Purchase this article with an account.
Andrew Joseph McClellan, Jacquelyn J Daubert, Harry W Flynn, Steven Gayer; A 19-Year Experience of Regional Anesthesia for the Surgical Repair of Open Globe Injuries. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6043.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To examine the changes over time in the factors and outcomes of open globe injuries repaired under regional anesthesia (RA), local block with monitored anesthesia care, compared with those repaired under general anesthesia (GA) in salvageable adult eyes.
A retrospective case series of all adult repairable open globe injuries receiving primary repair at the Bascom Palmer Eye Institute between January 1st, 2004 and December 31st, 2013. Cases were identified by a post-operative diagnosis of open globe injury (ICD-9: 360.5, 360.6, 871, or 918.1). Exclusion criteria were patients less than 18 years of age and those treated with primary enucleation. This data was then compared to that collected from our own institution 1995 to 2003 with identical inclusion and exclusion criteria [AJO 2002;134:707-711][OSLI 2005;36:122-128].
714 eyes met inclusion criteria. There was a high rate of RA use at 79%. This is significantly more frequent than the preceding 10 years; 64% from 1995 to 1999 [p<0.001] and 41% from 2000 to 2003 [p<0.001]. The majority of subjects were male (70%), but there was an insignificant difference in gender between those repaired with RA versus GA [p=0.4]. Age was found to be significantly different between these groups [p<0.001] with the mean age of those repaired under GA being 7 years younger than those repaired with RA (45 v. 53 yrs). This difference was not found during the prior two study periods. No mechanism of injury was any more prevalent in either study group (bunt, sharp, intraocular foreign body, perforating, or mixed) [p=0.6]. Open globe injuries repaired under RA, versus GA, had wounds that were more anterior in location (Zone 1: 60 v. 23%, Zone 2: 29 v. 33%, Zone 3: 11 v. 44%), and smaller in size (8 v. 14 mm) [p<0.001]. These eyes also had better presenting and final logMAR visual acuities (2.13 v. 2.6, and 2 v. 2.58) [p<0.001]. Wound characteristics between the RA and GA group parallel those found between 1995 and 2003 with a trend towards larger and more posterior injuries being repaired with RA in the current study period, though it was not found to be statistically significant.
Regional anesthesia is a suitable alternative to the risks of general anesthesia for the repair of open globe injuries in selected patients.
This PDF is available to Subscribers Only