5
Biometry and Intraocular Lens Power Calculation
Î Accurate measurement of axial length and central corneal power,
combined with an appropriate IOL selection based on a power
calculation formula, is the minimal requirement to achieve the
targeted postoperative refraction. (III, G, S)
Î The surgeon should consider the patient's individual desires and needs
in selecting an appropriate postoperative refractive target. (III, G, S)
Anesthesia
Î Local (regional) and topical anesthesia is generally preferred, with
or without sedation/analgesia. General anesthesia may be utilized
if needed for patients with medical, psychosocial, or surgical
indications. In a review of studies on cataract surgery using local
anesthesia, investigators have concluded that a variety of anesthesia
strategies for cataract surgery are safe and effective and that they
provide good or excellent intraoperative pain control. (I++, G, S)
Î Intravenous access is recommended to treat potential adverse events
when sedation/analgesic agents are administered. (I+, G, S)
• However, given the trend toward topical anesthesia and reduction or elimination
of intravenous analgesia/sedation, IV access may be unnecessary.
• Topical anesthetic drops may be supplemented with intracameral lidocaine for
increased pain control.
Î Monitoring during administration of anesthesia and surgery generally
includes using a heart monitor, pulse oximetry, and measurement
of blood pressure and respirations. These should be performed by
personnel (other than the operating ophthalmologist) qualified to
monitor and manage the patient's systemic status. (III, G, S)
ÎA review of cataract surgery studies involving local anesthesia found weak
evidence for improved pain relief, anxiety control, and patient satisfaction
with IV or intramuscular sedation or analgesia and insufficient evidence to
recommend one technique over the other. (I+, G, S)
Î Given the lack of evidence for a single optimal anesthesia strategy
for cataract surgery, the type of anesthesia management should be
determined according to the patient's needs, the preference of the
patient, the anesthesia professionals, and the surgeon. (I+, G, S)
