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Y.H. Yoon, T. Lim, M.S. Humayun; Vtreoretinal Surgery Under Retrobulbar Block Only . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5433.
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Purpose: The majority of vitreoretinal (VR) surgery is performed under general anesthesia or monitored anesthesia care. The purpose of this study was to demonstrate the scope of retrobulbar block only (RB) for VR surgery, to measure the acceptance of local anesthesia to patients and surgeons. Methods: Ninety patients who had undergone either 20G pars plana vitrectomy (PPV) or 25G transconjunctival sutureless vitrectomy (TSV25) were included. To determine the acceptability of RB to patients and surgeons, a clinical survey was carried out using a questionnaire and vital signs were monitored during operation. Surgical outcome was also assessed to confirm the validity of this practice pattern in clinical setting. Results: Under retrobulbar anesthesia only, 65 patients were treated with PPV and 25 with TSV25. Preoperative diagnoses included diabetic hemorrhage/RD/CSME in 49, macular pucker/hole/hemorrhage in 18, RD in 4, vein occlusion in 5, and others in 14 patients. In 25 patients, phacoemulsification and posterior IOL implantation was also combined. Mean operation time was 39 (range 20–60) minutes for TSV25 and 57 (30–150) minutes for PPV. Twenty–eight patients complained mild and 4 patietns moderate degree of pain during surgery. Among them 29 required either topical (15) or infiltrative (14) anesthesia additionally. There was no case of intraoperative complication because of movement of the patients. Increase of systolic blood pressure by 15 mmHg or higher occurred in 11 cases, and respiratory rate by 3 or more in 7 cases. Anatomical success rate was 95 % and visual improvement was achieved in 80%. Complications included a manageable retrobulbar bleeding in one case and postoperative neovascular glaucoma in 2 cases. Conclusions: We conclude that VR surgery can be safely and efficiently performed under retrobulbar block only. With the adoption of local anesthesia for TSV25, a new era of office–based VR surgery is just around the corner.
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