Ophthalmology Retina, May/June 2017
McClellan et al. compared the clinical features and physician selection of either regional anesthesia (peribulbar or retrobulbar block) with monitored anesthesia care (RA-MAC) or general anesthesia (GA) for repair of open-globe injuries. They found that patients managed with RA-MAC had, among other factors, smaller, more anterior wounds and shorter operative time than those who received GA.
Participants in this nonrandomized comparative retrospective chart review were adults with open-globe injuries who received primary repair at a single university referral center between Jan. 1, 2004, and Dec. 31, 2014. Data collected from each patient included age, gender, injury type, location, length of wound, presenting visual acuity (VA), type of anesthesia used, duration of procedure, months of clinical follow-up, and final VA. Complete data were available for 448 patients.
In this case series, repair was performed using RA-MAC in 78% of patients and GA in 22%. With regard to location of injury, the rates of RA-MAC versus GA, respectively, were as follows: Zone 1 (anterior to the limbus), 213/241 (88%) and 28/241 (12%); Zone 2 (<5 mm posterior to the limbus), 104/135 (77%) and 31/135 (23%); and Zone 3 (>5 mm posterior to the limbus), 34/72 (47%) and 38/72 (53%). Open-globe injuries repaired under RA-MAC had significantly shorter wound length, more anterior wound location, and shorter operative times, as well as a better presenting VA. However, neither class of anesthesia conferred a greater VA improvement, and use of GA did not lengthen the time between the injury and surgical repair.
The authors noted that the choice between RA-MAC and GA is debatable, as each type has particular risks and benefits in this setting. They concluded that RA-MAC is a reasonable alternative to GA for the repair of open-globe injuries in selected adult patients. Further, the study demonstrates that neither type of anesthesia, for any single zone of injury, provides a clear advantage in visual outcome and that the amount of improvement of VA is more likely related to the severity of injury than the type of anesthesia used.
The original article can be found here.