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J. Goshe, M. A. Feldman, W. J. Dupps; Graft Dislocation After DSAEK in Patients Receiving General Versus Local Anesthesia. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2198.
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To compare the incidence graft dislocation in patients receiving general versus local anesthesia who underwent Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK).
The charts of 101 patients (127 eyes) who had primary DSAEK performed by four surgeons at the Cole Eye Institute were retrospectively reviewed. Ninety-three were performed with local anesthesia and 34 with general anesthesia. The indication, operative procedure, type of anesthesia used, and any operative or post-operative complications were recorded. Based on the type of anesthesia used (local versus general) the patients were divided into two groups. The proportion of patients with graft dislocation was compared and the relative risk was calculated.
For the local anesthesia group, complications were reported in 6 patients (6.4%), including: graft dislocation in 3 patients (3.2%), formation of peripheral anterior syenchiae requiring lysis of adhesions in 2 patients (2.1%), and vitreous in the anterior chamber requiring anterior vitrectomy in 1 patient (1.0%). For the general anesthesia group, complications were reported in 9 patients (26.5%), including: graft dislocation in 7 patients (20.6%), formation of peripheral anterior syenchiae resulting in angle closure glaucoma and requiring lysis of adhesions in 2 patients (5.9%), and inadvertent injection of air posteriorly requiring vitrectomy in 1 patient (3.0%). The relative risk of all complications for the general anesthesia group was calculated to be 4.1 (95% CI=1.6-10.7). The relative risk of requiring re-bubbling in the general anesthesia group was calculated to be 6.38 (95% CI=1.7-23.3).
The choice of anesthesia for DSAEK is dictated by many factors, including patient health, patient preference, and the surgeon’s desire to reduce unwanted movement. It has been our observation that patients receiving general anesthesia have more difficulty maintaining post-operative positioning due to nausea and disorientation. This is supported by the greater rate of graft dislocation seen in our general anesthesia group. Although other factors including surgical technique and experience may confound this data, ophthalmologists should be aware that general anesthesia may increase the risk of complications in patients undergoing DSAEK.
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