Anesthesia techniques and the risk of complications as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO).

Abstract

To determine the trends in anesthesia techniques for cataract surgery over the past decade and their relationship to surgical complications.Setting: Clinics affiliated with the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO).Design: Retrospective cross-sectional register-based study.Methods: Variables include patient demographics, visual acuity, ocular comorbidities, surgery characteristics, intraoperative complications, and postoperative complications for the study period from January 2008, to December 2018. The anesthesia methods registered in the EUREQUO and included in the study are topical, combined topical and intracameral, sub-Tenon, regional, and general anesthesia. Multivariate logistic regression models for each complication were constructed to estimate the adjusted odds ratio (OR) and 95% CIs.Results: Complete data were available of 1 354 036 cataract surgeries. Topical anesthesia increased significantly over time (from 30% to 76%, P < .001). Sub-Tenon and regional anesthesia decreased (from 27% and 38% to 16% and 6%, respectively, P < .001), and general and combined topical and intracameral anesthesia remained stable (around 2%). Sub-Tenon (OR, 0.80; 95% CI, 0.71-0.91, P < .001), regional (0.74; 95% CI, 0.71-0.78, P < .001), general (0.53; 95% CI, 0.50-0.56, P < .001), and intracameral anesthesia (0.76; 95% CI, 0.64-0.90, P = .001) carried a significantly decreased risk of posterior capsule rupture (PCR), with and without dropped nucleus, compared with topical anesthesia. The risk of endophthalmitis was significantly lower with regional anesthesia compared with topical anesthesia (OR, 0.60; 95% CI, 0.44-0.82, P = .001). Conclusions:The use of topical anesthesia for cataract surgery increased over time. Topical anesthesia is associated with an increased risk of PCR with and without dropped nucleus, and endophthalmitis.

Comment on: Anesthesia techniques and the risk of complications as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery

“…Our original article discussed possible explanations for the higher risk of PCR and endophthalmitis with topical anesthesia, such as pain control and ocular movement. 1 We agree with Al-Hashimi et al that additional patient-centered factors, such as overall patient comfort, may also play a role. This letter is a welcome addition to the discussion of our findings.…”

“…Comment on: Anesthesia techniques and the risk of complications as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery We thank Segers et al for their observational study. 1 We have been waiting for a case series large enough to address the question of anesthesia technique and rates of posterior capsular rupture (PCR) and endophthalmitis. The authors found that the rates of PCR and endophthalmitis were significantly higher with topical anesthesia (TA) alone and lower when TA is supplemented with intracameral anesthesia or with sub-Tenon or regional ophthalmic blocks.…”

Controversies in anterior segment surgery at the 2023 JCRS symposia

“…4 Dr. Mor Dickman (the Netherlands) presented results from the European Registry of Quality Outcomes for Cataract and Refractive Surgery regarding trends in anesthesia techniques for cataract surgery between January 2008 and December 2018, including 1 354 036 procedures. 5 Topical anesthesia increased significantly over time (from 30% to 76%). Sub-Tenon, regional, general, and intracameral anesthesia carried a significantly decreased risk of posterior capsule rupture, with and without dropped nucleus, compared with topical anesthesia, and possible explanations for this could be less ocular movement and better pain control.…”

“…It is noteworthy that this study received the JCRS Obstbaum Award for Best Original Article published in 2022. 5 During the last part of the session, 4 speakers made different considerations regarding refractive surgical procedures in myopes. Dr. Edward Manche (U.S.) presented data from the last quarter of 2022 showing that laser in situ keratomileusis (LASIK) still dominates the U.S. market, representing 71.1% of refractive procedures, followed by small-incision lenticule extraction (SMILE; 13.7%), surface ablation (9.3%), and phakic IOLs (5.9%).…”

“…It is noteworthy that this study received the JCRS Obstbaum Award for Best Original Article published in 2022. 5…”