Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 11, techniques and complications of local anesthesia for cataract surgery in the United Kingdom

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.