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Topical anesthesia for penetrating keratoplasty
H Keith Riddle1, Marianne O Price, Francis W Price
1Montgomery Eye Associates, Clinton, SC, USA.
Cornea
|September 28, 2004
Summary
Penetrating keratoplasty (PKP) using topical anesthesia is a safe and effective alternative for patients with contraindications to traditional anesthesia. This method offers a viable option for high-risk individuals, ensuring successful corneal transplantation with minimal discomfort.
Area of Science:
- Ophthalmology
- Anesthesiology
Background:
- Traditional anesthesia methods for penetrating keratoplasty (PKP) carry risks and may not be suitable for all patients.
- Certain medical conditions or patient factors can make retrobulbar, peri/parabulbar, or general anesthesia inadvisable or unavailable.
Purpose of the Study:
- To evaluate the efficacy and safety of topical anesthesia for performing PKP.
- To assess the feasibility of using topical anesthesia in specific patient populations where other anesthetic options are contraindicated.
Main Methods:
- Retrospective analysis of 8 consecutive cases of PKP performed with topical anesthesia.
- Cases were selected where standard anesthesia was not feasible or posed excessive risk.
- Anesthesia was supplemented with limbal injections, intravenous sedation, or intraocular anesthesia in some instances.
Main Results:
- All PKP procedures were successfully completed without complications.
- Patients reported good tolerance and only mild discomfort during the surgery.
- Two cases required leaving an anterior chamber intraocular lens (ACIOL) in place due to discomfort during lens manipulation.
Conclusions:
- Penetrating keratoplasty can be successfully performed using topical anesthesia in cooperative patients.
- This technique is particularly beneficial for patients with perforated corneal ulcers, on anticoagulation, or with severe medical conditions.
- Topical anesthesia provides a safer alternative when other anesthetic methods present higher risks.