Local anaesthesia for trans‐scleral cyclodiode laser procedures: surgeon and patient satisfaction with sub‐Tenon's and peribulbar anaesthesia

Abstract

Local anaesthesia for trans-scleral cyclodiode laser procedures: surgeon and patient satisfaction with sub-Tenon's and peribulbar anaesthesia This was a prospective assessment of routine practice for two glaucoma specialists at the same institution. One specialist routinely used a small volume posterior sub-Tenon's LA (2 mL of 2% lidocaine via a Stevens type long metal cannula); the other used a one-site peribulbar approach (6 mL of 2% lidocaine via infero-temporal approach). Laser settings and technique were the same for both specialists. The Iris Medical OcuLight SLx laser (810 nm) was used. Standard technique was to apply 40 laser shots of 1500 mW power and 1500 ms duration, using the G-probe. The globe was transilluminated in order to identify the ciliary body, prior to commencing laser treatment. Treatment was delivered to 360°, except for the 3 o'clock and 9 o'clock positions (long ciliary nerves and vessels) and sites of previous glaucoma surgery.We looked at patient discomfort scores for LA and for the laser itself. Patients were asked to rate their discomfort using a 0-10 scale (0 = no discomfort, 10 = worst pain imaginable). Chemosis and/or subconjunctival haemorrhage in the perilimbal area could interfere with laser application, so this was also recorded on a scale of 0-12 clock hours. At the end of the procedure, we assessed eye movement and lid closure. We asked all patients if they would be happy to have the same LA again, if the procedure needed to be repeated.Results are summarized in the table. Thirty-three patients had peribulbar LA, and 50 had sub-Tenon's LA. Pain scores for both LA techniques were low, with mean pain score in the order of 3/10 for both peribulbar and sub-Tenon's LA. Mean score for the laser itself was around 1/10 for each LA technique. Other 'patient acceptability' criteria appear in the table.Conditions for applying the laser were assessed (Table 1). There was a low rate of chemosis and haemorrhage in the perilimbal area. There were no complications that could be ascribed to LA technique.Our study shows that sub-Tenon's LA and peribulbar LA can both provide adequate anaesthesia for cyclodiode laser to the ciliary body.Pain scores were low for both groups. Peribulbar anaesthesia was associated with slightly lower pain scores, both for the LA and for laser application. However, more patients in the peribulbar group were given a 'top-up' LA (36% vs. 4%), and more patients in the peribulbar group stated that they would not wish to have the same LA/procedure again (18% vs. 0%). A prospective

Incidence of hypotony and sympathetic ophthalmia following trans‐scleral cyclophotocoagulation for glaucoma and a report of risk factors

“…Four cases of sympathetic ophthalmia have been reported following TSCPC . In the extended literature search conducted, we identified 5979 eyes (6049 eyes including the current study) that had undergone diode laser TSCPC . If we include all cases of diode laser TSCPC reported in the literature (including the current study), the incidence is estimated at one in 1512, or 0.07% (95% CI 0.03%–0.17%).…”