Clinical Ophthalmology (Jan 2020)
Outcomes and Adverse Events of Sub-Tenon’s Anesthesia with the Use of a Flexible Cannula in 35,850 Refractive Lens Exchange/Cataract Procedures
Abstract
Dagobert Lerch, 1, 2 Jan A Venter, 2 Anca M James, 1, 2 Martina Pelouskova, 2 Barrie M Collins, 2 Steven C Schallhorn 2–4 1Montanamed Ltd., Sankt Gallen, Switzerland; 2Optical Express, Glasgow, UK; 3University of California, Department of Ophthalmology, San Francisco, CA, USA; 4Carl Zeiss Meditec, Dublin, CA, USACorrespondence: Dagobert LerchMontanamed Ltd, Ozartstraße 6, Leipzig D-04107, GermanyTel +49 152 53447537Email [email protected]: To describe our technique of sub-Tenon’s anesthesia and report adverse events and patient comfort.Setting: Optical Express, United Kingdom.Design: Retrospective case series.Methods: The outcomes of 35,850 intraocular procedures (phacoemulsification and implantation of an intraocular lens) were retrospectively reviewed and the incidence of adverse events related to sub-Tenon’s anesthesia was calculated. On the first postoperative day, patients were asked to complete a questionnaire enquiring about their comfort during and after the procedure. The anesthetic solution consisted of a combination of Lidocaine and Hyaluronidase, which was administered into sub-Tenon’s space with a single-use sterile polyurethane 22G x 1” (0.9 x 25 mm) cannula. Mild conscious sedation (midazolam) was used during anesthetic and surgical procedure.Results: No significant adverse events that would affect the posterior segment of the eye or result in vision loss were recorded. Subconjunctival haemorrhage related to sub-Tenon’s anesthesia was noted in 4.3% of eyes. Five minutes after the administration of sub-Tenon’s block, 80.6% of eyes had no chemosis, 14.8% had chemosis that affected only 1 quadrant of the eye and 4.5% of eyes had chemosis affecting 2 or more quadrants of the eye. Other adverse events included 14 cases of cyst/granuloma formation in the area of sub-Tenon’s incision and 7 eyes required suturing of the conjunctival cut. Of all patients, 93.2% experienced no or only mild discomfort during or after surgical procedure.Conclusion: Sub-Tenon’s anesthesia with the use of a flexible cannula is a safe option for ophthalmic anesthesia. No sight-threatening adverse events occurred.Keywords: sub-Tenon’s anesthesia, flexible cannula, refractive lens exchange, adverse events
