Cataract surgery local anesthesia introduction of sub-Tenon anesthesia techniques used to reduce the risk of peribulbar or retrobulbar anesthetic complications.
Cataract Surgery Local Anesthesia
Cataract is the most common cause of blindness worldwide. Cataracts are the opacity of the lens inside the eye that cause loss of eye transparency. Cataracts usually worsen over time. Surgery is the only treatment that proves effective for cataracts. Surgery / cataract surgery involves replacing the cloudy lens inside your eyes with an artificial lens. Cataract surgery is usually performed under local anesthesia, either peribulbar or retrobulbar anesthesia. There is a debate as to whether the peribulbar approach provides more effective and safer anesthesia for cataract surgery than for retrobulbar blocks. Peribulbar anesthesia is performed by injecting an anesthetic in orbit around the equator of the eyeballs (globe). Retrobulbar anesthesia is performed by injecting an anesthetic drug in orbit further behind the eyeballs, which is near the nerves that control eye movement and sensation.
When the incisional size of cataract extraction has decreased, anesthesia techniques have also increased significantly. General anesthesia was introduced in the mid-19th century. Koller and Knapp can be regarded as the pioneer of local anesthesia for cataract surgery. Koller introduced topical cocaine in 1884 while Knapp introduced retrobulbar anesthesia in 1884. In the early 19th century, the orbicularis block was introduced by Van Lint, O’Beriens, and Alkinson. In the last 25 years, local anesthetic techniques have progressed from the posterior peribulbar to a “no anesthetic” technique.
Peribulbar and retrobulbar techniques are associated with the risk of complications such as perforation of the eyeballs, optic nerve damage, retrobulbar bleeding, and ocular muscle injury. However, the technique is rarely life-threatening. The introduction of sub-Tenon anesthesia techniques reduces the risk of peribulbar / retrobulbar anesthetic complications, but this technique is still associated with the possibility of all complications of the peribulbar / retrobulbar technique. Surgical surgery has reduced the need for akinesia. In 1992, Fichman introduced topical anesthesia for cataract surgery. Topical anesthesia is used to block afferent nerves from the cornea and conjunctiva (long and short ciliary nerves, nasociliary, and lacrimal nerves). This technique eliminates the possibility of anesthetic injection complications. However, the anesthesia does not eliminate the pain sensitivity of the iris, zonule, and ciliary body. In 1992, Insang introduced an intracameral anesthetic technique with preservative-free lidocaine. In 1999, Koch-Assia introduced the use of Xylocaine jelly for surface anesthesia.
There is no evidence of differences in pain perception during surgery with retrobulbar or peribulbar anesthesia. Both are very effective. There is no evidence of any difference in complete akinesia or the need for further local anesthetic injections. Conjunctival chemosis is more common after peribulbar blocks and hematoma caps are more common after retrobulbar blocks. Retrobulbar haemorrhage is rare and occurs only once, in patients with retrobulbar blocks.
There is little choice between the peribulbar and retrobulbar blocks in terms of anesthesia and akinesia during surgery. Severe local or systemic complications are rare in both types of blocks. The question of millions of people is which anesthesia is chosen for cataract surgery? Only two people can decide this, e.g. patients who undergo cataract surgery and an ophthalmologist will operate. For the same patient, different surgeons may choose different anesthesia techniques. The skills and experience of the surgeon, the cooperation of the patient, the type of cataract, the associated ocular morbidities such as corneal opacity, pupil dilatation, etc., are important factors when deciding on anesthesia. Over the past few years, anesthesia for cataract surgery has shifted from general anesthesia to be localized.
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