Effect of local anesthesia on trabeculectomy success

To compare the long-term results of trabeculectomy surgery with subconjunctival anesthesia versus topical lidocaine 2% jelly.

A retrospective review of the long-term intraocular pressure (IOP) of 57 trabeculectomies previously enrolled in a prospective study comparing subconjunctival anesthesia to topical lidocaine 2% jelly. Baseline data included patient demographics, diagnosis, and ophthalmic history. Postoperative data included IOP, glaucoma therapy, and any interventions. Follow-up was conducted by reviewing the medical charts from July 2002 to August 2007. Differences between the groups were statistically assessed by the Student t test, chi(2) test, Fisher exact test, and Kaplan-Meier survival analysis.

Data were available for 57 of the 58 original study patients, with a median age of 65 years. The median follow-up time was 4.2 years for both groups (range: 0.1 to 4.8). There were no statistically significant differences in baseline characteristics and follow-up observations. At the 4-year follow-up, 29.5% of the subconjunctival anesthesia patients versus 39.5% of the topical lidocaine 2% jelly patients were complete success (IOP between 6 to 21 mm Hg and 20% reduction without glaucoma therapy or repeat filtration surgery, P=0.15) and 82.7% of the subconjunctival anesthesia patients versus 95.8% for the topical lidocaine 2% jelly patients were qualified success (above with or without glaucoma therapy, P=0.39).

Though small numbers observed, the 2 anesthetic techniques did not seem to influence the long-term success of trabeculectomy surgery. Further studies with more patients are warranted.