Evolving use of regional versus general anesthesia for the surgical repair of open-globe injuries

Abstract

Purpose : The purpose of the current study is to report outcomes with the increased use of regional anesthesia with monitored anesthesia care (RA-MAC) versus general anesthesia (GA) in the repair of open globe injuries.

Methods : The study design is a retrospective consecutive case series. The study includes 507 eyes of 507 patients with open globe injuries treated at a tertiary referral center between 2015 and 2020. The main outcome measure was visual acuity at last follow-up. Results were compared to previously published study groups between 1995 to 2014.

Results : Primary closure of open-globe injury was performed under RA-MAC anesthesia in 462 patients (91%) and under GA in 45 patients (9%). Zone 1, 2, and 3 injuries were recorded in 251, 170, and 86 patients, respectively. Zone 1 (96%, 240 of 251 patients) or zone 2 (92%, 156 of 170 patients) (p< 0.001) were more likely to be repaired under RA-MAC versus zone 3 injuries (76%, 65 of 86 patients). Cases performed under RA-MAC were significantly shorter in duration than cases performed under GA (p<0.01, CI 18.2 to 50.9). The improvement from presenting visual acuity was similar for the two groups, 0.52 logMAR and 0.46 logMAR for RA-MAC and GA respectively (p=0.68, CI -0.3 to 0.2). The use of RA-MAC anesthesia for open globe injuries has increased at our institutionfrom: 64% in 1995-1999 to 91% in the present study, 2015-2020 (p<0.00001).

Conclusions : The current study demonstrates that RA-MAC can be safely used as an alternative to general anesthesia for open globe repair without adverse consequences.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.