Author’s Disclosure Block: Angelica Hanna, none; Jake Armstrong, none; Efstathia Tsioros, none; Cindy Hutnik, none; Iqbal "Ike" Ahmed, none

Abstract Body
Purpose:Cataract surgery is widely performed globally, with recent major advancements improving techniques and outcomes. Sedation practices vary, with centers providing intravenous (IV), oral or no sedation for surgery. The purpose of this review is to assess the effectiveness of IV sedation compared to non-intravenous sedation for routine cataract surgery. Study Design: Systematic Review and Meta-Analysis Methods: Medline, Embase, Cochrane Library, BIOSIS, Web of Science, and CINAHL were searched from inception to July 2024 for relevant articles containing original data. Randomized controlled trials that compared IV to non-IV sedation and 1) used a validated pain scale to report on pain or 2) reported on perioperative complications were included. Risk of bias was assessed using the Cochrane’s Risk of Bias Tool. A random effects meta-analysis was conducted and odds ratios, standard mean differences, 95% confidence intervals (CIs), and I² statistics were reported. The review was registered in PROSPERO (registration number, CRD42024582495) and PRISMA guidelines were followed. Results: 12 randomized controlled trials including 1269 patients were included in the meta-analysis. IV sedation was associated with significantly decreased pain scores compared to no sedation (SMD = -0.98, 95% CI -1.68 to -0.29, p=0.006). Comparison of IV sedation to oral sedation showed no statistically significant difference in pain scores between groups (SMD = -0.56, 95% CI -1.60 to 0.48, p=0.29). Analysis of perioperative complications showed that patients with IV sedation were more likely to have adverse events when compared to patients receiving non-IV anesthesia (OR = 1.07, 95% CI 0.34 to 3.41). Conclusions: For routine cataract surgery, IV sedation was associated with significantly lower pain scores compared to no sedation, but oral and IV sedation provided comparable pain control. Perioperative complications seem to occur at slightly higher rates in patients who receive IV sedation. These findings may inform sedation practices for cataract surgery.