Abstract
Purpose :
We performed a prospective, observational study to determine if monitored anesthesia care (MAC) provides an equivalent patient experience as retrobulbar injection for cyclophotocoagulation (CPC).
Methods :
Patients in an urban hospital who were treated with traditional or micropulse transscleral CPC were enrolled. Patients received either regional anesthesia with retrobulbar injection in the clinic procedure room or MAC without a regional block in an operating room. The choice of anesthesia was made by the attending surgeon and the patient separate from and prior to study recruitment. Participants were given a brief survey with a combination of numeric scale, yes/no, and open-ended questions to assess pain levels and overall experience. The survey was administered preoperatively (pre-op) and postoperatively (post-op) at 1 day (POD1), 1 week (POW1), and 1 month (POM1) after the procedure. Visual acuity (VA) and intraocular pressure (IOP) were obtained at each visit.
Results :
Results from our ongoing study included 11 patients, with 5 receiving retrobulbar anesthesia and 6 receiving MAC. There were no significant differences in pre-op VA (P=.82, 95%CI [-1.49, 1.22]) and pre-op pain level (P=.32, 95%CI [-3.82, 1.42]) between groups. Both groups demonstrated a significant reduction in IOP post-op (retrobulbar P=.009, MAC P=.012), with no significant reduction in VA (retrobulbar P=.24, MAC P=.27). There was no significant difference in post-op pain on POD1, POW1, or POM1 between the groups (P=.24, 95%CI [-3.64, 1.04]; P=.38, 95%CI [-1.43, 3.37]; P=.56, 95%CI [-1.47, 0.87] respectively). Both groups reported similar overall satisfaction with the procedure (retrobulbar mean 4.36, MAC mean 4.43; 0 to 5 low-to-high scale; P=.84, 95%CI [-0.94, 0.80]). Open-ended comments were overall positive for both groups, with the exception of one patient in the retrobulbar group who reported pain with needle entry. At POM1, all patients reported they would elect to have the same anesthesia if CPC was needed in the future.
Conclusions :
Patients with comparable pre-op characteristics who underwent CPC demonstrated similar levels of post-op pain, high overall satisfaction, and significant IOP lowering regardless of whether regional anesthesia or MAC was utilized. These findings suggest MAC can provide an option that eliminates the risk to the periorbital area during retrobulbar block.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.