To the Editor:

I read with interest the recent article by Ripart et al.  1about ophthalmic regional anesthesia for cataract surgery. The authors stated, ‘Cataract surgery requires a potent motor blockade (akinesia) of the eyeball and eyelids.‘ However, this statement is contradicted by the fact that excellent operating conditions can be obtained by using topical anesthesia with or without sedation. 2,3Moreover, the topical technique avoids the rare but severe complications that may occur with injection anesthesia for ophthalmic surgery, such as perforation of the globe, retrobulbar hemorrhage, and dural or intravascular injection of local anesthetics. 4–5The use of topical anesthesia for cataract surgery increased to more than 37% of cases in 1998. 6At my facility, an increasing portion of the cases is treated with use of topical anesthesia, and the advantages in comparison with regional or injection anesthesia are dramatic.

Ripart J, Lefrant J-Y, Vivien B, Charavel P, Fabbro-Peray P, Jaussaud A, Dupeyron G, Eledjam J-J: Ophthalmic regional anesthesia: Medial canthus episcleral (sub-Tenon) anesthesia is more efficient than peribulbar anesthesia. A nesthesiology 2000; 92: 1278–85
Naor J, Slomovic AR: Anesthesia modalities for cataract surgery. Curr Opin Ophthalmol 2000; 11: 7–11
Fichman RA: Use of topical anesthesia alone in cataract surgery. J Refract Surg 1996; 22: 612–14
Cionni RJ, Osher RH: Retrobulbar hemorrhage. Ophthalmology 1991; 98: 1153–55
Hamilton RC: Brain-stem anesthesia as a complication of regional anesthesia for ophthalmic surgery. Can J Ophthalmol 1992; 27: 323–5
Leaming DV: Practice styles and preferences of ASCRS members: 1998 survey. J Cataract Refract Surg 1999; 25: 851–9