Surgical Modifications Required for Planned Extracapsular Cataract Extraction under Topical Anaesthesia with Van Lint Block

Objective: To assess the intensity of pain after applying some modifications in the surgical steps undertaken during the course of planned extracapsular cataract extraction under topical anaesthesia with Van Lint block. Study Design and Patients: This is a prospective study of 20 patients divided into 2 groups. Fifteen patients had previous extracapsular cataract extraction in 1 eye under retrobulbar anaesthesia (group 1). Those were chosen to compare the difference in their perception of pain under retrobulbar anaesthesia vs topical anaesthesia using these surgical modifications. Group 2 was initially made of 15 patients who had no previous ocular surgery and had no preference for the type of anaesthesia. They were chosen to outline their response to topical anaesthesia. This would have made the total of 30 patients, however, it was felt that the first 10 patients of this group did not have the benefit of all the surgical modifications and their responses would distort the results. Therefore, only the responses of the last 5 who benefited from the modifications were included. Setting: The Eye Department, Pilgrim Hospital, Boston, Lincolnshire, UK. Main Outcome Measures: Single dose of 0.5 ml preservative free Xylocaine 4% drops in the conjunctival sac with the lids maintained open for up to 1 min immediately preoperatively gives complete anaesthesia of the cornea and conjunctiva. A ‘clear corneal incision’, a wide ‘can-opener capsulotomy’, and ‘equatorial flush’ are surgical modifications required to abolish any feeling of pain in planned extracapsular cataract extraction under topical anaesthesia. Results: The severity of the pain was graded from 0–4. Eight patients had no pain, 5 patients had grade 1 and 7 patients had grade 2 pain. No patients graded 3 or 4. Conclusions: Xylocaine 4% preservative-free drops produce complete corneal anaesthesia and decrease the palpebral reflex when applied immediately before the start of surgery for 30–60 s while the lids are held apart—allowing complete immersion of the ocular surface under a layer of drops. Corneal section and wide capsulotomy are surgical steps that prevented pain during nucleus delivery. Equatorial flush speeds aspiration/irrigation. Pain was caused during suturing the posterior lip of the incision involving the conjunctiva if the surgery took longer than expected.