Intraoperative Use of a Topical Anesthetic Gel Versus Balanced Salt Solution During Cataract Surgery: Effects on Corneal Structure and Ocular Surface

Background/Objectives: During cataract surgery, topical anesthesia is routinely achieved through the instillation of topical anesthetic eye drops, while different agents may be applied to the corneal surface during the procedure to support lubrication and protection. The impact of these intraoperative strategies on corneal integrity and postoperative ocular surface recovery remains an area of clinical interest. This study aimed to compare the intraoperative and postoperative effects of applying a topical anesthetic gel (Ophtesic, Horus Pharma) on the corneal surface versus the use of balanced salt solution (BSS) during cataract surgery. Methods: In this longitudinal, observational prospective study, 24 eyes of 24 patients undergoing phacoemulsification received either topical anesthetic gel (n = 15) or BSS irrigation (n = 9). Central corneal thickness (CCT) and epithelial thickness were measured preoperatively and on postoperative days 1, 5, and 15 using anterior segment optical coherence tomography (AS-OCT). Basal epithelial cell (BEC) density was assessed by in vivo confocal microscopy (IVCM), while OSDI score, non-invasive breakup time (NI-BUT), and Schirmer test I values were evaluated preoperatively and on postoperative days 5 and 15. Patient and surgeon satisfaction were rated using a Likert-like scale. Results: Both groups showed increased CCT and epithelial thickness at day 1. In the gel group, CCT returned to baseline by day 15 (p = 0.361), and epithelial thickness normalized by day 5 (p = 0.066). In the BSS group, CCT remained elevated at day 15 (p < 0.05), and epithelial thickness decreased at day 5 (p < 0.05) before returning to baseline. BEC density normalized at day 15 in the gel group (p = 0.107) but remained altered in the BSS group (p < 0.05). NI-BUT Schirmer I, and OSDI showed a trend toward faster recovery in the gel group than in the BSS group. Conclusions: In this exploratory study, intraoperative application of a topical anesthetic gel appeared to support early normalization of corneal and tear film parameters while providing effective anesthesia. Further studies are warranted to confirm these observations and evaluate potential long-term benefits.