Patients undergoing ophthalmic surgery may represent extremes of age. Many of them may have coexisting diseases (e.g., diabetes mellitus, coronary artery disease, essential hypertension, chronic lung disease, renal insufficiency/failure). The primary goal of any successful cardiac anesthetic is prevention of myocardial ischemia and prompt identification and treatment of new ischemic episodes. Case : A 51 th-year-old male was diagnosed with complicated cataract and was planned to undergo VPP (Pars Plana Vitrectomy) and Phaco. The patient has uncontrolled diabetes mellitus since 10 years, had used OADs and insulin but was self-discontinued, currently using insulin glargin 8 units at night since the first right eye surgery. The patient also has a history of hypertension and severe coronary arterial disease (CAD) known since July 2024. The choice is Peribulbar nerve block with mild sedation if needed to guarantee pain free and not anxious during the surgery so as not to worsen his CAD problems. Post nerve block evaluate akinesia and analgesia of the eye achieved before surgery. Discussion : Advantages of the peribulbar technique include less risk of penetration of the globe, optic nerve, and artery and less pain on injection. The peribulbar that has been done in this case showed that peripheral nerve block with ropivacaine can mimimalize cardiac event and avoid general anesthesia in patient with severe CAD. Conclussion : This case demonstrates that the administration of ropivacaine in peribulbar nerve block is beneficial in ophthalmic surgical procedures with patients who have severe CAD