Topical, subconjunctival anesthesia combined safe for IOL placement in eyes without capsular support

Using topical and subconjunctival anesthesia combined appears effective for secondary implantation of a foldable IOL in eyes lacking capsular support, according to a study by researchers in Portugal. No patients required supplemental anesthesia during surgery, the authors noted.

Manuel Monteiro, MD, and colleagues reviewed outcomes for 22 eyes in 22 patients who received topical plus subconjunctival anesthesia for scleral fixation of a foldable IOL (PC 425Y, Ophtec), which was inserted through a self-sealing scleral incision. They published their findings in the December issue of Acta Ophthalmologica Scandinavica.

Patients averaged 60 years of age. Of the 22 eyes, 12 had traumatic cataract, seven had post-phacoemulsification complications and three were aphakic, according to the study.

Investigators scored levels of intraoperative pain using a scale from 1 to 10, with a score of 1 equaling no pain.

Overall, 19 patients (86%) tolerated the procedure well, reporting pain scores ranging from 1 to 3, and none required supplemental anesthesia, according to the study.

At 4 months follow-up, best corrected visual acuity ranged from 20/100 to 20/25.

Also at 4 months postop, patients had a mean myopic shift of 1.25 D, astigmatism averaged 1.75 D and central corneal endothelial cell loss averaged 12.24%, the authors reported.

Five eyes experienced a microscopic hyphema intraoperatively. However, "four cystoid macular edema and four peripheral anterior synechia were the only complications, each occurring at the final follow-up," the authors said.