Objectives
To assess Dexmedetomidine’s effect as an adjuvant to peribulbar anesthesia on the retinal vasculature in patients with glaucoma undergoing cataract extraction surgery via optical coherence tomography angiography (OCT-A).

Participants
Thirty-nine glaucoma participants planned for phacoemulsification were allocated into two groups. A 10 ml mixture of peribulbar anesthesia was administered to group I. This anesthetic mixture consisted of 4.5 ml of lidocaine 2% mixed with 4.5 ml of bupivacaine 0.5%,1 ml of dexmedetomidine (50 µg), and 150 IU hyaluronidase. Group II was administered a peribulbar anesthetic mixture consisting of 4.5 ml of lidocaine 2% combined with 4.5 ml of bupivacaine 0.5%,150 IU of hyaluronidase, and 1 ml of normal saline, totaling 10 ml. Optical coherence tomography angiography was used 10 mi before and 10 min after injection to scan optic disc total vessel density, foveal superficial deep capillary plexuses (DCP) density, radial peripapillary capillary network density, and total vessel density plus foveal avascular zone (FAZ) diameter. We also checked the intraocular pressure (IOP) before and 10 min after the anesthetic injection.

Results
After the administration of the peribulbar anesthetic, group II demonstrated a notably higher significance in the DCP fovea median percent change (–43.7%) compared with group I (-2%) (P