Phacoemulsification in vitrectomized eyes under topical anesthesia I. ZAHEER 1 , S.R.J. TAYLOR 2 , R.V. PEARSON 3 1 Bristol Eye Hospital, Bristol 2 Moorfields Eye Hospital, London 3 Southend Hospital, Essex - UK INTRODUCTION It is becoming increasingly common for surgeons to be faced with the prospect of performing cataract surgery in vitrectomized eyes as a result of the increase in use of pars plana vitrectomy (PPV) in the manage- ment of posterior segment disorders (1). In this study, we examined phacoemulsification in vitrectomized eyes under topical anesthesia, assessing the feasibility of this anesthetic approach, intraoperative challenges, and visual outcomes. METHODS We conducted a prospective study of 52 consecutive cataract operations performed on vitrectomized eyes under topical anesthesia. All surgery was performed by two surgeons (R.V.P. and I.Z.) over a period of 3 years from 2001 to 2004. Data were collected on pre- operative patient characteristics, intraoperative ob- servations and complications, postoperative compli- cations including the need for Nd:YAG laser posteri- or capsulotomy, as well as visual outcome. A vast ma- jority of our routine cataract surgery patients are op- erated under topical anesthesia and our criteria for choosing the patients in this study do not differ from those chosen for routine cataract surgery under top- ical anesthesia (except see below). Exclusion criteria Any patients with in situ silicone oil and requiring cataract surgery were excluded from this study. European Journal of Ophthalmology / Vol. 17 no. 3, 2007 / pp. 336-340 1120-6721/336-05$15.00/0 © Wichtig Editore, 2007 PURPOSE. To study phacoemulsification in vitrectomized eyes under topical anesthesia, as- sessing anesthetic and intraoperative characteristics and complications. METHODS. A prospective study was performed on 52 eyes of 51 patients who underwent pha- coemulsification of cataract with intraocular lens implantation under topical anesthesia, having previously undergone pars plana vitrectomy. Surgical and anesthetic observations and complications were recorded, as were visual outcomes. RESULTS. Ninety-two percent of patients had improved visual acuity postoperatively with on- ly one patient having visual loss as a result of surgery. The most common intraoperative ob- servations were of a deep anterior chamber, posterior capsular plaques, posterior synechi- ae, and nuclear sclerotic cataracts. Topical anesthesia proved satisfactory in 96%, with on- ly two patients requiring intracameral lignocaine 1%; no patients required conversion to in- jection anesthesia. There were no major operative or postoperative complications. CONCLUSIONS. Phacoemulsification in vitrectomized eyes can be challenging, but is visually re- warding. Topical anesthesia proved satisfactory for the vast majority of cases, with none of our patients requiring conversion to injection anesthesia. (Eur J Ophthalmol 2007; 17: 336-40) KEY WORDS. Phacoemulsification, Topical anesthesia, Vitrectomy Accepted: October 10, 2006