Techniques And Complications Of Local Anaesthesia For Cataract Surgery In The United Kingdom: A 10 Years Prospective Study

Published 2022 - 40th Congress of the ESCRS

Reference: FPM05.01 | Type: Free paper | DOI: 10.82333/j9kr-b879

Authors: Yan Ning Neo* ¹ , Marta H Gruszka-Goh ² , Alice J Braga ³ , Timothy de Klerk ⁴ , Dan Lindfield ⁵ , Achim Nestel ⁶ , Paul HJ Donachie ⁷ , John C Buchan ⁸

¹Cornea and external diseases department,Moorfields Eye Hospital NHS Foundation Trust,London,United Kingdom;Department of Ophthalmology,Imperial College Healthcare NHS Trust,London,United Kingdom;National Ophthalmology Database Audit,The Royal College of Ophthalmologists,London,United Kingdom, ²National Ophthalmology Database Audit,The Royal College of Ophthalmologists,London,United Kingdom;Department of Ophthalmology,Gloucestershire Hospitals NHS Foundation Trust,Cheltenham,United Kingdom, ³Department of Anaesthesia,Worcestershire Acute Hospitals NHS Trust,Worcestershire,United Kingdom, ⁴Department of Ophthalmology,Manchester University NHS Foundation Trust,Manchester,United Kingdom, ⁵Department of Ophthalmology,Royal Surrey County Hospital NHS Foundation Trust,Surrey,United Kingdom, ⁶Department of Ophthalmology,Northern Devon Healthcare NHS Trust,Devon,United Kingdom, ⁷Department of Medical Statistics,Gloucestershire Hospitals NHS Foundation Trust,Cheltenham,United Kingdom;National Ophthalmology Database Audit,The Royal College of Ophthalmologists,London,United Kingdom, ⁸Department of Ophthalmology,Leeds Teaching Hospitals NHS Trust,Leeds,United Kingdom;International Centre for Eye Health,London School of Hygiene and Tropical Medicine,London,United Kingdom;National Ophthalmology Database Audit,The Royal College of Ophthalmologists,London,United Kingdom

Purpose

To describe variation in local anaesthesia techniques and complications over a 10-year period and between centres undertaking cataract surgery in the United Kingdom.

Setting

Centres undertaking cataract surgery across the United Kingdom in the National Health System (NHS) and independent sector treatment centres (ISTC)

Methods

Data were analysed from the Royal College of Ophthalmologists National Ophthalmology Database (NOD). Eligible cataract operations were performed using local anaesthesia between 01/04/2010 and 31/03/2020. Eligible for analysis were 1,195,900 operations performed in 80 centres.

Results

Overall, topical alone (TA) was used in 152324(12.7%) operations, combined topical and intracameral (CTA) in 522854(43.7%), sub-Tenon’s (ST) in 461183(38.6%), and peri/retrobulbar (PB/RB) in 59539(5.0%). 48.3% NHS operations were TA/CTA vs 88.7% in ISTC. 45.9% were ST in NHS vs 9.6% in ISTC. 5.8% were PB/RB in NHS vs 1.7% in ISTC. Anaesthetic complication rates decreased from 2.7% in 2010 to 1.5% in 2019. Anaesthetic complication rates were 0.3% for AT, 0.3% for CTA, 3.5% for ST and 3.1% PB/RB. Complication rates were higher for PB/RB in patients taking warfarin rather than direct oral anticoagulants (4.8%vs3.1%;p=0.024). Considerable variation existed between centres for choice of anaesthesia and incidence of anaesthetic complications

Conclusions

Combined topical and intracameral is the most common choice of anaesthesia for cataract surgery in the United Kingdom and is associated with a lower rate of complications than sub-Tenon’s and peribulbar/retrobulbar anaesthesia. Marked variation in anaesthetic choice exists between centres and notably between traditional NHS and ISTC sectors.