Preoperative Preparation and Anesthesia for Trabeculectomy.

Area of Science:

• Ophthalmology
• Surgical Anesthesia

Background:

• Preoperative preparation is essential for optimizing trabeculectomy success.
• Glaucoma patients face heightened risks for sight-threatening complications due to optic nerve vulnerability.

Purpose of the Study:

• To review preoperative preparation strategies for trabeculectomy.
• To evaluate the impact of anesthesia techniques on trabeculectomy outcomes and patient safety.

Main Methods:

• Review of current literature on preoperative optimization and anesthesia for trabeculectomy.
• Analysis of potential risks associated with different anesthesia techniques, particularly posterior placements.
• Discussion of medication adjustments and anesthesia choices relevant to trabeculectomy.

Main Results:

• Posterior anesthesia techniques (retrobulbar, peribulbar, posterior sub-Tenon's) pose a risk of optic nerve damage and vision loss.
• Anesthesia choice can influence vitreous bulge and surgical difficulty.
• No strong evidence indicates superiority of any anesthesia technique for long-term intraocular pressure control.

Conclusions:

• Tailored preoperative preparation, including medication management, enhances trabeculectomy success.
• Anesthesia selection requires careful consideration to mitigate risks, especially optic nerve damage.
• Subconjunctival-intracameral anesthesia without sedation is the author's preferred technique.