A Comparison of Retrobulbar Versus Topical Anesthesia in Trabeculectomy and Aqueous Shunt Surgery

Abstract

Although supplemental anesthesia and pain scores were statistically increased in the topical group, the prevalence and the severity of pain was low. Therefore, TA is feasible and a reasonable option for glaucoma surgery. Furthermore, this conclusion applies when glaucoma surgery is performed alone or in combination with the other eye surgery.

Surgical Advancement of Tenon’s Layer During Trabeculectomy Improves Bleb Morphology

“…Anesthesia choice for trabeculectomy is debated, with topical, sub-Tenon, and retrobulbar administration as common and reasonable options. Although retrobulbar injection may provide superior anesthesia and akinesia compared with topical or sub-Tenon routes of administration,23 potentially rare but devastating complications can occur including retrobulbar hemorrhage, globe perforation, and apnea 24. To avoid these risks, topical anesthesia has become increasingly used for anterior segment surgery including cataract surgery25 and trabeculectomy 26.…”

“…To avoid these risks, topical anesthesia has become increasingly used for anterior segment surgery including cataract surgery25 and trabeculectomy 26. However, as might be expected, topical anesthesia does not provide the same degree of pain control as retrobulbar anesthesia in incisional glaucoma surgery 23. In contrast, creation of a potential space between Tenon’s layer and sclera allows for a true sub-Tenon anesthesia with extension into the retrobulbar space using a blunt tip cannula.…”

“…26 However, as might be expected, topical anesthesia does not provide the same degree of pain control as retrobulbar anesthesia in incisional glaucoma surgery. 23 In contrast, creation of a potential space between Tenon's layer and sclera allows for a true sub-Tenon anesthesia with extension into the retrobulbar space using a blunt tip cannula. Furthermore, injection of anesthesia in this plane provides fluid-dissection and assistance of establishment of this new potential space.…”

Anesthesia for ophthalmic surgery

“…Other considerations include the appropriate selection of general anesthetics, monitoring the effects of topical glaucoma medications, and the control of IOP. [56,57] Trabeculectomy can be performed under various forms of anesthesia, including local or general anesthesia. If a nerve block is preferred, the anterior sub-Tenon's block is recommended because it has a lower impact on the optic nerve.…”

“…When opting for topical anesthesia for trabeculectomy, it should be noted that additional intravenous analgesics may be necessary for pain management. [57] For non-penetrating surgeries such as deep sclerectomy and viscocanalostomy, all anesthesia options are applicable, but general anesthesia is typically not the preferred choice. [46] In the case of minimally invasive glaucoma procedures such as drainage devices and shunt placement, topical anesthesia emerges as the safest and most well-tolerated option.…”