Prospective study of cooperation and satisfaction in glaucoma surgery under sub-Tenon's anesthesia.

OBJECTIVES: To evaluate the analgesic effect as well as patient cooperation and satisfaction with sub-tenon's anesthesia in glaucoma surgery. MATERIAL AND METHODS: Prospective uncontrolled study. Fifty-three patients who underwent glaucoma surgery, with or without cataract extraction, with sub-Tenon's anesthesia have been studied. Satisfaction and cooperation were evaluated on a qualitative scale. The pain level was quantified using a numerical scale from 1 (no pain) to 10 (unsupportable pain). RESULTS: The mean pain score at the different periods was: 2.13 (standard deviation [SD] 1.47) on administering anesthesia, 1.74 (SD 1.27) during the surgery, 1.63 SD (1.23) immediately after the procedure, 1.38 (SD 0.38) 30 min later, and 1.38 (SD 0.63) when leaving the recovery unit. The postoperative satisfaction was "fairly or very satisfied" in 92.6% of the cases for both the surgeons and the patients. Twenty-four patients complained during the surgery, 15 of them at the conjunctival suture; in these cases additional anesthesia was administered, and, in 4 cases, intravenous paracetamol was given. Pain scores were significatively higher during the surgery (P=.033), and immediately after the procedure (P=.027) in trabeculectomy than in deep sclerectomy patients. CONCLUSIONS: The good analgesic level reached led to a high level of patient and surgeon satisfaction, even in longer procedures such as deep sclerectomy combined with cataract extraction, or implantation of drainage devices. Pain scores were significatively higher in trabeculectomy than in deep sclerectomy patients.

Estudio prospectivo sobre colaboración y satisfacción en cirugía de glaucoma con anestesia subtenoniana / Prospective study of cooperation and satisfaction in glaucoma surgery under sub-Tenon's anesthesia

Objetivos: Valorar el efecto analgésico así como la colaboración y satisfacción de los pacientes en la cirugía de glaucoma con anestesia subtenoniana. Material y métodos: Estudio prospectivo no controlado. Se estudiaron datos de 53 pacientes operados de glaucoma, asociado o no a cirugía de catarata, bajo anestesia subtenoniana, valorándose de manera cualitativa la satisfacción y colaboración, así como el grado de analgesia mediante una escala numérica de 1 (no dolor) a 10 (máximo). Resultados: La calificación media del dolor ha sido: 2,13 desviación estándar (DE): 1,47 al administrar la anestesia, 1,74 DE: 1,27 durante la intervención, 1,63 DE: 1,23 en el postoperatorio inmediato, 1,38 DE: 0,38 a los 30min y 1,38 DE: 0,63 al alta. El grado de satisfacción fue «bastante o muy satisfecho» en el 92,6% de los casos, tanto para pacientes como para cirujanos. En 24 casos el paciente refirió molestias, 15 de ellos durante la sutura conjuntival, requiriendo anestesia adicional y en cuatro casos, paracetamol sistémico. La puntuación del dolor fue significativamente mayor durante la cirugía (p=0,033) y en el postoperatorio inmediato (p=0,027) en los pacientes operados de trabeculectomía que en la esclerectomía profunda no penetrante (EPNP). Conclusiones: El buen nivel analgésico conseguido favoreció un alto grado de satisfacción por parte de cirujanos y pacientes, incluso en procedimientos de larga duración como esclerectomía profunda no penetrante combinada con facoemulsificación e implantes de dispositivos de drenaje. El dolor percibido por los pacientes durante la cirugía y postoperatorio inmediato fue mayor en la trabeculectomía que en la EPNP(AU)

Objectives: To evaluate the analgesic effect as well as patient cooperation and satisfaction with sub-tenon's anesthesia in glaucoma surgery. Material and methods: Prospective uncontrolled study. Fifty-three patients who underwent glaucoma surgery, with or without cataract extraction, with sub-Tenon's anesthesia have been studied. Satisfaction and cooperation were evaluated on a qualitative scale. The pain level was quantified using a numerical scale from 1 (no pain) to 10 (unsupportable pain). Results: The mean pain score at the different periods was: 2.13 (standard deviation [SD] 1.47) on administering anesthesia, 1.74 (SD 1.27) during the surgery, 1.63 SD (1.23) immediately after the procedure, 1.38 (SD 0.38) 30min later, and 1.38 (SD 0.63) when leaving the recovery unit. The postoperative satisfaction was “fairly or very satisfied” in 92.6% of the cases for both the surgeons and the patients. Twenty-four patients complained during the surgery, 15 of them at the conjunctival suture; in these cases additional anesthesia was administered, and, in 4 cases, intravenous paracetamol was given. Pain scores were significatively higher during the surgery (P=.033), and immediately after the procedure (P=0.027) in trabeculectomy than in deep sclerectomy patients. Conclusions: The good analgesic level reached led to a high level of patient and surgeon satisfaction, even in longer procedures such as deep sclerectomy combined with cataract extraction, or implantation of drainage devices. Pain scores were significatively higher in trabeculectomy than in deep sclerectomy patients(AU)

[Needle revision of late failing filtering blebs after glaucoma surgery]. / Repermeabilización mediante revisión con aguja de ampollas de filtración con fracaso tardío tras cirugía de glaucoma.

PURPOSE: To evaluate the results of bleb needling in eyes subjected to filtering surgery six months or more previously. METHODS: A retrospective study of 23 eyes in 21 patients subjected to bleb needling performed by means of a 25G needle, 6 months to 23 years after failed filtering surgery (mean 67.3 months). The mean number of bleb needlings was 1.2 and the mean number of 5-fluorouracil subconjunctival injections was 3.9. RESULTS: The mean intraocular pressure (IOP) before needling was 26 mmHg and the mean anti-glaucoma medications was 1.3 per eye. The mean postoperative IOP was 16.3 mmHg and mean anti-glaucoma medications 0.7. A diffuse filtering bleb was evident in 12 eyes (54.5%). The results of needling were worse in eyes subjected to previous surgery for glaucoma or other failed bleb needling procedures (75% failure). CONCLUSION: Needle revision of the filtering bleb is a simple and safe technique that offers good results even years after a filtering surgery had been performed. It should be considered before other medical or surgical treatments in patients with a previously functioning bleb and a permeable sclerectomy site at gonioscopy.

Repermeabilización mediante revisión con aguja de ampollas de filtración con fracaso tardío tras cirugía de glaucoma / Needle revision of late failing filtering blebs after glaucoma surgery

Objetivo: Analizar los resultados de la cistitomía de la ampolla de filtración en ojos operados de cirugía filtrante de glaucoma seis meses antes o más. Material y métodos: Estudio retrospectivo de 23 ojos de 21 pacientes en los que se ha realizado revisión de la ampolla de filtración con una aguja de 25 G, entre 6 meses y 23 años tras cirugía filtrante (media 67,3 meses). Se realizaron una media de 1,2 cistitomías por ojo y 3,9 inyecciones de 5-fluorouracilo subconjuntival. Resultados: De una presión intraocular (PIO) media preoperatoria de 26 mmHg y 1,3 fármacos hipotensores hemos pasado a una PIO media postoperatoria de 16,3 mmHg y una media de 0,7 fármacos, con una ampolla de filtración difusa en 12 casos (54,5%). Los resultados fueron peores en ojos con cirugía previa de glaucoma u otra cistitomía previa fracasada (75% fracaso). Conclusiones: La revisión con aguja es una técnica sencilla y segura que ofrece buenos resultados incluso años después de una cirugía filtrante, y debe ser considerada de manera previa a la reinstauración de tratamiento médico o quirúrgico en los pacientes operados de glaucoma con fracaso tardío de una ampolla de filtración previamente funcionante y esclerectomía abierta en la gonioscopia

Purpose: To evaluate the results of bleb needling in eyes subjected to filtering surgery six months or more previously. Methods: A retrospective study of 23 eyes in 21 patients subjected to bleb needling performed by means of a 25G needle, 6 months to 23 years after failed filtering surgery (mean 67.3 months). The mean number of bleb needlings was 1.2 and the mean number of 5-fluorouracil subconjunctival injections was 3.9. Results: The mean intraocular pressure (IOP) before needling was 26 mmHg and the mean anti-glaucoma medications was 1.3 per eye. The mean postoperative IOP was 16.3 mmHg and mean antiglaucoma medications 0.7. A diffuse filtering bleb was evident in 12 eyes (54.5%). The results of needling were worse in eyes subjected to previous surgery for glaucoma or other failed bleb needling procedures (75% failure). Conclusion: Needle revision of the filtering bleb is a simple and safe technique that offers good results even years after a filtering surgery had been performed. It should be considered before other medical or surgical treatments in patients with a previously functioning bleb and a permeable sclerectomy site at gonioscopy