surgery in patients with special needs, such as children, Dr. Gayer said. One advantage with general anesthesia is that patients do not experience the sting associated with topical anesthetics. But, "regardless of their amount of discomfort, [these patients] will rub their eyes and cause disruption of the delicate surgery that you have just done," he said.

Because of the risk of rubbing, Dr. Gayer suggests placing local diluted anesthetic prior to the patient's emergence from general anesthesia. This will reduce sensation so that the patient is less likely to rub his or her eyes.