The outcome of keratoplasty is progressively getting worse with time in pseudophakic or traumatic keratopathies whereas survival rates are still stable from 10 to 17 years in grafts performed after keratoconus or herpetic keratitis.

Aims-A prospective study was carried out in order to evaluate the eYcacy and safety of peribulbar anaesthesia during keratoplasty and to describe surgical conditions. Methods-Of 137 consecutive keratoplasties, 100 (73%) were performed under peribulbar anaesthesia. Patients received a mean volume of 16.5 (SD 4) ml (range 9-22 ml) of a mixture of etidocaine, bupivacaine, and hyaluronidase. Ocular compression duration was at least 20 minutes and intraocular pressure (IOP) was measured with a Tonopen after injection, compression, and before trephination. Degree of akinesia, pain scoring, complications, and surgical conditions were studied. Results-Before trephination, IOP was 5.73 mm Hg below the preinjection value and was never above 21 mm Hg. Akinesia was complete in 80% of cases and 94% of patients found that surgery was painless. Two patients (2%) were very agitated during surgery. The last patient presented with an acute intraoperative suprachoroidal haemorrhage that did not result in a true expulsive haemorrhage despite an "open sky" situation. Surgical conditions were judged to be optimal by the patients in 92% of cases and by the surgeon in 98% of cases. Conclusion-These results demonstrate that peribulbar anaesthesia oVers excellent anaesthesia and akinesia during keratoplasty and may be recommended for this type of surgery. (Br J Ophthalmol 1999;83:104-109)

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