Abstract
Purpose
To describe variation in local anaesthesia techniques and complications over a 10-year period for cataract surgery in the United Kingdom.
Setting
Reporting centres to the Royal College of Ophthalmologists (RCOphth) National Ophthalmology Database (NOD).
Design
Retrospective cross-sectional register-based study.
Methods
Data from the RCOphth NOD was used. Eligible for analysis were 1195882 cataract operations performed using local anaesthesia between 01/04/2010 and 31/03/2020 in 80 centres.
Results
Overall, topical anaesthesia alone was used in 152321 (12.7%) operations, combined topical and intracameral in 522849 (43.7%), sub-Tenon’s in 461175 (38.6%), and peribulbar/retrobulbar in 59537 (5.0%). In National Health Service (NHS) institutions, 48.3% operations were topical with/without intracameral vs 88.7% in independent sector treatment centres (ISTC). 45.9% were sub-Tenon’s in NHS vs 9.6% in ISTC. 5.8% were peribulbar/retrobulbar in NHS vs 1.7% in ISTC. Anaesthetic complication rates decreased from 2.7% in the 2010 NHS year to 1.5% in the 2019 NHS year (overall, 2.1% for NHS; 0.2% for ISTC). Overall anaesthetic complication rates were 0.3%, 0.3%, 3.5% and 3.1% for topical alone, combined topical/intracameral, sub-Tenon’s and peribulbar/retrobulbar respectively. Complication rates were higher for sharp needle anaesthesia (peribulbar/retrobulbar) in patients taking warfarin rather than direct oral anticoagulants (4.8% vs 3.1%; p= 0.024). Considerable variation was observed between centres on anaesthetic choices and anaesthetic complication rates.
Conclusions
Combined topical and intracameral is the most common choice of anaesthesia for cataract surgery in the United Kingdom and is associated with lower anaesthetic-related complication rates than sub-Tenon’s and peribulbar/retrobulbar anaesthesia. Variation in anaesthetic choice exists between centres and between NHS & ISTC sectors.
To describe variation in local anaesthesia techniques and complications over a 10-year period for cataract surgery in the United Kingdom.
Setting
Reporting centres to the Royal College of Ophthalmologists (RCOphth) National Ophthalmology Database (NOD).
Design
Retrospective cross-sectional register-based study.
Methods
Data from the RCOphth NOD was used. Eligible for analysis were 1195882 cataract operations performed using local anaesthesia between 01/04/2010 and 31/03/2020 in 80 centres.
Results
Overall, topical anaesthesia alone was used in 152321 (12.7%) operations, combined topical and intracameral in 522849 (43.7%), sub-Tenon’s in 461175 (38.6%), and peribulbar/retrobulbar in 59537 (5.0%). In National Health Service (NHS) institutions, 48.3% operations were topical with/without intracameral vs 88.7% in independent sector treatment centres (ISTC). 45.9% were sub-Tenon’s in NHS vs 9.6% in ISTC. 5.8% were peribulbar/retrobulbar in NHS vs 1.7% in ISTC. Anaesthetic complication rates decreased from 2.7% in the 2010 NHS year to 1.5% in the 2019 NHS year (overall, 2.1% for NHS; 0.2% for ISTC). Overall anaesthetic complication rates were 0.3%, 0.3%, 3.5% and 3.1% for topical alone, combined topical/intracameral, sub-Tenon’s and peribulbar/retrobulbar respectively. Complication rates were higher for sharp needle anaesthesia (peribulbar/retrobulbar) in patients taking warfarin rather than direct oral anticoagulants (4.8% vs 3.1%; p= 0.024). Considerable variation was observed between centres on anaesthetic choices and anaesthetic complication rates.
Conclusions
Combined topical and intracameral is the most common choice of anaesthesia for cataract surgery in the United Kingdom and is associated with lower anaesthetic-related complication rates than sub-Tenon’s and peribulbar/retrobulbar anaesthesia. Variation in anaesthetic choice exists between centres and between NHS & ISTC sectors.
| Original language | English |
|---|---|
| Journal | Journal of Cataract and Refractive Surgery |
| Volume | 49 |
| Issue number | 12 |
| Early online date | 21 Aug 2023 |
| DOIs | |
| Publication status | Published - 01 Dec 2023 |