A systematic literature search was performed to identify prospective randomized studies comparing akinetic (sub-Tenon, peribulbar, or retrobulbar) and kinetic (topical or topical and intracameral) local anesthesia for phacoemulsification surgery. Only studies that stated the rate of posterior capsule rupture or that stated without qualification that there were no intraoperative complications were included. Of the initial 3182 articles, 15 papers met the inclusion criteria. The number of eyes ranged between 26 and 282 per group (mean 95.4 eyes per group), with a total of 2862 eyes. Eleven articles mentioned posterior capsule rupture specifically; 4 stated that no intraoperative complications occurred. Eleven (0.74%) of 1494 eyes in the akinetic group and 11 (0.80%) of 1368 eyes in the kinetic group experienced posterior capsule rupture. The chi-square test confirmed the difference was not statistically significant (P = .84). This analysis indicates that there appears to be no clinically or statistically significant difference in the risk for posterior capsule rupture between akinetic and kinetic local anesthesia techniques.
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