Transcript Pre-Operative RNFL Thickness

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, MD
Harkness Eye Institute, Columbia Universty and New York Presbyterian
Medical 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 RNFL
demonstrate more subtle changes following standard
peribulbar 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
Peribulbar and Compression
Topical Only
Pre-Operative RNFL Thickness
Operative Eye Average: 99.7
Fellow Eye Average: 95.0
Pre-Operative RNFL Thickness
Operative Eye Average: 90.1
Fellow Eye Average: 87.8
Post-Operative RNFL Thickness
Operative Eye Average: 94.9
Fellow Eye Average: 93.7
Post-Operative RNFL Thickness
Operative Eye Average: 84.6
Fellow Eye Average: 88.1
Analysis of Overall Optic Nerve Thickness
RNFL Thickness Pre and Post-Operatively
Percent Change Pre to Post-Operative
Peribulbar and Compression
Percent Change
Operative Eye: -6.6%
Fellow Eye: -1.6%
Topical Only
Percent Change
Operative Eye: -6.4%
Fellow Eye: 0.7%
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, MD
Loh-Shan Leung, MD
Michael Weisberg, MD
Joseph Tseng, MD