The authors of the present study conducted a comparative analysis of procaine hydrochloride topical anesthesia and Nadbath-Rehman-Ellis akinesia to observe orbicularis oculi stress against the eyelid speculum and occurrence of postoperative ptosis.

In 40 eyes of 20 patients, 1 eye underwent a cataract operation by topical anesthesia and the other eye underwent Nadbath-Rehman-Ellis akinesiaDepending on the anesthetic method, the 2 groups were evaluated to determine the difference in marginal reflex distance and levator function after the surgery.

There were no significant differences between the 2 groups in the mean preoperative MRD1 which was 2.5 ± 0.4 mm and levator function which was 9.0 ± 1.1 mm. After 1 week and 4 weeks, the mean MRD1 on eyes with topical anesthesia was 2.0 ± 0.3 mm and 2.3 ± 0.3 mm, respectively, and the mean MRD1 on eyes with Nadbath-Rehman-Ellis akinesia was 2.3 ± 0.2 mm and 2.4 ± 0.4 mm, respectively, which was significantly lower ( p = 0.046, 0.042). The levator functions showed no significant differences. The reduction of MRD1 over 2 mm was shown only in the group with topical anesthesia which was significantly higher in comparison to the group with Nadbath-Rehman-Ellis akinesia which had none.

In cataract surgery, Nadbath-Rehman-Ellis akinesia can reduce damage to the levator aponeurosis decreasing the occurrence of postoperative ptosis.