[A Case Series of Elderly Patients with Aortic Stenosis (AS) Undergoing Conscious Glaucoma Surgery in Sub-Tenon's or Subconjunctival Anaesthesia]. / Eine Fallserie wacher Glaukomoperationen mittels Sub-Tenon- oder subkonjunktivaler Anästhesie bei älteren PatientInnen mit Aortenklappenstenose.

ABSTRACT

With the current demographic changes, an increasing number of patients scheduled for glaucoma surgery presents with aortic sclerosis (AS) as part of their list of systemic diseases. This presents a definite challenge for anaesthesiologists and eye surgeons alike. We illustrate 6 cases of patients with aortic sclerosis undergoing glaucoma surgery in subconjunctival local anaesthesia or sub-Tenon block (STB). In one patient, due to discomfort, local anaesthesia had to be given repeatedly. Her blood pressure rose permanently to hypertensive values. During surgery, localised, temporal choroidal bleeding was noticed. The follow-up was complicated by exorbitant intraocular pressure swings and secondary localised choroidal bleeding. Anaesthesiologist and ophthalmic surgeon must harmonise their strategy to provide optimal transmural pressure across choroidal vessels and stenotic aortic valve outlet. Clinicians are often not aware of the core principals of each other's speciality. Our discussion considers different approaches for both disciplines to safely reduce the risk of suprachoroidal bleeding for this high-risk patient population with aortic stenosis.