Journal of Current Glaucoma Practice

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VOLUME 10 , ISSUE 1 ( January-April, 2016 ) > List of Articles

REVIEW ARTICLE

Preoperative Preparation and Anesthesia for Trabeculectomy

Tom Eke

Keywords : Anesthesia, Intracameral anesthesia, Local anesthesia, Peribulbar anesthesia, Retrobulbar anesthesia, Subconjunctival anesthesia, Sub-Tenon\'s anesthesia, Topical anesthesia, Trabeculectomy

Citation Information : Eke T. Preoperative Preparation and Anesthesia for Trabeculectomy. J Curr Glaucoma Pract 2016; 10 (1):21-35.

DOI: 10.5005/jp-journals-10008-1198

License: CC BY-NC 4.0

Published Online: 00-04-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Preoperative preparation should improve the likelihood of successful trabeculectomy surgery. The team can reconsider the appropriateness of the proposed surgery, and steps can be taken to maximize the chance of a good outcome. For example, adjustments to anti-hypertensive or anti-coagulant medications may be made, and topical ocular medications adjusted. Choice of anesthesia technique is of particular relevance to the trabeculectomy patient. Some anesthesia techniques are more likely to have serious complications, and glaucoma patients may be at higher risk of some sight-threatening complications, because the optic nerve is already damaged and vulnerable. Posterior placement of local anesthesia (retrobulbar, peribulbar, posterior sub-Tenon\'s techniques) could potentially damage the optic nerve, and thereby cause “wipe-out” of vision. Anesthesia technique may influence the likelihood of vitreous bulge and surgical difficulty. Regarding long-term control of intraocular pressure, there is no good evidence to indicate that any particular anesthesia technique is better than another. There is little high-quality evidence on this topic. The author\'s preferred technique for trabeculectomy is subconjunctival-intracameral anesthesia without sedation.


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