Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting

Abstract

Purpose:The purpose of this study was to evaluate the feasibility and safety of office-based vitreoretinal procedures.Methods:Patients undergoing primary elective pars plana vitrectomy were elected for surgery in an office-based setting (performed in a minor procedure room under topical anesthesia [TA] and oral anxiolysis). Rates of surgical objective achievement, surgical timing, and comfort were recorded to evaluate feasibility. Intraoperative and postoperative adverse events were assessed to evaluate safety.Results:Office-based vitrectomy surgery was performed in 34 eyes of 30 patients. The mean surgical time was 12.351 ± 8.21 min. Surgical objectives were achieved in 100% of cases. The mean best-corrected visual acuity improvement was 9.08 letters (P < 0.0001). During most parts of the procedure, no patient reported pain or discomfort. Neither intraoperative nor postoperative adverse events were reported until the final follow-up visit.Conclusion:Office-based vitreoretinal procedures under TA could be as feasible and as safe as vitreoretinal procedures under conventional anesthesia.

A New Two-Step Anesthesia for 23- or 25-Gauge Vitrectomy Surgery: A Prospective, Randomized Clinical Trial

“…Due to the absence of akinesia and the potential for limited patient cooperation, we suggest that (1) the two-step anesthesia method should be used in carefully selected cases and (2) the surgeon must be well experienced in vitrectomy. It has to be kept in mind that despite the perceived risk of akinesia, application of topical anesthesia alone also results in lack of akinesia but is unlikely to cause sight-threatening complications during cataract surgery [33], vitrectomy [20, 21, 27, 28, 32, 34, 35], combined phacoemulsification and vitrectomy [29], or vitrectomy-related procedures, like fluid-gas exchange for open macular hole after vitrectomy [36]. A 2-year prospective study comparing lidocaine 2% jelly versus peribulbar anesthesia for 25- and 23-gauge sutureless vitrectomy also indicated that lack of akinesia did not prevent a successful surgical result [37].…”

Comment on: Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting

“…We read with great interest the article titled “Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting” by Trujillo-Sanchez et al . [1] This is an interesting study highlighting that 27-Gauge vitrectomy surgeries can be performed as an office procedure under topical anesthesia without complications.…”

Response to comment on: Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting

“…We appreciate the authors for their keen interest in our article. [1] We cautiously analyzed their observations and concerns about 27-gauge vitrectomy procedures in an office-based setting[2] and we have the following comments. First, we consider that office-based vitrectomy under topical anesthesia is not only safe for vitreous floaters but these procedures could be excellent tools for prompt, cost-effective evaluation in macular interventions; however, just in a selected group of patients.…”