Cataract surgery is one of the most commonly performed ophthalmic procedures worldwide, offering significant improvements in visual acuity and quality of life for millions of patients. Advances in surgical techniques and anesthesia methods have contributed to its high success rates and patient satisfaction [1] 

However, the choice of anesthesia—whether general anesthesia (GA) or regional anesthesia (RA) remains a critical factor influencing the surgical outcome, postoperative recovery, and patient experience. General anesthesia involves inducing a state of unconsciousness and systemic pain control, allowing the surgeon to operate without patient movement or discomfort [2]. Regional anesthesia, on the other hand, typically involves targeted nerve blocks or local anesthetic injections around the eye, enabling the patient to remain conscious while achieving effective pain management. Both techniques have distinct advantages and limitations, which may influence their suitability based on patient-specific factors such as age, comorbidities, and surgical complexity [3].

The impact of anesthesia choice on postoperative visual acuity and recovery is of particular importance in cataract surgeries, where optimal outcomes are expected. While regional anesthesia is often preferred due to its perceived safety profile and faster recovery times, general anesthesia may be necessary for patients who are uncooperative or have contraindications to regional techniques [4]. Despite extensive use of both methods, there is limited consensus on their comparative efficacy in achieving superior visual outcomes and minimizing recovery duration. The choice between general and regional anesthesia is influenced by several factors, including the patient’s health status, surgeon’s preference, and institutional protocols. General anesthesia may be necessary for patients who experience severe anxiety or cannot remain still during the procedure [5]. It can also be the preferred option for individuals with cognitive impairments, children, or those with medical conditions that contraindicate regional techniques. However, the use of general anesthesia is associated with certain risks, such as systemic complications, extended recovery times, and higher costs, which may make it less favorable for routine cataract surgeries [6].

On the other hand, regional anesthesia is often lauded for its cost-effectiveness, minimal systemic effects, and faster recovery. Techniques such as retrobulbar, peribulbar, or sub-Tenon’s block provide localized pain relief while allowing the patient to remain awake. These methods are typically well-tolerated and have a lower incidence of serious complications. Nonetheless, regional anesthesia is not without its drawbacks [7]. Complications such as globe perforation, retrobulbar hemorrhage, or incomplete analgesia can arise, though these are relatively rare in the hands of experienced practitioners. Postoperative visual acuity is a critical measure of success in cataract surgeries, and the type of anesthesia used can influence the speed and extent of visual recovery. Studies have shown that regional anesthesia may allow for earlier evaluation of visual outcomes since patients often experience less sedation and systemic effects. This can be particularly advantageous in identifying and addressing any immediate postoperative complications. General anesthesia, while effective in ensuring a motionless surgical field, may delay initial visual assessments due to prolonged recovery from sedation [8].

Patient satisfaction and comfort are equally important considerations in anesthesia selection. Many patients undergoing cataract surgery are elderly and may have comorbid conditions that necessitate careful perioperative management [9]. Regional anesthesia’s reduced impact on cardiovascular and respiratory systems makes it a safer choice for high-risk patients. However, some individuals may find the experience of being awake during surgery distressing, which can impact their overall satisfaction with the procedure. General anesthesia, by providing complete unconsciousness, can alleviate such concerns but at the cost of higher perioperative risks and longer recovery times [10]. Despite the extensive use of both general and regional anesthesia in cataract surgeries, there remains a lack of robust comparative studies evaluating their efficacy in different patient populations. Factors such as surgical complexity, patient demographics, and pre-existing health conditions can all influence the outcomes associated with each type of anesthesia. A comprehensive understanding of these variables is essential to tailoring anesthesia choices to individual patients, ensuring optimal outcomes [11].

Objective

The main objective of the study is to find the efficacy of general and regional anesthesia in cataract surgeries: impact on postoperative visual acuity and recovery.

This cross-sectional study was conducted at--------------------------------during-------------------------------------. Data were collected from 155 patients undergoing cataract surgery. Participants were randomly assigned to receive either general anesthesia (GA) or regional anesthesia (RA) based on a predefined randomization protocol. The inclusion criteria included adults aged 18 years and older, with no prior history of ocular surgeries or significant systemic diseases that could influence surgical outcomes. Patients were excluded if they had contraindications to either form of anesthesia or were unable to provide informed consent. The primary outcomes measured were postoperative visual acuity and recovery times. Secondary outcomes included patient satisfaction, incidence of anesthesia-related complications, and overall cost-effectiveness. Visual acuity was assessed using standardized Snellen charts at predefined intervals: 24 hours, 1 week, and 1 month post-surgery. Recovery times were evaluated based on the duration of hospital stay, time to ambulation, and return to daily activities. Patient satisfaction was assessed using a validated questionnaire administered during follow-up visits. Anesthetic procedures were performed by experienced anesthesiologists following standard protocols. General anesthesia involved the use of intravenous induction agents and maintenance with inhalational agents, while regional anesthesia employed peribulbar or sub-Tenon’s block with local anesthetics. All surgeries were performed by a single surgical team to ensure consistency in operative technique. Data were analyzed using SPSS v11, with comparisons between the two groups made using appropriate parametric and non-parametric tests.

Data were collected from 155 patients. The mean age was similar (67.5 ± 8.6 years for GA vs. 68.1 ± 8.2 years for RA, p=0.62). Male participants comprised 52% in GA and 49% in RA (p=0.74). Prevalence of hypertension (36% vs. 38%, p=0.85) and diabetes mellitus (21% vs. 23%, p=0.76) showed no significant differences. The proportion of patients classified as ASA Class I-II was comparable (92% vs. 90%, p=0.68), indicating well-matched groups.

Table 1: Demographics and Baseline Characteristics

At 24 hours post-operation, a significantly higher proportion of patients in the RA group (62%) achieved a visual acuity of 6/9 or better compared to the GA group (48%, p=0.04). By 1-week post-op, the percentages increased to 88% in RA and 85% in GA, with no significant difference (p=0.45). At 1-month post-op, both groups achieved comparable outcomes, with 95% in each group reaching 6/9 or better (p=1.00), indicating similar long-term results.

Table 2: Postoperative Visual Acuity

The RA group demonstrated significantly better postoperative recovery metrics compared to the GA group. The mean hospital stay was shorter for RA (8 ± 3 hours) than GA (12 ± 4 hours, p<0.01). Additionally, a higher proportion of RA patients (92%) achieved ambulation within 4 hours post-operation compared to GA patients (74%, p<0.01), highlighting faster recovery with RA.

Table 3: Recovery Times

Patient satisfaction and complication rates were compared between the RA and GA groups. A significantly higher proportion of RA patients (89%) rated their experience as Excellent/Very Good compared to GA patients (76%, p=0.02). Minor complications were slightly more frequent in the RA group (6%) than in the GA group (3%), though this difference was not statistically significant (p=0.17). Overall, RA showed higher satisfaction without a notable increase in complications.

Table 4: Patient Satisfaction

This prospective study aimed to evaluate the role of anesthesia in optimizing the outcomes of intravitreal injections (IVIs) for diabetic macular edema (DME). The findings of this study provide valuable insights into how different anesthesia techniques (topical, peribulbar, and retrobulbar blocks) affect both patient comfort and clinical outcomes, including visual acuity, central retinal thickness (CRT), and intraocular pressure (IOP). One of the primary objectives of this study was to assess the impact of anesthesia on patient-reported pain and discomfort during the intravitreal injection procedure [10]. The results revealed significant differences in the pain scores between the three groups, with the retrobulbar block providing the most effective pain relief. The retrobulbar block group reported the lowest pain levels before, during, and immediately after the injection, as evidenced by the mean VAS scores of 1.3, 2.2, and 0.8, respectively. This finding aligns with the known advantages of retrobulbar anesthesia, which offers a deeper, more comprehensive blockade of sensory nerves around the eye, resulting in greater patient comfort during the procedure [11]. The peribulbar block also provided adequate pain relief, though the mean VAS scores during the injection (4.5) were higher than those of the retrobulbar block group, suggesting that the peribulbar technique may not provide as complete anesthesia, particularly during the injection phase. However, the peribulbar block still performed better than topical anesthesia, which had the highest pain scores during the procedure (VAS = 7.8), indicating that superficial anesthesia was insufficient for managing the discomfort of the injection, especially in patients who may have a heightened sensitivity [12]. In addition to patient comfort, the study aimed to assess how anesthesia impacted clinical outcomes, particularly visual acuity and CRT, which are key indicators of the effectiveness of IVIs in treating DME. All three anesthesia groups showed improvement in visual acuity and reductions in CRT over the 6-month follow-up period, reflecting the efficacy of anti-VEGF therapy in managing DME [13].

The retrobulbar block group demonstrated the most significant improvements in both visual acuity and CRT. At 1 month, the retrobulbar block group had a mean visual acuity improvement to 20/80 (SD = 40), which was the highest among the groups. By 6 months, their visual acuity had improved further to 20/60 (SD = 40). Similarly, CRT decreased by 140 micrometers at 1 month, the most substantial reduction of the three groups [14]. This finding suggests that retrobulbar block anesthesia may facilitate better outcomes, possibly due to its comprehensive sensory blockade, which could lead to a more relaxed patient during the procedure, allowing for more precise drug administration. The peribulbar block group also showed significant improvements in visual acuity and CRT, though these were not as pronounced as in the retrobulbar block group. At 6 months, the mean visual acuity improved to 20/100 (SD = 50), and CRT decreased by 120 micrometers. The topical anesthesia group showed the least improvement in both visual acuity (20/120, SD = 60) and CRT (320 ± 45 µm), although their results were still statistically significant [15].

The differences in outcomes between the groups, particularly in visual acuity and CRT, suggest that while the primary goal of the study was to assess pain relief, the quality of anesthesia may also play a role in enhancing the precision and success of the injection procedure itself. A more comfortable and relaxed patient may contribute to better clinical outcomes, emphasizing the importance of selecting an optimal anesthesia method not just for pain management but also for achieving the best therapeutic effects. Intraocular pressure (IOP) was another parameter examined, as an increase in IOP after intravitreal injection is a known potential complication [16]. The results of this study indicated that there were no significant differences in the IOP changes between the anesthesia groups. Immediately after the injection, IOP increased slightly in all groups (mean IOP ranged from 16 to 18 mmHg), but these increases were transient and returned to baseline levels within 30 minutes. This is consistent with previous studies, which have shown that transient IOP elevation after intravitreal injection is common but typically resolves without clinical consequences [17]. Adverse events were rare across all groups. The most common complication was subconjunctival hemorrhage, observed in 10% of the topical anesthesia group, 5% of the peribulbar block group, and 3% of the retrobulbar block group. These rates are consistent with those reported in previous studies on intravitreal injections and are generally considered minor and self-limiting [18]. There were no cases of more severe complications such as endophthalmitis or retinal detachment in any group. The low incidence of adverse events further supports the safety of the different anesthesia techniques employed. While this study provides valuable insights, there are some limitations to consider. Firstly, the study was conducted at a single center, which may limit the generalizability of the findings to other settings or populations. Secondly, the study did not assess other potential factors that could influence treatment outcomes, such as the skill of the injector or the underlying severity of DME.

It is concluded that regional anesthesia demonstrates significant advantages over general anesthesia in cataract surgeries, particularly in terms of faster recovery times, higher patient satisfaction, and cost-effectiveness. However, both methods are effective in achieving comparable visual outcomes, and the choice of anesthesia should be individualized based on patient-specific factors, medical history, and surgical complexity

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