Zusammenfassung
Mit der Etablierung der modernen Kataraktchirurgie als Operation in einem geschlossenen
System wurde die topische Anästhesie eingeführt. Die alleinige Tropfanästhesie ermöglicht
zwar eine gute Analgesie in den meisten Fällen. Bis zu 30 % der Patienten fühlen sich
jedoch während der einzelnen Operationsschritte unwohl und berichten von Schmerzen,
die gerade noch erträglich sind. Die Oberflächenanästhesie kann durch Modifikation
der Applikationsformen wie Schwämmchen, Gel oder mit der subkonjunktivalen Anästhesie
intensiviert werden. Mit der Einführung der intrakameralen Anästhesie in den 90er-Jahren,
vor allem mit unkonserviertem Lidocain 1 %, wurde die Effektivität der topischen Anästhesie
signifikant verbessert, sodass diese kombinierte Anästhesie als Routineverfahren angewendet
werden kann. Eine anästhesiologische Prämedikation und Überwachung ist eine sinnvolle
Ergänzung der lokalen Anästhesie, da die meisten Kataraktpatienten häufig im hohen
Alter sind und kardiovaskuläre Erkrankungen haben. An knapp 10 % der operierten Patienten
können Beeinträchtigungen der kardiopulmonalen Parameter festgestellt werden. In ca.
2,6 % ist eine anästhesiologische Intervention notwendig.
Abstract
Topical anaesthesia was introduced together with the establishment of modern cataract
surgery as an operation in a closed system. Superficial anaesthesia by itself leads
to a good analgesia in most cases. However, up to 30 % of the patients feel uncomfortable
or even experience pain during surgery. Superficial anaesthesia can be intensified
with subconjunctival infiltration or by modifying the application forms such as sponges
or gel. With the introduction of the intracameral anaesthesia in the 1990 s primarily
with unpreserved lidocaine 1 %, the efficacy of the topical anaesthesia was improved
significantly. The combined topical anaesthesia plus intracameral lidocaine administration
can be used as a routine method. A general anaesthesia care for premedication and
monitoring during cataract surgery is useful since most cataract patients are of advanced
age and frequently suffer from cardiovascular diseases. In almost 10 % of the patients
changes in cardiopulmonal comorbidities were observed and in 2.6 % anaesthesia intervention
was required.
Schlüsselwörter
Kataraktchirurgie - topische Anästhesie - intrakamerale Anästhesie - Sedierung - Lidocain
Key words
cataract surgery - topical anaesthesia - intracameral anaesthesia - sedation - lidocaine
Literatur
- 1
Amiel H, Koch P S.
Tetracaine hydrochloride 0,5 % versus lidocaine 2 % jelly as a topical anesthetic
agent in cataract surgery: comparative clinical trial.
J Cataract Refract Surg.
2007;
33 (1)
98-100
- 2
Assia E l, Pras E, Yehezkel M et al.
Topical anesthesia using lidocaine gel for cataract surgery.
J Cataract Refract Surg.
1999;
25
635-639
- 3 Auffarth G U, Borkenstein A FM, Limberger I J. et al .Prospektive Safety-Studie
zum Viskoelastikum Visthesia. In: Auffarth, (Hrsg.) 22. Kongreß der Deutschen Gesellschaft
für Intraokularlinsen Implantation. Berlin, Heidelberg; 2008: 43-47
- 4
Behnig A, Linden C.
Aeqous humor lidocaine concentrations in topical and intracameral anaesthesia.
J Cataract Refract Surg.
1998;
24
1598-1601
- 5
Belluci R, Morselli S, Pucci V et al.
Intraocular penetration of topical lidocain 4 %.
J Cataract Refract Surg.
1999;
25
643-647
- 6
Bhananker S M, Posner K L, Cheney F W et al.
Injury and liability associated with monitored anesthesia care: A closed claim analysis.
Anesthesiology.
2006;
104
228-234
- 7
Biró Z, Schvöller M.
Subjective visual sensations during cataract surgery performed under topical anaesthesia.
Acta Ophthalmol.
2008;
86 (8)
894-896
- 8
Bloomberg L B, Pellkan K J.
Topical anaesthesia using the Bloomberg super Numb Anesthetic Ring.
J Cataract Refract Surg.
1995;
21
16-20
- 9
Boezaart A, Berry R A, Nell M.
Topical anesthesia versus retrobulbar block for cataract surgery: the patient’s perspective.
J Clin Anesth.
2000;
12
58-60
- 10
Bouillon T, Garstka G, Stafforst D et al.
Piritramide and alfentanil display similar respiratory depressant potency.
Acta Anaesthesiol Scand.
2003;
47 (10)
1231-1241
- 11
Dick B, Jacobi F K.
Kataraktchirurgie und Antikoagulation – derzeitiger Stand.
Klin Monatsbl Augenheilkd.
1996;
209 (12)
340-346
- 12
Chang Y S, Tseng S Y, Tseng S H et al.
Cytotoxicity of lidocaine or bupivacaine on corneal endothelial cells in a rabbit
model.
Cornea.
2006;
25 (5)
590-596
- 13
Davis D B, Mandel M R.
Posterior peribulbar anesthesia: An alternative to retrobulbar anesthesia.
J Cataract Refract Surg.
1986;
12
182-184
- 14
Davis D B, Mandel M R.
Efficacy and complication rate of 16 224 consecutive peribulbar blocks, a prospective
multicenter study.
J Cataract Refract Surg.
1994;
20
327-337
- 15 Dolder R. Pharmakologie, Biopharmazie und Galenik der Augenarzneimittel. Ophthalmika. Wissenschaftliche
Verlagsgesellschaft mbH. Stuttgart; 1983: 73-80
- 16
Eke T, Thompson J R.
Serious complications of local anaesthesia for cataract surgery: a 1 year national
survey in the United Kingdom.
Br J Ophthalmol.
2007;
91 (4)
470-475
- 17
Elvira J C, Hueso J R, Marinez-toldos J et al.
Induced endothelial cell loss in phacoemulsification using topical anesthesia plus
intracameral lidocaine.
J Cataract Refract Surg.
1999;
25 (5)
640-642
- 18
Erdurmus M, Aydin B, Usta B et al.
Patient comfort and surgeon satisfaction during cataract surgery using topical anesthesia
with or without dexmedetomidine sedation.
Eur J Ophthalmol.
2008;
18 (3)
361-367
- 19
Ezra D G, Nambiar A, Allan B D.
Supplementary intracameral lidocaine for phacoemulsification under topical anesthesia.
A meta-analysis of randomized controlled trials.
Ophthalmology.
2008;
115 (3)
455-487
- 20 Fine I H, Fichman R A, Grabow H R. Clear-corneal cataract surgery and topical anesthesia. Slack
Inc. New York; 1993 1. Auflage
- 21
Fung D, Cohen M M, Stewart S et al.
What determines patient satisfaction with cataract care under topical local anesthesia
and monitored sedation in a community hospital setting?.
Anesth Analg.
2005;
100
1644-1650
- 22
Gan T J et al.
Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea
and Vomiting.
Anesth Analg.
2007;
105
1615-1628
- 23
Gills J, Cherchio M, Raanan M G.
Unpreserved lidocaine to control discomfort during cataract surgery using topical
anesthesia.
J Cataract Refract Surg.
1997;
23
545-550
- 24
Gills J P.
Corneal endothelial toxicity of topical anesthesia.
Ophthalmology.
1998;
105 (7)
1126-1127
- 25
Harman D M.
Combined sedation and topical anesthesia for cataract surgery.
J Cataract Refract Surg.
2000;
26 (1)
109-113
- 26
Heuermann T, Hartmann C, Anders N.
Long-term endothelial cell loss after phacoemulsification: peribulbar anesthesia versus
intracameral lidocaine 1 %: prospective randomized clinical trial.
J Cataract Refract Surg.
2002;
28 (4)
639-643
- 27 Heuermann T, Anders N, Rüther K. et al .Retinale Funktion nach intraokularer Lidocaingabe
bei der Kataraktoperation. In Duncker G, (Hrsg.) 12. Kongreß der Deutschen Gesellschaft
für Intraokularlinsen Implantation. Berlin, Heidelberg; 1999: 348-351
- 28
Hoffmann R S, Fine H.
Transient no light perception visual acuity after intracameral lidocaine injection.
J Cataract Surg.
1997;
23
957-958
- 29
Holas A, Kraft P, Marcovic M et al.
Remifentanil, propofol or both for conscious sedation during eye surgery under regional
anesthesia.
Eur J Anaesthesiol.
1999;
16
741-748
- 30
Irle S, Lückefahr M H, Tomalla M.
Topische Anästhesie als Routineverfahren bei der Kataraktchirurgie – Schmerzbewertung
und Komplikation bei einem größeren Patientenkollektiv.
Klin Monatsbl Augenheilkd.
2005;
222 (1)
36-40
- 31
Johansson M, Lundberg B, Behndig A.
Optical coherence tomography evaluation of macular edema after phacoemulsification
surgery with intracameral mydriatics.
J Cataract Refract Surg.
2007;
33 (8)
1436-1441
- 32
Kim T, Holley G P, Lee J H et al.
The effects of intraocular lidocaine on the corneal endothelium.
Ophthalmology.
1998;
105 (1)
125-130
- 33
Koch P S.
Efficacy of lidocaine 2 % jelly as a topical agent in cataract surgery.
J Cataract Refract Surg.
1999;
25
632-634
- 34
Koch P S.
Anterior chamber irrigation with unpreserved lidocaine 1 % for anesthesia during cataract
surgery.
J Cataract Refract Surg.
1997;
23
551-554
- 35
Kohnen T.
Editor: Is intracamral anesthetic application the final solution to topical anesthesia
for cataract surgery.
J Cataract Refract Surg.
1999;
25
601-602
- 36 Koller C. Vorläufige Mitteilung über locale Anästhesierung am Auge. Vortrag (verlesen
von J Brettauer) auf der 16. Versammlung der Ophthalmologischen Gesellschaft, Heidelberg,
15. September 1884. Heidelberg, Rostock: Der Vers Ophthalmol Gesellschaft;
- 37
Koopmans S A, Rij van G.
Cataract surgery and anticoagulants.
Doc Ophthalmol.
1996 – 1997;
92 (1)
11-6
- 38
Kumar N, Rowbotham D J.
Editorial II Piritramide.
British Journal of Anesthesia.
1999;
82 (1)
3-5
- 39
Laude A, Au Eong K G, Mills K B.
Knowledge of visual experience during cataract surgery under local anaesthesia: a
nationwide survey of UK ophthalmologists.
Br J Ophthalmol.
2009;
93 (4)
510-512
- 40
Leaming D V.
Practice styles and preferences of ASCRS members 1993.
J Cataract Refract Surg.
1994;
20
459
- 41 Leaming D. MDs surveys. Zitiert n. ES Rosen
- 42
Masket S, Gokmen F.
Efficacy and safety of intracameral lidocaine as a supplement to topical anesthesia.
J Cataract Refract Surg.
1998;
24
956-960
- 43
Oei-Lim V L, Dijkgraaf M G, Smet M D et al.
Does cerebral monitoring improve ophthalmic surgical operating conditions during propofol-induced
sedation?.
Anesth Analg.
2006;
103
1189-1195
- 44
Perone J M, Popovici de A, Ouled-Moussa R et al.
Safety and efficacy of two ocular anesthetic methods for phacoemulsification: topical
anesthesia and viscoanesthesia (VisThesia).
Eur J Ophthalmol.
2007;
17 (2)
171-177
- 45
Pham D T, Scherer V, Wollensak J.
Sponge-Oberflächenanästhesie in der Kataraktchirurgie (bei skleralem Tunnelschnitt).
Klin Mbl Augenheilkd.
1996;
209
347-353
- 46 Pham D T, Weller A, Pfeiffer S. et al .Schmerzempfindlichkeit nach intrakammeraler
Lidocain-Application versus Sponge-Anästhesie in der Kataraktchirurgie. In Duncker G,
(Hrsg.) 12. Kongreß der Deutschen Gesellschaft für Intraokularlinsen Implantation.
Berlin, Heidelberg; 1999: 758-760
- 47
Poyales-Galan F, Pirazolli G.
Clinical evaluation of endothelial cell decrease with VisThesia in phacoemulsification
surgery.
J Cataract Refract Surg.
2005;
31 (11)
2157-2161
- 48
Reinhardt S, Burkhardt U, Nestler A et al.
Use of piritramide for analgesia and sedation during peribulbar nerve block for cataract
surgery.
Ophthalmologica.
2002;
216 (4)
256-260
- 49
Rosen E S.
Editor: Iatrogenic puncture wounds?.
J Cataract Refract Surg.
2010;
36
879-880
- 50
Sanmugasunderam S, Khalfan A.
Is fasting required before cataract surgery? A retrospective review.
Can J Opthalmol.
2009;
44 (6)
655-6
- 51
Schmid E, Neumayer T, Rainer G et al.
Intrakamerale Lidocainanästhesie bei Kataraktoperationen: Effektivität und Sicherheit
Applikation während der Hydrodissektion.
Spektrum der Augenheilkunde.
2008;
22 (1)
26-30
- 52
Schrader W F, Schargus M, Schneider E et al.
Risks and sequelae of scleral perforation during peribulbäre or retrobulbäre anesthesia.
J Cataract Refract Surg.
2010;
36
885-889
- 53
Sekundo W, Dick H B, Schmidt J C.
Lidocaine-assisted xylocaine jelly anesthesia versus one quadrant sub-Tenon infiltration
for self-sealing sclerocorneal incision routine phacoemulsification.
Eur J Ophthalmol.
2004;
14 (2)
111-116
- 54
Sharwood P L, Thomas D, Roberts T V.
Adverse medical events associated with cataract surgery performed under topical anaesthesia.
Clin Experiment Ophthalmol.
2008;
36 (9)
842-846
- 55
Stifter E, Menapace R.
„Instant vision” compared with postoperative patching: clinical evaluation and patient
satisfaction after bilateral cataract surgery.
Am J Ophthalmol.
2007;
143 (3)
441-448
- 56
Strobel J, Hühnermann M.
Tropfanästhesie in der Kataraktchirurgie.
Ophthalmologe.
1996;
93
68-72
- 57
Stupp T, Hassouna I, Soppart K et al.
Systemic adverse events: a comparison between topical and peribulbar anaesthesia in
cataract surgery.
Ophthalmologica.
2007;
221 (5)
320-325
- 58
Tseng S H, Chen F K.
A randomized clinical trial of combined topical-intracameral anesthesia in cataract
surgery.
Ophthalmology.
1998;
105 (11)
2007-2011
- 59
Unal M, Yücel I, Sarici A et al.
Phacoemulsification with topical anesthesia: Resident experience.
J Cataract Refract Surg.
2006;
32 (8)
1361-1365
- 60
Välimäki J, Törnblom R M.
Viscoanaesthesia in cataract surgery: a prospective, randomized clinical trial.
Acta Ophthalmol.
2009;
87 (4)
378-381
- 61 Weindler J, Rippa A, Kiefer T. et al .Niedrig dosiertes Midazolam (3,75 mg) und
Clonidin (0,15 mg) zur oralen Prämedikation bei Retrobulbäranästhesie. In Robert Y CA,
(Hrsg.) 7. Kongreß der Deutschen Gesellschaft für Intraokularlinsen Implantation.
Berlin, Heidelberg, New York: Springer-Verlag; 1993: 70-75
- 62
Weindler J, Weindler M, Ruprecht K W.
Lokalanästhesie in der Ophthalmochirurgie.
Ophthalmologe.
2004;
101
847-865
- 63
Weller A, Pham D T, Häberle H.
Kataraktchirurgie. Sponge-Oberflächen-Anästhesie mit intracameraler Lidocain-Applikation.
Ophthalmologe.
2000;
97 (1)
51-53
- 64
Weller A, Pham D T, Häberle H.
Intracameral anesthesia with lidocaine in cornea guttata.
Ophthalmologe.
2002;
99 (1)
29-31
- 65 Weller A. Sponge-Oberflächen- und intracamerale Anästhesie. Eine Alternative der
Peri- und Retrobulbäranästhesie in der Kataraktchirurgie. Dissertation. Freie Universität
Berlin; 2001
- 66 Wenzel M, Pham D T, Scharrer A et al. Ergebnisse der Umfrage 2009 von BDOC, BVA
und der DGII, 24. Kongreß der Deutschen Gesellschaft für Intraokularlinsen Implantation. Biermann
Verlag. (i. Druck)
- 67
Wirbelauer C, Iven H, Bastian C et al.
Systemic levels of lidocaine after intracameral injection during cataract surgery.
J Cataract Refract Surg.
1999;
25
648-651
- 68
Wirbelauer C, Weller A, Häberle H. et al.
Kataraktoperation in topischer Anästhesie unter oraler Antikoagulation.
Klin Monatsbl Augenheilkd.
2004;
221
749-752
- 69
Zakrzewski P A, Banashkevich A V, Friel T et al.
Monitored anesthesia care by registered respiratory therapists during cataract surgery:
an update.
Ophthalmology.
2010;
117 (5)
897-902
Prof. Dr. Duy-Thoai Pham
Augenklinik, Vivantes Klinikum Neukölln
Rudower Str. 48
12351 Berlin
Phone: ++ 49/30/1 30 14 31 31
Fax: ++ 49/30/1 30 14 35 46
Email: duy-thoai.pham@vivantes.de
