Mmari A., Pfeiffer N.

Universitäts-Augenklinik, Langenbeckstr. 1, 55101 Mainz

Objective: Retrobulbar anesthesia is the standard regional anesthesia for trabeculectomy. But several complications, such as globe perforation, have been reported. In some cases it can result in loss of visual acuity (wipeout). In order to avoid this or if there are any contraindications for retrobulbar anesthesia, subconjunctival anesthesia can be an alternative method.
Methods: A prospective, randomized study was performed to compare subconjunctival anesthesia with retrobulbar anesthesia for trabeculectomy. 58 eyes from 58 patients undergoing trabeculectomy were examined. For retrobulbar anesthesia a mixture of 3 ml lidocaine 2%, 2 ml bupivacaine 0,5%, and hyaluronidase was given. For subconjunctival anesthesia 0,5 ml lidocaine 2% was applied under the upper temporal quarter of the subconjunctiva, after pretreatment with tetracainehydrochloride eyedrops. This study was performed to find differences regarding pain and eye motility during the operation as well as loss of visual acuity and changes of the visual field six weeks, three months and six months after trabeculectomy.
Results: The pain while giving local anesthesia was stated to be much stronger in the group of retrobulbar anesthesia (p = 0,00014). The intensity of pain during the operation was significantly stronger after subconjunctival anesthesia (p = 0,0035) but in both groups of patients it was considered as "low". Interfering eye motility appeared more often in the group with subconjunctival anesthesia (p = 0,00016) but did not affect the operation. Six months postoperatively no significant difference was found for loss of visual acuity (p = 0,25) or changes of the visual field (mean defect: p = 1,0 and loss variance: p = 0,98).
Conclusion: Subconjunctival anesthesia for trabeculectomy is safe and well tolerated by patients.

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