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Local anaesthesia for penetrating keratoplasty: standard of care?

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First Author: M.Bizrah UK

Co Author(s):    G. Ching   A. Iovieno   S. Holland              

Abstract Details

Purpose:

To determine trends, efficacy and safety of local anaesthesia (LA) versus general anaesthesia (GA) for a standard penetrating keratoplasty.

Setting:

Study carried out at the department of ophthalmology and visual sciences at University of British Columbia, Vancouver, British Columbia. A retrospective analysis of local anaesthesia complications rates was carried our in the cornea department. A survey was also sent to cornea specialists in the UK (UK) and Canada.

Methods:

A survey was sent to 40 cornea specialists; 20 in the UK and 20 in Canada. The aim of the survey was to detect a difference in trends of use of anaesthesia in patients undergoing a standard penetrating keratoplasty. A retrospective analysis of penetrating keratoplasties performed from 1st January 2010 to 1st January 2020 was also performed to investigate for occurrence of major ocular or systemic complications.

Results:

All 20 (100%) cornea specialists in Canada prefer the use of local anaesthesia to general anaesthesia, whilst none of the cornea specialists in the UK prefer LA to GA. 70% of Canadian specialists used retrobulbar anaesthesia, 20% used subtenon’s anaesthesia and 10% stated no preference. Of the UK specialists, 82% (14/17) explicitly mentioned that GA was preferred over LA due to lower risk of suprachoroidal haemorrhage. A retrospective review of 1,000 PK’s performed over 10 years revealed the following complications: 1 panic attack possibly due to intrathecal injection, and 3 inferior rectus iatrogenic damage requiring squint surgery.

Conclusions:

Local anaesthesia is the standard of care in Canada, and our retrospective study suggests a low incidence of major ocular complications. In the absence of major systemic or ocular risk factors, this study questions the need for general anaesthesia for a standard penetrating keratoplasty.

Financial Disclosure:

Receives consulting fees, retainer, or contract payments from a competing company