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I. Theocharis, A. Alexandridou; Sutureless 25G and 23G Vitrectomy Under Topical Anaesthesia . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4657.
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To evaluate the safety and patients' tolerance to topical anaesthesia in vitreoretinal surgery
Thirty (n=30) patients (group A) were operated with 25g (n=25) and 23g (n=5) sutureless vitrectomy under topical anaesthesia with 2% unpreserved lidocaine gel, for various vitreoretinal diseases such as macula holes, epimacular membranes, dislocated crystalline lens, vitreous haemorrhage, proliferative diadetic retinopathy and retinal detachment. All patients had been informed about alternative forms of anaesthesia and accepted to undergo surgery under topical anaesthesia. Subjective patients' pain was recorded using a visual analogue scale and a numerical rating scale from 0 to 10. Results were compared with the subjective pain recorded from a control group of ten patients (group B), who underwent similar procedures under peribulbar anaesthesia. Mann– Whitney U–test was used to compare the two samples.All surgery performed by the same surgeon and the surgeon compared the difficulty of the operations under topical anaesthesia with similar procedures under peribulbar anaesthesia; surgeon's evaluation was recorded and categorized in five categories; One year after the beginning of the study all patients' records were reviewed.
Follow–up period ranged from one month to one year ; two cases were reoperated . No anaesthesia–related complication was noted during surgery or during the follow–up period . The operation converted in 20g vitrectomy and subtennon anaesthesia in 2 out of 30 cases.One retinal touch occured during the 'en block' epimacular membrane and internal limiting membrane peeling of the first patient with epiretinal membrane. No complication occured intraoperatively and postoperatively to the control group. Patients with peribulbar anaesthesia expierienced more pain with a marginal statistical propability (p= 0047). Maximal pain level recorded was +3 (moderate) in group A and +8 (severe ) in group B. The most painful steps of the procedures were scleral indentation and subconjuctival injection of antibiotics and steroids in the topical anaesthesia group and peribulbar injection and scleral indentation in the peribulbar anaesthesia group. According to the surgeon macula surgery performed under topical anaesthesia and with 25g instruments represents the most difficult combination.
Topical anaesthesia with 2% unpreserved lidocaine gel may be a safe and well–tolerated alternative anaesthesia in a broad spectum of vitreoretinal surgical cases
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