Subtenons Anesthesia in Pterygium Excision with Conjunctival Autograft

1
Subtenons Anesthesia in Pterygium Excision with
Conjunctival Autograft

• Michael R. Gagnon, M.D.
• Clinical Instructor, Stanford University
• Valley EyeCare Center, Pleasanton, California

I have no financial interests in the subject
matter.
2
Introduction

• Subtenons anesthesia has been used in a number
  of different types of intraocular surgeries
  including cataract, trabeculectomy, posterior
  segment, and strabismus surgery.
• Subtenons anesthesia lowers the risks associated
  with retrobulbar and peribulbar anesthesia
  including globe perforation, retrobulbar
  hemorrhage, optic nerve and extraocular muscle
  damage.

3
Purpose

• To describe using subtenons anesthesia for
  pterygium excision with conjunctival autograft.

4
Purpose

• To determine if subtenons anesthesia in
  pterygium surgery provided pain control and
  akinesia.
• To determine if subtenons anesthesia resulted in
  sight threatening complications.

5
Methods

• A retrospective review was conducted of
  consecutive eyes who had pterygium excision with
  conjunctival autograft with subtenons
  anesthesia.

6
Methods

• An incision was made in the inferonasal or
  inferotemporal quadrant opposite the location of
  the pterygium.
• A 23 gauge Corbin subtenons anesthesia cannula
  (Katena) was inserted along the sclera and the 3
  ml solution was injected into the subtenons
  space.
• The 3 ml injection was a 11 mixture of
  lidocaine 1 and bupivicaine 0.75 with 50 units
  of hyaluronidase.

7
Methods

• The standard surgical procedure for pterygium
  excision involved harvesting a free conjunctival
  graft from the superotemporal conjunctiva with
  assistance from a corneal traction suture.
• The conjunctival graft was placed onto the bare
  sclera and anchored at the limbus with two 9-0
  vicryl sutures.
• Tisseel fibrin glue was used to glue the graft
  into place.

8
Results

• A total of 21 eyes in 21 patients were
  identified.
• The twenty-one patients included eleven females
  and ten males and were predominantly left eyes
  (57).
• Average age was 48 years (28-65 years).
• Eighteen cases were primary pterygia
• Three were recurrent pterygia.

9
Results

• Subtenons anesthesia provided pain control 21 of
  21 eyes and akinesia in 18 of 21 eyes.
• Three eyes developed subconjunctival hemorrhage.
• There were no sight threatening complications in
  these patients.

10
Conclusions

• Subtenon's anesthesia is a safe and effective
  technique in pterygium excision with conjunctival
  autograft and can be used as an alternative to
  retrobulbar or peribulbar anesthesia.