Choosing Anaesthesia for Corneal Surgery
If you require corneal surgery; whether is be a corneal transplant, DMEK, DSEK, ptergyium surgery, etc., there are several choices of anaesthesia for your eye surgery.
I operate at various locations throughout Melbourne, including the Royal Victorian Eye and Ear Hospital, Northpark Private Hospital, and Manningham Day Procedure Centre. Surgery is mostly performed on an outpatient basis, meaning you can go home soon after surgery is completed.
Let me also note that the choice of anaesthesia is usually determined between you and the anaesthesiologist. While I may suggest a preference, the decision is really up to the anaesthesiologist.
Local Anesthesia with Sedation
This is probably the most common choice of anaesthesia. This is sometimes called “twilight anaesthesia” due to the sedation given through the intravenous (I.V.) line.
Before numbing your eye with a “local” injection, you are given medication through the I.V. for sedation. You will be sedated for a few minutes while your eye is numbed with a retrobulbar, peribulbar or subtenon’s injection.
For a retrobulbar, peribulbar or subtenon’s injection, a small volume of numbing medicine such as lignocaine is given. The injection will both numb the eye and keep it still for surgery. Once the sedation wears off, patients are usually awake, but very, very comfortable. On occasion, additional sedation can be given during the operation.
General anaesthesia using a laryngeal mask airway (LMA) can also be used. General anaesthesia is an option if the anaesthesiologist feels it is safe enough for you. Sometimes patients are not healthy enough for this type of anaesthesia.
I like to use general anaesthesia when performing a full thickness corneal transplant (also called a penetrating keratoplasty). I prefer general anaesthesia in these cases as it minimises the risk of increased pressure around or behind the eye during the surgery. If the anaesthesiologist does not recommend a general anaesthesia this surgery can also be completed with a successful retrobulbar block.
While it is possible to start a cornea transplant operation with local anaesthesia and then “convert” to general anaethesia, it’s more difficult once the operation has started. Even with general anaesthesia, I usually give a local block at the conclusion of surgery. This local block lasts for several hours after surgery and keeps you comfortable in the postoperative period.
With modern operating techniques, a cornea transplant can often be completed in an hour or less. This requires minimal amounts of anaesthesia so that going home shortly after surgery is usually possible. Sometimes with long operations under general anesthesia, recovery from the anesthesia is prolonged. You have the option of spending the night in hospital if its needed.
Local Anaesthesia Only
On occasion, I have patients who do not want any sedation and request only the retrobulbar injection. This is always an option if desired by the patient.
No matter what technique is used for your cornea surgery, the main goal is to keep you comfortable and without pain or discomfort.
It is also our job to keep you safe and healthy. I want to operate knowing you will be comfortable and cooperative. Sometimes if a patient is too anxious or cannot lie still, it will impact our choice of anaesthesia. Efficient operating times allow for reduced anaesthesia. This, in turn, allows you to recover from the anaesthesia much quicker and avoid health concerns with longer operations.
Ross MacIntyre MD FRANZCO