Richard M H Lee1, John R Thompson2, Tom Eke3. 1. Department of Ocular Biology and Therapeutics, Institute of Ophthalmology, London, UK. 2. Department of Health Sciences, University of Leicester, Leicester, UK. 3. Department of Ophthalmology, Norfolk & Norwich University Hospital, Norwich, UK.
Abstract
BACKGROUND: Recent years have seen a major change in practice of local anaesthesia (LA) for cataract surgery. AIMS: (1) To estimate current usage of LA techniques for cataract surgery, (2) to estimate the incidence of severe adverse events associated with each LA technique, (3) to compare with our previous 2003 study. METHODS: This was a prospective, observational study of routine practice. For 13 months in 2012-2013, the British Ophthalmological Surveillance Unit sent monthly mailings to all senior British ophthalmologists, asking for reports of 'potentially sight-threatening or life-threatening complications of LA for cataract surgery'. Current practice was assessed by questionnaire. RESULTS: Cataract surgery comprised 3.4% general anaesthesia, 92.5% LA alone and 4.1% LA with sedation. Techniques for the estimated 357 000 LA cataracts were: 8.8% peribulbar, 1.3% retrobulbar, 50.5% sub-Tenon's, 1.4% subconjunctival, 13.8% topical, 24.2% topical-intracameral LA. Severe sight-threatening complications included seven globe perforations, one cilioretinal artery occlusion and one severe corneal oedema. Severe life-threatening complications included one profound vasovagal episode, one silent myocardial infarction, one anaphylactic reaction and one supraventricular tachycardia. Under-reporting means that more complications probably occurred. CONCLUSIONS: There has been a large swing towards 'non-injection' LA in recent years. Serious adverse events were reported with all techniques except topical-intracameral and subconjunctival LA, though the incidence appears lower for 'non-injection' LA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND: Recent years have seen a major change in practice of local anaesthesia (LA) for cataract surgery. AIMS: (1) To estimate current usage of LA techniques for cataract surgery, (2) to estimate the incidence of severe adverse events associated with each LA technique, (3) to compare with our previous 2003 study. METHODS: This was a prospective, observational study of routine practice. For 13 months in 2012-2013, the British Ophthalmological Surveillance Unit sent monthly mailings to all senior British ophthalmologists, asking for reports of 'potentially sight-threatening or life-threatening complications of LA for cataract surgery'. Current practice was assessed by questionnaire. RESULTS:Cataract surgery comprised 3.4% general anaesthesia, 92.5% LA alone and 4.1% LA with sedation. Techniques for the estimated 357 000 LA cataracts were: 8.8% peribulbar, 1.3% retrobulbar, 50.5% sub-Tenon's, 1.4% subconjunctival, 13.8% topical, 24.2% topical-intracameral LA. Severe sight-threatening complications included seven globe perforations, one cilioretinal artery occlusion and one severe corneal oedema. Severe life-threatening complications included one profound vasovagal episode, one silent myocardial infarction, one anaphylactic reaction and one supraventricular tachycardia. Under-reporting means that more complications probably occurred. CONCLUSIONS: There has been a large swing towards 'non-injection' LA in recent years. Serious adverse events were reported with all techniques except topical-intracameral and subconjunctival LA, though the incidence appears lower for 'non-injection' LA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Entities:
Keywords:
Anterior chamber; Drugs; Treatment Surgery