Association Between Peribulbar Anesthesia Followed By

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Association Between Peribulbar Anesthesia
Followed By Ocular Compression Before Cataract
Surgery and Optic Nerve Changes on RNFL OCT
Tarek El-Sawy, MD PhD, Eric Wolf, MD, Lynda
Kleiman, MD
Harkness Eye Institute, Columbia Universty and
New York Presbyterian Medical Center. New York, NY
No financial relationship or conflict of interest
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Background and Purpose

• Known complications of peribulbar anethesia
• Globe trauma
• Injection into subarachnoid space
• Diplopia
• Ischemic optic neuropathy
• Question
• Does OCT imaging of optic nerve and RNFL
• demonstrate more subtle changes following
  standard
• peribulbar anesthesia and ocular compression?

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Study Design

• Retrospective chart review from 7/2007 3/2009
• Five resident surgeons all with attending
  support
• All surgeries performed at the Harkness Eye
  Institute
• Inclusion Criteria
• Elective surgery for visual significant cataract
• Exclusion Criteria
• History of glaucoma, optic neuropathy, optic
  neuritis
• History of clinically significant macular edema
• Complicated surgery including but not limited to
  capsule rupture and lens loss
• Poor quality imaging

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Materials and Methods

• Thirteen patients included in study
• Nine patients received peribulbar anesthesia and
  ocular compression
• Four patients received topical anesthesia only

• RNFL-OCT performed between 1 week and 2 months
  prior to surgery
• RNFL-OCT repeated between 1 month and 3 months
  following surgery
• RNFL thickness was compared within and between
  groups
• The fellow eye was used as an internal control

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RNFL Thickness by OCT - Example
Pre-Operative RNFL Thickness
Post-Operative RNFL Thickness
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Analysis of Overall Optic Nerve Thickness
Peribulbar and Compression
Topical Only
Pre-Operative RNFL Thickness Operative Eye
Average 99.7 Fellow Eye Average 95.0
Pre-Operative RNFL Thickness Operative Eye
Average 90.1 Fellow Eye Average 87.8
Post-Operative RNFL Thickness Operative Eye
Average 94.9 Fellow Eye Average 93.7
Post-Operative RNFL Thickness Operative Eye
Average 84.6 Fellow Eye Average 88.1
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Analysis of Overall Optic Nerve Thickness
RNFL Thickness Pre and Post-Operatively
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Percent Change Pre to Post-Operative
Peribulbar and Compression
Topical Only
Percent Change Operative Eye -6.6 Fellow Eye
-1.6
Percent Change Operative Eye -6.4 Fellow Eye
0.7
Result pattern was equivalent when optic nerve
was analyzed by quandrant in all four groups
(data not shown)
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Conclusions

• Mild and equivalent RNFL thinning by OCT in both
  peribulbar and topical anesthesia only groups
• Essentially no change in RNFL thickness in
  fellow eyes

• However, the range of percent change was large
• Peribulbar group -33.7 to 7.6
• Topical Group -13.5 to 6.5

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Conclusions

• Unclear how to interpret data
• Large range of percent change in all groups
• Differences in operative technique
• Unknown susceptibility to compression
• Undiagnosed optic nerve disease (glaucoma, other
  neuropathies)
• Reliability of imaging technique despite reports
  to the contrary

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Conclusions
No clear difference between peribulbar and
topical anesthesia to suggest significant concern
in standard cataract surgery with peribulbar
anesthesia and ocular compression
To address the limitations of this study,
additional patients will be recruited
particularly in the topical anesthesia only
group and followed for longer time points.
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Thank You
Mentors Lynda Kleiman, MD Eric Wolf,
MD Resident Surgeons Irena Tsui, MD Suzanna
Airiani, MD Loh-Shan Leung, MD Michael Weisberg,
MD Joseph Tseng, MD