The effect of sub-Tenon versus topical anesthesia on pupil responses in the early postoperative period after cataract surgery.

OBJECTIVE

To evaluate whether sub-Tenon anesthesia used during cataract surgery has a potential effect on pupillary dynamics by assessing late-term pupillary responses, and to compare these outcomes with those under topical anesthesia to ensure the safety of sub-Tenon anesthesia.

METHODS

The medical records of 63 eyes of 63 patients aged 50-70 who underwent cataract surgery between January 2022 and December 2023 were retrospectively analyzed. Demographic data and medical histories were reviewed. Comprehensive eye examinations including visual acuity, biomicroscopic and detailed fundus examination, and pupillography measurements (photopic, mesopic, scotopic, and dynamic responses) were recorded preoperatively and at postoperative week 1 follow-up.

RESULTS

The mean ages of patients in the topical and sub-Tenon anesthesia groups were 67.25 ± 10.29 and 68.84 ± 9.31 years, respectively. A total of 21 patients were male and 42 were female. Topical anesthesia was applied to 31 eyes and sub-Tenon anesthesia to 32 eyes. Both groups showed significant changes in pre- and postoperative scotopic, mesopic, and dynamic 10-second pupillary responses (p < 0.05). However, there was no statistically significant difference in static and dynamic pupil diameters between the two groups (p > 0.05).

CONCLUSIONS

Sub-Tenon's anesthesia does not cause clinically significant changes in pupillary dynamics one week postoperatively, suggesting it is a safe alternative to topical anesthesia in terms of autonomic pupillary response.