Topical anesthesia in posterior vitrectomy

Juan Yepez, Jazmin CedeÑo De Yepez, J Fernando Arevalo

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate the efficacy of topical anesthesia as an alternative to peribulbar or retrobulbar anesthesia in posterior vitrectomy procedures. Methods: Posterior vitrectomy using topical anesthesia (4% lidocaine drops) was performed prospectively in 134 eyes (134 patients) with various vitreoretinal diseases, including severe proliferative diabetic retinopathy (n = 69), vitreous hemorrhage (n = 12), rhegmatogenous retinal detachments (n = 11), epiretinal membranes (n = 10), macular holes (n = 7), dislocated crystalline lens or intraocular lens (n = 6), giant retinal tears (n = 5), intraocular foreign bodies (n = 3), trauma (n = 3), endophthalmitis (n = 3), subfoveal choroidal neovascular membrane (n = 3), and neovascular glaucoma (n = 2). In 26 (19.4%) eyes, posterior vitrectomy was combined with a scleral buckling procedure, and in 84 (62.6%) eyes, argon laser photocoagulation was performed. Preoperative and intraoperative sedation of varying degrees was necessary. Subjective pain and discomfort were graded from 1 (no pain or discomfort) to 4 (severe pain and discomfort). Results: All patients had grade 1 pain and discomfort during most of the procedure. All patients had grade 2 (mild) pain and discomfort during pars plana sclerotomies, external bipolar cautery, and conjunctival closure. The average amount of 4% lidocaine drops needed during each procedure was 0.5 mL. No patient required additional retrobulbar, peribulbar, or sub-Tenon anesthesia. Conclusions: This technique avoids the risk of globe perforation, retrobulbar hemorrhage, and prolonged postoperative akinesia of the eye. With appropriate case selection, topical anesthesia is a safe and effective alternative to peribulbar or retrobulbar anesthesia in three-port pars plana vitrectomy procedures.

Original languageEnglish (US)
Pages (from-to)41-45
Number of pages5
JournalRetina
Volume20
Issue number1
StatePublished - 2000

Fingerprint

Vitrectomy
Anesthesia
Pain
Retinal Perforations
Temazepam
Lidocaine
Retrobulbar Hemorrhage
Neovascular Glaucoma
Scleral Buckling
Epiretinal Membrane
Vitreous Hemorrhage
Cautery
Crystalline Lens
Endophthalmitis
Light Coagulation
Argon
Intraocular Lenses
Retinal Detachment
Diabetic Retinopathy
Foreign Bodies

Keywords

  • Lidocaine
  • Posterior vitrectomy
  • Topical anesthesia
  • Vitreoretinal surgery

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems

Cite this

Yepez, J., CedeÑo De Yepez, J., & Arevalo, J. F. (2000). Topical anesthesia in posterior vitrectomy. Retina, 20(1), 41-45.

Topical anesthesia in posterior vitrectomy. / Yepez, Juan; CedeÑo De Yepez, Jazmin; Arevalo, J Fernando.

In: Retina, Vol. 20, No. 1, 2000, p. 41-45.

Research output: Contribution to journalArticle

Yepez, J, CedeÑo De Yepez, J & Arevalo, JF 2000, 'Topical anesthesia in posterior vitrectomy', Retina, vol. 20, no. 1, pp. 41-45.
Yepez J, CedeÑo De Yepez J, Arevalo JF. Topical anesthesia in posterior vitrectomy. Retina. 2000;20(1):41-45.
Yepez, Juan ; CedeÑo De Yepez, Jazmin ; Arevalo, J Fernando. / Topical anesthesia in posterior vitrectomy. In: Retina. 2000 ; Vol. 20, No. 1. pp. 41-45.
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abstract = "Purpose: To evaluate the efficacy of topical anesthesia as an alternative to peribulbar or retrobulbar anesthesia in posterior vitrectomy procedures. Methods: Posterior vitrectomy using topical anesthesia (4{\%} lidocaine drops) was performed prospectively in 134 eyes (134 patients) with various vitreoretinal diseases, including severe proliferative diabetic retinopathy (n = 69), vitreous hemorrhage (n = 12), rhegmatogenous retinal detachments (n = 11), epiretinal membranes (n = 10), macular holes (n = 7), dislocated crystalline lens or intraocular lens (n = 6), giant retinal tears (n = 5), intraocular foreign bodies (n = 3), trauma (n = 3), endophthalmitis (n = 3), subfoveal choroidal neovascular membrane (n = 3), and neovascular glaucoma (n = 2). In 26 (19.4{\%}) eyes, posterior vitrectomy was combined with a scleral buckling procedure, and in 84 (62.6{\%}) eyes, argon laser photocoagulation was performed. Preoperative and intraoperative sedation of varying degrees was necessary. Subjective pain and discomfort were graded from 1 (no pain or discomfort) to 4 (severe pain and discomfort). Results: All patients had grade 1 pain and discomfort during most of the procedure. All patients had grade 2 (mild) pain and discomfort during pars plana sclerotomies, external bipolar cautery, and conjunctival closure. The average amount of 4{\%} lidocaine drops needed during each procedure was 0.5 mL. No patient required additional retrobulbar, peribulbar, or sub-Tenon anesthesia. Conclusions: This technique avoids the risk of globe perforation, retrobulbar hemorrhage, and prolonged postoperative akinesia of the eye. With appropriate case selection, topical anesthesia is a safe and effective alternative to peribulbar or retrobulbar anesthesia in three-port pars plana vitrectomy procedures.",
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AB - Purpose: To evaluate the efficacy of topical anesthesia as an alternative to peribulbar or retrobulbar anesthesia in posterior vitrectomy procedures. Methods: Posterior vitrectomy using topical anesthesia (4% lidocaine drops) was performed prospectively in 134 eyes (134 patients) with various vitreoretinal diseases, including severe proliferative diabetic retinopathy (n = 69), vitreous hemorrhage (n = 12), rhegmatogenous retinal detachments (n = 11), epiretinal membranes (n = 10), macular holes (n = 7), dislocated crystalline lens or intraocular lens (n = 6), giant retinal tears (n = 5), intraocular foreign bodies (n = 3), trauma (n = 3), endophthalmitis (n = 3), subfoveal choroidal neovascular membrane (n = 3), and neovascular glaucoma (n = 2). In 26 (19.4%) eyes, posterior vitrectomy was combined with a scleral buckling procedure, and in 84 (62.6%) eyes, argon laser photocoagulation was performed. Preoperative and intraoperative sedation of varying degrees was necessary. Subjective pain and discomfort were graded from 1 (no pain or discomfort) to 4 (severe pain and discomfort). Results: All patients had grade 1 pain and discomfort during most of the procedure. All patients had grade 2 (mild) pain and discomfort during pars plana sclerotomies, external bipolar cautery, and conjunctival closure. The average amount of 4% lidocaine drops needed during each procedure was 0.5 mL. No patient required additional retrobulbar, peribulbar, or sub-Tenon anesthesia. Conclusions: This technique avoids the risk of globe perforation, retrobulbar hemorrhage, and prolonged postoperative akinesia of the eye. With appropriate case selection, topical anesthesia is a safe and effective alternative to peribulbar or retrobulbar anesthesia in three-port pars plana vitrectomy procedures.

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