Topical versus retrobulbar anesthesia for combined phacotrabeculectomy

PURPOSE: To compare the safety and efficacy of topical and retrobulbar anesthesia for combined phacotrabeculectomy. SETTING: Tertiary-care university hospital ambulatory surgical center. METHODS: In this prospective study, 40 consecutive patients having combined phacotrabeculectomy were randomized to receive topical (n = 20) or retrobulbar (n = 20) anesthesia. Operating conditions, patient comfort, and surgical outcome were evaluated. RESULTS: There was no significant between-group difference in operating conditions (P =.56), pain during (P =.41) or after (P =.23) surgery, or supplemental anesthesia required (P =.49). Few patients in either group were bothered by tissue manipulation or the microscope light, although more patients in the topical group were slightly bothered by touch sensation (P =.05). Chemosis, subconjunctival hemorrhage, and eyelid hematoma were seen almost exclusively in the retrobulbar group (P <.05). Inadvertent eye movement was present more frequently in the topical group (P =.04), although this did not pose a problem to the surgeon. CONCLUSION: Topical anesthesia is a safe and effective alternative to retrobulbar anesthesia for combined phacotrabeculectomy.