Comparison of retrobulbar anesthesia and intracameral anesthesia using preservative free bupivacaine hydrochloride 0.5% in phacoemulsification with posterior chamber intraocular lens implantation.

OBJECTIVE To compare the retrobulbar anesthesia and intracameral anesthesia using preservative-free bupivacaine hydrochloride 0.5% in terms of effectiveness, complications and comfort to the patient during phacoemulsification with posterior chamber intraocular lens implantation. METHODS This was a hospital based comparative study of two methods of anesthesia, conducted at LRBT Free Eye and Cancer Hospital, Lahore from January to July 2000. Study included 200 patients with uncomplicated age-related cataract, equally divided in two groups on simple random basis. Group A (100 patients) received the retrobulbar anesthesia and Group B (100 patients) received the intracameral anesthesia with bupivacaine hydrochloride 0.5% for phacoemulsification with posterior chamber intraocular lens implantation. Outcome measures like pain, visual acuity, intraocular pressure and anterior chamber reaction were compared. RESULTS On day 1, 79% of the patients in group A and 82% patients in group B had unaided visual acuity ranging between 6/6-6/18. On day 7, this was 88% in group A and 89% group B. On day 1, 99% in group A and 98% in group B had <1+ cells in the anterior chamber while on day 7 this increased up to 100%. On day 1, 97% in group A and 98% group B had intraocular pressure less than 20 mmHg. On day 7, it increased up to 100% in both groups. 97% patients in group A and 96% patients in group B had painless surgery. Results were analysed using computer software SPSS version 10.0. Results showed no significant statistical difference between two groups in terms of pain, visual acuity, intraocular pressure, anterior chamber reaction and patient comfort. CONCLUSION In the hands of expert surgeons and in selected patients, intracameral anesthesia with preservative-free bupivacaine hydrochloride 0.5% is a safe and effective technique of ocular anesthesia for phacoemulsification with posterior chamber intraocular lens implantation.