Clinical Study
Eye (2007) 21, 1387–1390; doi:10.1038/sj.eye.6702447; published online 2 June 2006
Sub-Tenon anaesthesia: reduction in subconjunctival haemorrhage with controlled bipolar conjunctival cautery
Fully informed patient consent was obtained and the procedures followed were in accordance with the Helsinki Declaration of 1975, as revised in 1983
Presentations: ESCRS meeting, Paris 2004; EVER meeting, Portugal 2004
V Gauba1, G M Saleh2, K Watson1 and A Chung1
- 1St James' University Hospital, Leeds, UK
- 2Royal Surrey County Hospital, Guildford, Surrey, UK
Correspondence: V Gauba, St James' University Hospital, 33 Alder Hill Avenue, Leeds, West Yorkshire LS6 4JQ, UK Tel: +44 7958306821/+44 1132160725; Fax: +44 8701332988. E-mail: vgauba@aol.com
Received 7 February 2006; Revised 23 April 2006; Accepted 23 April 2006; Published online 2 June 2006.
Abstract
Purpose
To evaluate the effect of controlled conjunctival cautery on the frequency and extent of subconjunctival haemorrhage (SCH) associated with sub-Tenon anaesthetic (STA) injection in patients with various clotting states.
Methods
One hundred forty-four patients suitable for cataract surgery with STA were prospectively divided into four groups: group A (n=36) were on warfarin (INR 1.8–4.2); group B (n=48) on aspirin (75 mg); group C (n=12) on clopidogrel (75 mg); and group D (n=48) on no anticoagulant or antiplatelet agents. All patients had no other known coagulopathy. Each group was randomly divided into two subgroups, one of which received localised bipolar cautery under microscope control to the STA conjunctival entry site before tissue dissection, whereas the other served as a control. 
2 and Fisher's exact tests were used to analyse the data with the SPSS package (v11.0).
Results
Conjunctival cautery reduced the frequency of SCH from 67 to 6% in group A (P=0.0001); from 37.5 to 4% in group B (P=0.005); from 50 to 0% in group C (P=0.9); and from 17 to 0% in group D (P=0.55). This overall reduction in SCH was highly significant (P<0.0001), especially in groups A and B. No statistically significant reduction in the extent of SCH was found.
Conclusions
Controlled localised bipolar conjunctival cautery before STA injection may significantly reduce the frequency of SCH, especially in patients on warfarin or aspirin.
Keywords:
sub-Tenon, subconjunctival, haemorrhage, cautery, anticoagulation
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