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Andrew Joseph McClellan, Jacquelyn J Daubert, Harry W Flynn, Steven Gayer; The Comparison of Regional versus General Anesthesia for Surgical Repair of Open Globe Injuries. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3850.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the factors and outcomes of open globe injuries repaired under regional anesthesia with monitored anesthesia care (RA/MAC) compared with those repaired under general anesthesia (GA) in salvageable adult eyes.
This study is a retrospective case review of adult repairable open globe injuries performed at the Bascom Palmer Eye Institute between 2004 and 2012. Exclusion criteria were patients under 18 years old and those treated with primary enucleation. For each record reviewed the following information was recorded: age, gender, time from injury to presentation, location (zone) of injury, presence of an intraocular foreign body, presenting visual acuity, presence of rhegmatogenous retinal detachment, presence of lens involvement, presence of endophthalmitis, number of organisms identified from vitreous culture, final visual acuity, and type of anesthesia used.
A survey of 56 eyes selected at random from the study time period revealed a low rate of GA use at 10.71%. This is significantly less frequent than previous studies carried out in our own institution; 36% from 1995 to 1999 and 41% from 2000 to 2003 [Am J Ophthalmol 2002; 134: 707-711][Ophthalmic Surg Lasers Imaging 2005;36:122-128]. Though the majority of subjects were male (92%), there was no significant difference in gender between those repaired with RA/MAC versus GA (p=0.5486). Age was also not found to be significantly different (p=0.86). Presenting and final LogMAR visual acuity was better for open globe injuries repaired under RA/MAC (2.13 v. 2.60, and 2.00 v. 2.58). Those repaired under RA/MAC did have a shorter time to presentation (50.26 v. 66.75 hours). Interestingly, the location of injury categorized by zone, presence of intraocular foreign body, rhegmatogenous retinal detachment, and lens involvement were not significantly different between the two groups (p = 0.60, 0.91, and 0.95). If endophthalmitis was proven by culture, the number of causative organisms identified was higher for those eyes repaired under GA (2 v. 1.56).
Regional anesthesia with monitored anesthesia care is a sensible alternative to general anesthesia for the repair of open globe injuries and is the preferred means of anesthesia for such surgeries in our institution.
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