Abstract
This study compares the clinical features and physician selection of 2 types of anesthesia—regional anesthesia (peribulbar or retrobulbar block) with monitored anesthesia care (RA-MAC) and general anesthesia (GA)—for open-globe injury repair.
A nonrandomized, comparative, retrospective case series at a university referral center.
All repairable open-globe injuries in adult patients receiving primary repair between January 1, 2004, and December 31, 2014 (11 years). Exclusion criteria were patients <18 years of age and those treated with primary enucleation.
Data were gathered via retrospective chart review.
Data collected from each patient were age, gender, injury type, location, length of wound, presenting visual acuity, classification of anesthesia used, duration of the procedure performed, months of clinical follow-up, and final visual acuity. Open globe injuries were classified into zone 1 (cornea and limbus), zone 2 (≤5 millimeters posterior to the limbus), and zone 3 (>5 millimeters posterior to the limbus).
During the 11-year study period, 448 patients with open-globe injuries and documented information on zone of injury were identified. Globe-injury repair was performed using RA-MAC in 351 of these patients (78%) and GA in 97 patients (22%). Zone 1, 2, and 3 injuries were recorded in 241, 135, and 72 patients, respectively. The rates of RA-MAC vs. GA in specific zones were as follows: zone 1, 213 of 241 patients (88%) vs. 28 of 241 patients (12%); zone 2, 104 of 135 patients (77%) vs. 31 of 135 patients (23%); and zone 3, 34 of 72 patients (47%) vs. 38 of 72 patients (53%). Open-globe injuries repaired under RA-MAC had significantly shorter wound length (P < 0.001), more anterior wound location (P < 0.001) and shorter operative times (P < 0.001). RA-MAC cases also had a better presenting and final visual acuity (P < 0.001). Neither class of anesthesia conferred a greater visual acuity improvement (P = 0.06). The use of GA did not cause any delay in the time elapsed from injury until surgical repair (P = 0.74).
RA-MAC is a reasonable alternative to GA for the repair of open-globe injuries in selected adult patients. RA-MAC was selected more often for zone 1 and zone 2 injuries. For eyes with zone 3 injuries, there are equal selection ratio for RA-MAC and GA.
