Anesthesia is an integral part of many surgeries. It was also an essential part of cataract surgeries done in earlier times. However, today Cataract surgery has metamorphosed greatly. From using General anesthesia and keeping patients in the hospital for several days, the surgery changed to using local anesthesia in the form of injections, and today it has so evolved that we perform most cataract surgeries under topical anesthesia (just using eye drops).
Modern cataract surgeries with advanced laser treatments have resulted in faster surgeries with smaller incisions, thereby involving the least need of anesthesia. Presently, during cataract surgery topical eye drops are administered by most skilled surgeons. However other kinds of anesthesia are also used in some cases, only if it is essential.
Let us understand more about this.
Major goals for administration of anesthesia for successful cataract surgery:
- To avoid pain during the surgery.
- To restrict movements of the eye during the surgery as required.
- Maintain safety of patient and optimize surgical outcome.
- To regulate the intraocular pressure.
- To facilitate quick recovery.
Selection of right anesthetic for cataract surgery depends on:
- The type of surgery performed.
- Patient’s health condition.
- The surgeon’s expertise.
- The time taken for surgery etc.
Kinds of anesthesia for cataract surgery depend on:
- Age of the patient and tolerance.
- The type of cataract surgery.
- Ocular co-morbidity like corneal opacity etc.
Types of anesthesia:
- Regional or Local anesthesia: It may be administrated with a sedative followed by a tiny injection generally on the top and underneath the eye. This is done to prevent blinking and restrict eye movements during the surgery. Intracameral Lidocaine / Lignocaine (local) is used commonly and Pro Paracaine eye drops are used as the anesthesia eye drops (topical) .
- General anesthesia: Health condition should be supportive and intake of food or drink should be avoided as instructed by the Doctor. Continuous monitoring of the progress on the blood pressure, heart beat rate and breathing are done during the procedure by an General anesthesia is mainly reserved for Pediatric patients and some adult patients (when uncooperative). Vomiting, drowsiness, nausea after general anesthesia is rare but gradually wanes off.
- Techniques in general anesthesia for cataract surgery:
- Peribulbar blocks- In this type a needle is inserted close to the eyeball for administering a local anesthetic agent like Lignocaine.
- Retrobulbar blocks- In this type a needle is inserted behind the eyeball for administering a local anesthetic agent like Lignocaine.
(Hyaluronidase for ophthalmic blocks is used at times to enhance the speed of action of the local anesthetic)
- Topical anesthesia– This is mainly administered as eye drops to block the afferent nerves of the cornea and the conjunctiva. It is most suitable for clear corneal incisions. It is advantageous in shorter surgeries and has fewer side effects. This type of anesthesia helps you to experience the benefit the cataract surgery at a faster rate and is the type of safe anesthesia used at Shroff Eye, Mumbai.
Risks: Modern anesthesia is generally safe, although not completely risk free. The risk factor varies according to the anesthetic used alongside other factors. Few of them are noted below but are rare and mostly associated with block- type anesthesia.
- Globe perforation.
- Damage to optic nerve.
- Retrobulbar hemorrhage.
- Ocular muscle injury.
- Any problems encountered by you during any previous surgeries or allergy to drugs etc. should be informed to the doctor before the procedure.
- Other prescription medications being taken should also be discussed prior to surgery to avoid any drug interactions.
- Your co-operation to remain calm and anxiety free during the cataract surgical process will help you immensely.
At Shroff Eye, we manage your cataract surgery in the safest and most helpful way for you and allow you to return home with a pleasant surgical experience.