Purchase this article with an account.
F. Segev, A.N. Voineskos, G. Hui, M.S. Law, R. Paul, F. Chung, A.R. Slomovic; Combined Topical and Intracameral Anesthesia in Penetrating Keratoplasty . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4702.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: The standard care for penetrating keratoplasty (PKP) is either retrobulbar or peribulbar anesthesia combined with 7th cranial nerve akinesia or general anesthesia. These methods are known to be associated with rare but potentially serious adverse ocular and systemic events. The purpose of this study was to determine the safety and efficacy of combined topical and intracameral anesthesia for repeat PKP. Methods: In this prospective study, combined topical tetracaine 0.5% and 0.2cc intracameral 1% lidocaine along with IV sedation of midazolam and fentanyl were used for repeated PKP in 15 eyes of 15 selected patients. The indication for surgery was failed corneal graft. Verbal pain scale (VPS) (0-3) was recorded intraoperatively at 4 time-points (immediately before surgery, after trephination, after placing 8 interrupted sutures, and after placing the running suture), and postoperatively (1 hour postoperatively, overnight pain and 1 day postoperatively). Patients and surgeon satisfaction were assessed postoperatively using a scale (1-5). After surgery patients were asked for their preferences comparing the current use of topical anesthesia compared to retrobulbar anesthesia used for their initial PKP. Results: The mean intraoperative VPS score was 0.41 (range 0-0.88) and the mean postoperative VPS score was 0.49 (range 0-1.67). There were as no intraoperative or postoperative complications. All patients reported high mean satisfaction score of 4.67 (range 4-5). The mean satisfaction score reported by the surgeon was 4.47 (range 3-5). All patients but one (93.3%) preferred combined topical over retrobulbar anesthesia, which they had in their previous surgery. Conclusions: We found combined topical and intracameral anesthesia to be safe and effective in selected patients undergoing repeat PKP and may provide a satisfactory alternative anaesthesia for patients in whom general, retrobulbar or peribulbar anaesthesia may be contraindicated.
This PDF is available to Subscribers Only