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, MDHarkness Eye Institute, Columbia Universty and New York

PresbyterianMedical Center. New York, NY

No financial relationship or conflict of interest

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 RNFLdemonstrate more subtle changes following

standardperibulbar anesthesia and ocular compression?

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

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

RNFL Thickness by OCT - Example

Pre-Operative RNFL Thickness

Post-Operative RNFL Thickness

Analysis of Overall Optic Nerve Thickness

Pre-Operative RNFL Thickness

Operative Eye Average: 99.7Fellow Eye Average: 95.0

Pre-Operative RNFL Thickness

Operative Eye Average: 90.1Fellow Eye Average: 87.8

Post-Operative RNFL Thickness

Operative Eye Average: 94.9Fellow Eye Average: 93.7

Post-Operative RNFL Thickness

Operative Eye Average: 84.6Fellow Eye Average: 88.1

Peribulbar and Compression

Topical Only

RNFL Thickness Pre and Post-Operatively

Analysis of Overall Optic Nerve Thickness

Percent Change Pre to Post-Operative

Percent ChangeOperative Eye: -6.6%

Fellow Eye: -1.6%

Percent ChangeOperative Eye: -6.4%

Fellow Eye: 0.7%

Peribulbar and Compression

Topical Only

Result pattern was equivalent when optic nerve was analyzed by quandrant in all four groups (data not shown)

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%

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

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.

Thank You

Mentors:Lynda Kleiman, MD

Eric Wolf, MD

Resident Surgeons:Irena Tsui, MD

Suzanna Airiani, MDLoh-Shan Leung, MD

Michael Weisberg, MDJoseph Tseng, MD