Anesthesia For Cataract Surgery

Published 2025 - 43rd Congress of the ESCRS

Reference: PO446 | Type: Free paper | DOI: 10.82333/xjc3-6v35

Authors: Mateja Jagić* ¹ , Maja Bohač ¹ , Lucija Žerjav ¹ , Ivan Gabrić ¹

¹Refractive surgery department,University Eye Hospital Svjetlost,Zagreb,Croatia

Purpose

To compare anesthesia techniques in cataract surgery, evaluating their efficacy, risks, and patient outcomes.

Cataracts, the leading cause of blindness, affect ~94 million people, projected to reach 120 million by 2030. Dexmedetomidine, an alpha-2 agonist, is gaining interest for sedation due to its analgesic properties, though its side effects necessitate caution, particularly in hypertensive patients.

Setting

University of Antwerpen

Methods

A literature review (1968–2025) using PubMed, Limo, and Cochrane databases included controlled trials and case series (>100 cases) on cataract surgery anesthesia. A case report on perioperative hypnosis in a high-risk patient was also examined.

Results

Topical: Most common, minimal side effects, but lacks akinesia.Intracameral lidocaine reduces pain. No eye pad is needed.

Sub-Tenon’s: Safer than peribulbar/retrobulbar, providing good analgesia and moderate akinesia. Risks: chemosis, hemorrhage, rare nerve damage.

Peribulbar/Retrobulbar: Peribulbar has a slower onset but fewer risks; retrobulbar offers better akinesia but higher complications.

Dexmedetomidine: Enhances sedation and analgesia but may cause bradycardia and hypotension.

General: For complex cases; risks include nausea, respiratory depression, cognitive decline.

Sedation/Hypnosis: Limited effect; hypnosis reduces anxiety.

No Anaesthesia: Some highly skilled surgeons, Dr. Amar, operate without anesthesia, warranting further study.

Conclusions

All anesthesia techniques are safe and effective, with distinct benefits and risks. Topical anesthesia is favored for uncomplicated cases, but its lack of akinesia may pose challenges. Regional blocks provide superior pain control and akinesia but increase the risk of complications. Among them, Sub-Tenon’s anesthesia offers a favorable balance between efficacy and safety. General anesthesia remains necessary for select cases. The choice should be tailored to patient needs, surgical complexity, and surgeon expertise. Further research is needed to refine recommendations, assess patient preferences, and evaluate cost-effectiveness.