If you are an expert cataract surgery with thousands upon thousands of cases of experience, you may be tempted to do phaco with just topical anesthesia in a patient with nystagmus. But is that really the best decision? In patients with nystagmus, intra-operative success depends on maximizing ocular stability and choosing anesthesia that minimizes globe movement. General anesthesia is often the most effective option because it reliably suppresses nystagmus and improves fixation, providing a controlled environment for capsulorhexis and phacoemulsification. When general anesthesia is not feasible, a local block can substantially dampen ocular oscillations; it offers akinesia which topical anesthesia does not. This local block can be a retrobulbar injection, a peri-bulbar injection or even a sub-tenon’s block. Topical anesthesia alone is generally inadequate for significant nystagmus. Yes, you can still do it, but should you? What are your thoughts?
And Happy Thanksgiving to my American colleagues 🙂