Comparative effectiveness of selected anesthetic agents and anesthesia techniques in complicated cataract phacoemulsification

Introduction. Patients with age-related cataracts frequently present with comorbid conditions such as glaucoma, diabetes mellitus, or a history of uveitis. These conditions may complicate cataract phacoemulsification due to the presence of small, rigid pupils. In such cases, the use of iris retractors is required, which is often associated with intraoperative and postoperative pain. Therefore, anesthesia that ensures adequate analgesia without causing discomfort or additional complications is essential for these surgical interventions. Objective: to identify the most effective anesthetic technique and anesthetic agent in complicated phacoemulsification cases requiring the use of iris retractors. Materials and methods. This study was conducted between May 2016 and May 2018 at the medical center MFC-Kuzbass LLC. A total of 56 patients (56 eyes) with cataract complicated by pseudoexfoliation syndrome (PEX), rigid pupils, and posterior synechiae were included. All patients underwent phacoemulsification with the use of iris retractors. Using a random number generator, patients were allocated into three groups: sub-Tenon’s anesthesia with 0.75 % ropivacaine (n = 18), sub-Tenon’s anesthesia with 2 % lidocaine (n = 19), and topical (epibulbar) anesthesia with 0.5 % proxymetacaine (n = 19). All patients underwent a comprehensive ophthalmic examination and standard preoperative laboratory testing. Pain intensity was assessed using a visual analog scale (VAS) ranging from 1 to 10 points, immediately after surgery and 24 hours postoperatively. Statistical analysis was performed using SPSS Statistics 22.0 with nonparametric tests (Mann– Whitney U test and Kruskal – Wallis test). Pain intensity was expressed as the median and interquartile range. Results. During surgery with iris retractors, the median pain score was 3.5 (2.0–5.0) in patients receiving sub-Tenon’s anesthesia with 0.75 % ropivacaine, 7.5 (6.0–8.0) in those receiving topical anesthesia with 0.5 % proxymetacaine, and 5.0 (5.0–5.0) in patients receiving sub-Tenon’s anesthesia with 2 % lidocaine. Intravenous analgesia during surgery was required in 11 patients from the proxymetacaine group and in 5 patients from the lidocaine group. No patients in the ropivacaine group required additional intravenous analgesia. In the early postoperative period, analgesics were not required in the ropivacaine group, whereas analgesics were prescribed to 6 patients in the proxymetacaine group and to 2 patients in the lidocaine group. Conclusion. Sub-Tenon’s anesthesia with 0.75 % ropivacaine demonstrated the highest effectiveness in complicated phacoemulsification cases involving iris retractors and can therefore be recommended for broader clinical use. Pharmaceutical companies should consider expanding approved indications for anesthetic agents in ophthalmology, including conducting safety studies on their intracameral use.

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