Abstract
Purpose :
Exposure keratopathy (EK) is the most common potential ocular complication following general anesthesia (GA), presenting with postoperative pain, tearing, photophobia, and blurred vision. The current study aims to evaluate the incidence of post-anesthesia exposure keratopathy before and after implementation of a bio-occlusive dressing eye protection protocol (Fig. 1).
Methods :
We conducted a single-center nonrandomized quality improvement study on 15,585 patients from March 2018 to June 2018 (before protocol) and from August 2018 to February 2019 (after protocol). The primary study outcome was the development of anesthesia-related exposure keratopathy in patients. Odds ratios (ORs) were generated using multivariate logistic regression models. Potential confounders in the model included patient demographics, duration of GA, smoking status, diabetic status, American society of anesthesiologists (ASA) wellness score, anesthesiologist type (i.e., CRNA, resident, faculty) and dependent surgical positioning. Inverse probability of treatment weighting (IPTW) was implemented to create a balanced comparison between periods on the baseline variables. Power analysis found that post-weighted samples sizes were large enough to ensure a power of 98.14% with a type I error of 0.05 to detect a 10% difference (RR=1.1) for outcomes. Two-tailed tests were evaluated with an alpha = 0.05.
Results :
There was no significant monthly trend in the number of GA cases during the 11-month period (Fig. 2). Prior to introduction of protection protocol, 25/6506 (0.38%) patients undergoing GA developed EK. After protocol implementation, the number of EK was reduced to 3/9352 (0.03%) (p<0.001). After IPTW adjustment, the relative risk reduction was 90.0% (CI: 67.3%, 96.9%) and the number needed to treat was 291.52 (CI: 206.7, 501.5). IPTW binary logistic regression analysis controlling for confounding found that there was a significantly decreased odds of developing EK after protocol implementation when compared to before (OR [95% CI], 0.083 [-0.016–0.182], P < .001) (Table 1).
Conclusions :
The lack of a standardized eye protection protocol results in higher EK incidence, suggesting that lagophthalmos is the most important factor in the development of anesthesia-related EK. The systematic use of a bio-occlusive dressing represents an effective method for reducing the post-GA keratopathy risk.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.