A Comparison of Topical and Retrobulbar Anesthesia for Trabeculectomy

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PurposeTo compare the safety and efficacy of topical versus retrobulbar anesthesia for primary trabeculectomyMethodsA prospective study of 36 consecutive patients undergoing trabeculectomy who were randomized to receive topical (n = 18) or retrobulbar (n = 18) anesthesia. Operating conditions, patient comfort, and surgical outcome were evaluated.SettingsTertiary-care university hospital ambulatory surgical center.ResultsThere were no differences in operating conditions (P = 0.14), pain during (P = 0.54) or after (P = 0.76) surgery, or supplemental anesthesia required (P = 0.34) between the two groups. Very few patients in either group were bothered by touch sensation, tissue manipulation, or the microscope light. Chemosis, subconjunctival hemorrhage and eyelid hemorrhage were seen exclusively in the retrobulbar group (P <0.03), and were all attributable to the injection. Inadvertent eye movement was present more frequently in the topical group (P = 0.01), although this did not pose a problem to the surgeon. No surgical complications were encountered in either group.ConclusionTopical anesthesia is a safe and effective alternative to retrobulbar anesthesia for primary trabeculectomy.

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