Abstract
Abstract: :
Purpose: To report factors associated with the use of local anesthesia with intravenous sedation rather than general anesthesia for surgical repair of open globe injuries. Methods: The current study is a retrospective, consecutive case series of patients with open globe injuries repaired at Bascom Palmer Eye Institute between January 2000 and January 2003. The results of the current study are compared to a previous similar study from 1995 to 1999 at the same institution. Results: The current study consisted of 64 eyes of 64 patients with a median age of 38.5 years (range 4–94). 55/64 (86%) of patients were at least 18 years old. General anesthesia was used in 27/64 (42%) and local anesthesia/sedation in 37/64 (58%) of cases. Patients under local were significantly more likely to have anterior wound location (57% corneal/limbal vs 30%, p=0.032, chi–square), shorter wound length (6.5mm for local vs 11mm for general, p=0.001, chi–square), and less likely to have an afferent pupillary defect (1/25 (4%) for local vs 10/18 (56%) for general, p=0.001, chi–square). The local anesthesia group had better presenting visual acuity than the general anesthesia group: local median=20/200 versus general median=light perception, p<0.001, t–test. The general anesthesia group had longer operating times than local: mean=81 min vs 50 min, p=0.017, t–test. Improvement in visual acuity between presenting and final examinations was similar between the two groups (0.36 vs 0.55 logMAR units, p=0.48, t–test). There was no intraoperative surgical or anesthesia–related complication in either group. Conclusions: Factors associated with the use of local anesthesia for open globe injury repair include better presenting visual acuity, more anterior wound location, and shorter wound length. Based upon the results from the current study of patients from 2000–2003 and our previous study from 1995–1999, local anesthesia with sedation is a reasonable alternative to general anesthesia for selected patients with open globe injuries.
Keywords: trauma • clinical (human) or epidemiologic studies: systems/equipment/techniques • vitreoretinal surgery