Topical anesthesia safer, more comfortable in select 25-gauge vitrectomy cases

PARIS — Transconjunctival 25-gauge vitrectomy can be performed under topical anesthesia in select cases, according to studies presented here at the French Society of Ophthalmology annual meeting.

"In the hands of an expert surgeon, this technique allows us to overcome the complications of peribulbar anesthesia, leading to faster and more comfortable postoperative recovery," said O. Rebollo, MD, of Montferrier-sur-Lez.

"Topical anesthesia has no complications, saves time and is a particularly interesting option for patients with severe heart problems, patients who are under anticoagulant therapy and highly myopic patients," said Raphael Adam, MD, of Paris.

Both surgeons reported their clinics' experiences performing 25-gauge vitrectomy using topical anesthesia containing 2% xylocaine gel. Indications for surgery included epiretinal membrane, intravitreal hemorrhage, vitreomacular traction and macular hole.

The study by Dr. Rebollo and colleagues included data for 55 patients. "All patients did extremely well during surgery," Dr. Rebollo said.

"A slight and transient pain sensation was experienced at the moment sclerotomies were performed. But a major reduction in [rates] of postoperative problems like hemorrhages, chemosis and conjunctival hyperemia was observed, and this improved greatly the satisfaction and comfort of both patient and surgeon," he said.

Among the 35 patients included in the study by Dr. Adam and colleagues, pain scores were low and ranged from no pain to only mild pain.

Patients treated for macular holes had the highest pain score, 4 on a scale from 0 to 10, Dr. Adam said.

"The only problem of topical anesthesia is that it does not blockade eye movements. It requires, therefore, some extra caution and a slightly longer learning curve," he said.