Local anaesthesia for vitreoretinal surgery: a case-control study of 200 cases

Phacoemulsification with transpupillary silicone oil removal and lens implantation through a corneal incision using topical anesthesia

PURPOSE

To evaluate phacoemulsification combined with transpupillary silicone oil removal and foldable intraocular lens (IOL) implantation through a single corneal incision and planned posterior capsulorhexis after pars plana vitrectomy using topical anesthesia.

SETTING

Department of Ophthalmology, University of Bari, Bari, Italy.

METHODS

This noncomparative nonrandomized noncontrolled interventional case series comprised 34 consecutive patients (34 eyes). The mean age of the 25 men and 9 women was 54.4 years +/- 13.3 (SD). A mean of 8.2 +/- 9.4 months after silicone oil injection, patients had phacoemulsification with transpupillary silicone oil removal and foldable acrylic IOL implantation through a single corneal incision and a planned posterior capsulorhexis under topical anesthesia. Patients were operated on by the same surgeon. Visual acuity, the frequency of retinal redetachment, secondary cataract and vitreous hemorrhage formation, subjective pain and discomfort, the duration of surgery, and intraocular pressure (IOP) were noted. The mean follow-up was 9.4 +/- 5.1 months (range 4 to 21 months).

RESULTS

Vision improved or stabilized in 88.2% of eyes. Retinal redetachment occurred in 4 eyes (11.8%) and transient vitreous hemorrhage in 1 (2.9%). All patients reported minimal discomfort during the procedure. The mean duration of surgery was 17 +/- 4 minutes. There was no significant intraoperative or postoperative IOP variation.

CONCLUSIONS

Combined phacoemulsification, transpupillary silicone oil removal, and IOL implantation through a single corneal incision under topical anesthesia was safe and effective. In general, the visual outcomes were good with improvement in visual acuity.

UK survey of attitudes to local anaesthesia for vitreoretinal surgery

BACKGROUND

The use of local anaesthesia (LA) for vitreoretinal (VR) surgery is growing although surgeons in the UK traditionally use general anaesthesia.

PURPOSE

To assess the use and attitudes towards local anaesthesia for VR surgery among the members of the British and Eire Association of Vitreo-retinal Surgeons (BEAVRS).

METHODS

A questionnaire was sent to members of BEAVRS. Use of LA was assessed for the following procedures: macular hole; diabetic vitrectomy; vitrectomy; cryopexy and gas; buckling and re-buckling procedures. Attitudes of surgeons generally using LA for primary retinal detachment surgery (> 50% of cases) were compared with those generally using general anaesthesia (GA) (> 50% of cases).

RESULTS

33.6% of surgeons preferred LA for macular hole; 26.2% for diabetic vitrectomy; 23.3% for vitrectomy, cryopexy and gas; 21.4% for buckling procedures; and 9.35% for re-buckling procedures. When surgeons routinely using LA were compared with those regularly using GA they considered LA less stressful for patients and surgeon, patients tolerant to longer operations, and buckling or redo surgery no more difficult under LA. However, both groups considered surgery on young patients and teaching relatively more difficult under LA.

CONCLUSION

The use of LA may convey benefits for VR surgery and faster rehabilitation for patients. However, we identified wide variations in the use of and attitudes to LA for VR surgery in British surgeons.

Local anaesthesia for 1221 vitreoretinal procedures

BACKGROUND

Vitreoretinal (VR) surgery has been increasingly performed under local anaesthesia (LA) in this unit. The results of an audit monitoring this change are presented.

METHODS

Data were collected on 1497 patients including type, volume, and position of the anaesthetic block, type of surgery, complications, and patient reactions.

RESULTS

1221/1479 (82%) patients had LA. They were older than those having general anaesthesia (GA) 63.5 years v 45.9 years; 146 (10.6%) blocks were intracone, 130 (10.6%) peribulbar, and 927 (75.9%) combined. Operations included 436 vitrectomies, 545 retinopexy with or without vitrectomy, and 238 buckling procedures. Some pain was felt by 9.4%, 8.8%, and 19.7% of patients during vitrectomy, retinopexy with or without vitrectomy, and buckling surgery respectively.

CONCLUSION

Local anaesthesia for VR surgery is well tolerated by patients, being effective throughout longer and more stimulating ocular surgery.