Topical-intracameral anesthesia without preoperative mydriatic agents for Descemet-stripping automated endothelial keratoplasty and phacoemulsification cataract surgery with intraocular lens implantation

We describe a technique for a new triple procedure comprising phacoemulsification and intraocular lens (IOL) implantation followed immediately by Descemet-stripping automated endothelial keratoplasty (DSAEK). It is performed under topical anesthesia, with dilation accomplished using methylparaben-free lidocaine 1% with no added epinephrine. In a case series of 32 patients, adequate dilation was achieved and no patient reported significant intraoperative discomfort. No operative or postoperative complications were encountered, and visual rehabilitation was quick and satisfactory. Topical anesthesia eliminated the risks associated with retrobulbar and peribulbar blocks, as well as the risks associated with general anesthesia. Intracameral dilation with preservative-free lidocaine 1% provided adequate and short-lived dilation, alleviating the need for intraoperative pharmacologic constriction when transitioning from IOL implantation to DSAEK. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.