Posterior vitrectomy under topical anesthesia
Background: To determine the safety and efficacy of topical anesthesia in posterior vitrectomy. Methods: A total of 93 patients (93 eyes) with various vitreoretinal diseases not needing scleral buckling and with short predicted duration of surgery underwent posterior vitrectomy under topical (49 eyes) or retrobulbar (44 eyes) anesthesia. Patients in the topical group were sedated with neuroleptic anesthesia. Postoperatively patients were shown a visual analogue pain scale (VAPS) from 0 (no pain) to 10 (unbearable pain) to rate the levels of pain. The main outcome measures were overall and worst intraoperative pain scores duration of surgery and pain score during the administration of the retrobulbar anesthetic agent. Results: Mean surgical time was 57.9 minutes in the topical group and 56.6 minutes in the retrobulbar group (p > 0.05). The pain scores were not significantly different. Mean overall pain scores were 1.71 (SD 1.04 range 0-5) in the topical group and 1.38 (SD 1.04 range 0-3) in the retrobulbar group (p > 0.05). Mean worst pain scores were 3.20 (SD 1.30 range 1-7) and 2.95 (SD 0.73 range 1-4) respectively (p > 0.05). There was no significant correlation between duration of surgery and overall pain score in either group (r = 0.146 p = 0.356 and r = 0.174 p = 0.385 respectively). No patient required additional injection anesthesia in the topical group. Interpretation: Topical anesthesia combined with systemic sedation and analgesia in posterior vitrectomy procedures provided sufficient analgesic effects in selected patients needing no scleral buckling and with short predicted surgery time.
SourceCanadian Journal of Ophthalmology