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. 2023 Oct 30;28(1):472.
doi: 10.1186/s40001-023-01447-2.

Safety and feasibility of sutureless pars-plana vitrectomy in sub-Tenon anesthesia (SAFE-VISA): a prospective study

Tibor Lohmann  1 , Sabine Baumgarten  2 , Julia Prinz  2 , Peter Walter  2 , Antonis Koutsonas  2
Affiliations

Safety and feasibility of sutureless pars-plana vitrectomy in sub-Tenon anesthesia (SAFE-VISA): a prospective study

Tibor Lohmann et al. Eur J Med Res. .

Abstract

Background: To determine the safety and feasibility of sutureless pars-plana vitrectomy (ppV) in sub-Tenon anesthesia.

Methods: In this prospective study. Pain and anxiety at various times after ppV using a visual analogue scale (VAS) and Wong-Baker-FACES scale as well as visual sensations during surgery were investigated. The surgeon evaluated motility, chemosis, overall feasibility.

Results: ppV was performed on 67 eyes (33 sub-Tenon anesthesia, 34 general anesthesia). Pain during surgery in sub-Tenon anesthesia was 1.8 ± 2.2 (0.0-8.0), anxiety was 2.3 ± 2.2 (0.0-8.5). There was a moderate correlation between pain and anxiety (R2 = 0.58). Comparing sub-Tenon and general anesthesia no difference in pain perception was found the day after surgery. 27.3% of patients saw details, 21.2% saw colors, 90.1% saw light/motion perception, 3.0% had no light perception. Median chemosis after surgery was 1.0 (IQR = 1.0). Median motility of the eye during surgery was 1.0 (IQR = 1.0), median grade was 1.0 (IQR = 1.0). 24.2% of patients showed subconjunctival hemorrhage during or after surgery.

Conclusions: Sutureless pars-plana vitrectomy in sub-Tenon anesthesia was performed safely, with pain and anxiety levels tolerable for the patients and without the necessity for presence of an anesthesiologist. With 88.9% of patients willing to undergo vitreoretinal surgery in sub-Tenon anesthesia again, we recommend it as a standard option. Trial registration This study was approved by the Institutional Ethical Review Board of the RWTH Aachen University (EK 111/19). This study is listed on clinicaltrials.gov (ClinicalTrials.gov identifier: NCT04257188, February 5th 2020).

Keywords: Anxiety; General anesthesia; Local anesthesia; Pain; Retina; Retinal surgery; Sub-Tenon anesthesia; Vitreoretinal surgery.

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Conflict of interest statement

The authors declare that there is no competing interests regarding the publication of this paper.

Figures

Fig. 1
Fig. 1
Flow chart of the patient selection process
Fig. 2
Fig. 2
Pain perception during and after vitreoretinal surgery under sub-Tenon anesthesia on the visual analogue scale (VAS) and the Wong-Baker FACES scale. Median is indicated with horizontal line the box. Bottom of the box represents 1st quartile, top 3rd quartile. Whiskers indicate 10th to 90th percentile. Outliers are indicated with staggered black circles and squares, respectively. *P = < 0.05
Fig. 3
Fig. 3
Pain perception on the day of and the day after vitreoretinal surgery under general anesthesia on the visual analogue scale (VAS) and the Wong-Baker FACES scale. Median is indicated with horizontal line the box. Bottom of the box represents 1st quartile, top 3rd quartile. Whiskers indicate 10th to 90th percentile. Outliers are indicated with staggered black circles and squares, respectively. *P = < 0.05
Fig. 4
Fig. 4
Anxiety perception during vitreoretinal surgery under sub-Tenon anesthesia and prior to vitreoretinal surgery under general surgery on the visual analogue scale (VAS). Median is indicated with horizontal line the box. Bottom of the box represents 1st quartile, top 3rd quartile. Whiskers indicate 10th to 90th percentile. Outliers are indicated with staggered black circles and squares, respectively. *P = < 0.05
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