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Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 11, techniques and complications of local anesthesia for cataract surgery in the United Kingdom.

Authors :
Neo YN
Gruszka-Goh MH
Braga AJ
de Klerk TA
Lindfield D
Nestel A
Stewart S
Donachie PHJ
Buchan JC
Source :
Journal of cataract and refractive surgery [J Cataract Refract Surg] 2023 Dec 01; Vol. 49 (12), pp. 1216-1222.
Publication Year :
2023

Abstract

Purpose: To describe variation in local anesthesia techniques and complications over a 10-year period for cataract surgery in the United Kingdom.<br />Setting: Reporting centers to the Royal College of Ophthalmologists (RCOphth) National Ophthalmology Database (NOD).<br />Design: Retrospective cross-sectional register-based study.<br />Methods: Data from the RCOphth NOD were used. Eligible for analysis were 1 195 882 cataract operations performed using local anesthesia between April 1, 2010, and March 31, 2020, in 80 centers.<br />Results: Overall, topical anesthesia alone was used in 152 321 operations (12.7%), combined topical and intracameral in 522 849 (43.7%), sub-Tenon in 461 175 (38.6%), and peribulbar/retrobulbar in 59 537 (5.0%). In National Health Service (NHS) institutions, 48.3% of operations were topical with/without intracameral vs 88.7% in independent sector treatment centers (ISTCs). 45.9% were sub-Tenon in NHS vs 9.6% in ISTCs. 5.8% were peribulbar/retrobulbar in NHS vs 1.7% in ISTCs. Anesthetic complication rates decreased from 2.7% in the 2010 NHS year to 1.5% in the 2019 NHS year (overall, 2.1% for NHS; 0.2% for ISTCs). Overall anesthetic complication rates were 0.3%, 0.3%, 3.5%, and 3.1% for topical alone, combined topical/intracameral, sub-Tenon, and peribulbar/retrobulbar, respectively. Complication rates were higher for sharp-needle anesthesia (peribulbar/retrobulbar) in patients taking warfarin rather than direct oral anticoagulants (4.8% vs 3.1%; P = .024). Considerable variation was observed between centers on anesthetic choices and anesthetic complication rates.<br />Conclusions: Combined topical and intracameral is the most common choice of anesthesia for cataract surgery in the United Kingdom and is associated with lower anesthetic-related complication rates than sub-Tenon and peribulbar/retrobulbar anesthesia. Variation in the anesthetic choice exists between centers and between NHS and ISTC sectors.<br /> (Copyright © 2023 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Details

Language :
English
ISSN :
1873-4502
Volume :
49
Issue :
12
Database :
MEDLINE
Journal :
Journal of cataract and refractive surgery
Publication Type :
Academic Journal
Accession number :
37599419
Full Text :
https://doi.org/10.1097/j.jcrs.0000000000001289