16 EyeWorld Asia-Pacific | September 2024 EDITOR’S PICKS Selected cataract surgical tips presented at the Wisdom of the Kung Fu Masters symposium by Tim Roberts, MD How To Improve The Effectiveness Of Intracameral Anaesthetic During Cataract Surgery Under Topical Anaesthesia Topical Anesthesia (TA) is a common, safe and effective method for clear corneal phacoemulsification. It eliminates the risks associated with orbital needle injection and minimizes patient discomfort during the procedure, allowing for minimal sedation. Visual recovery is rapid, and patients do not require an eye pad after surgery. This allows for early (same-day) instillation of antibiotic and anti-inflammatory eye drops postoperatively, reducing complications and improving surgical outcomes. Benefits of Topical Anaesthesia • Eliminates complications of orbital injections • Minimises risk with anticoagulants • Minimises IV sedation • Easier to administer and manage • More efficient theater time • Allows earlier (same-day) administration of antibiotic/ anti-inflammatory drops • Quicker visual recovery post-surgery Supplementing TA with IntraCameral Anesthesia (ICA) may further reduce discomfort which can occur particularly during stages involving manipulation of intraocular structures or rapid changes in eye pressure.1,2,3 At the recent 36th APACRS-24th CSCRS Joint meeting in Chengdu, I shared a simple technique which has greatly improved patient comfort with ICA and is a practical tip that all cataract surgeons can use immediately on their next surgical list. SURGICAL TIP – TO MAINTAIN THE ANTERIOR CHAMBER, DON’T WASH OUT THE INTRACAMERAL ANAESTHETIC WHEN INJECTING OVD How OVD is injected into the AC immediately after the ICA can have a significant impact on the anaesthetic effect. Over the last year I observed that most of my patients were comfortable and pain free, but a small and vocal minority complained of discomfort during surgery. I reviewed the surgical videos and initially couldn’t see any difference in phacoemulsification or IOL insertion techniques that could explain why some patients complained of discomfort while others didn’t. It was, however, a case of “looking but not perceiving.” After many hours looking at videos I finally “saw the light” and discovered a direct correlation between how the OVD is injected into the AC and the effect of ICA. Avoid This Technique The OVD cannula tip is passed through the corneal incision and across the anterior chamber and OVD is injected, filling the anterior chamber toward the corneal incision. Whilst this does flush out any air bubbles (especially with FLACS), it ‘flushes’ the intracameral anesthetic out of the eye, reducing the anesthetic effect and increasing a patient’s likelihood of being aware of discomfort.
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