Changing trends in anaesthesia for trabeculectomy: a clinical effectiveness and safety analysis

Glaucoma is a progressive optic neuropathy and represents the leading cause of irreversible blindness worldwide [1]. Intraocular pressure (IOP) is an important modi ﬁ able risk factor and trabeculectomy remains the procedure of choice for most glaucoma specialists [2, 3]. Anaesthesia choice is paramount when planning for trabeculectomy. Factors to consider include surgeon ’ s preference, patient ’ s age and preference, anticipated dif ﬁ culty and duration of the operation, and logistical concerns [4]. The clinical records of patients who underwent trabeculectomy as a sole procedure in a single tertiary referral trust in London between 2006 and 2022 (King ’ s College Hospital, London, UK) were retrospectively reviewed using a single electronic medical record system (Medisoft ® , Leeds, UK). The criteria for general anaesthesia (GA) in our cohort were very advanced glaucoma at risk of visual ﬁ eld wipe out, only eye, very high IOP and patient preference. All surgeries were performed by a glaucoma consultant or fellow in a standard ophthalmic operating room with anaesthetic consultant cover. Overall, 26% of trabeculectomies were performed under GA ( n =

Glaucoma is a progressive optic neuropathy and represents the leading cause of irreversible blindness worldwide [1].Intraocular pressure (IOP) is an important modifiable risk factor and trabeculectomy remains the procedure of choice for most glaucoma specialists [2,3].Anaesthesia choice is paramount when planning for trabeculectomy.Factors to consider include surgeon's preference, patient's age and preference, anticipated difficulty and duration of the operation, and logistical concerns [4].
The clinical records of patients who underwent trabeculectomy as a sole procedure in a single tertiary referral trust in London between 2006 and 2022 (King's College Hospital, London, UK) were retrospectively reviewed using a single electronic medical record system (Medisoft®, Leeds, UK).The criteria for general anaesthesia (GA) in our cohort were very advanced glaucoma at risk of visual field wipe out, only eye, very high IOP and patient preference.All surgeries were performed by a glaucoma consultant or fellow in a standard ophthalmic operating room with anaesthetic consultant cover.
Anaesthetic complications were recorded in 9.4% of surgeries performed under LA, 7.8% of PLA cases, and 10% of SLA cases (p = 0.607) (Table 1).No anaesthetic complication was documented in the GA group.Post-operative complications occurred in 8% of GA cases, 14.5% of PLA cases and 15.7% of SLA cases (p = 0.064) (Table 1).The mean time from first incision to end of procedure was 73 min for the GA group, 81 min for the PLA group and 72 min for the SLA group (p < 0.001).Post-hoc testing demonstrated a significant difference between the GA and PLA groups (p < 0.001).Longer surgical time in the PLA group may represent the additional time required to ensure adequate anaesthesia and akinesia.
Reports on anaesthetic practices for trabeculectomy are sparse.Our findings from this large cohort of patients showed a strong downward trend in the number of trabeculectomies performed under GA and an increase in use of LA over the 16-year period.
A recent study conducted in Australia and New Zealand correlate these findings and reflect the shift towards day case surgery within the NHS [5].Although PLA is the traditional anaesthetic of choice for trabeculectomy, SLA has gained popularity in recent years, possibly due to the risks of sharp-needle LA.Our data demonstrates that all

P. Asodaria et al.
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Table 1 .
Raw data regarding of anaesthetic and post-operative outcomes.