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Subtenon’s Anesthesia in Pterygium Excision with Conjunctival Autograft

Subtenon’s 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.*. Introduction.

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Subtenon’s Anesthesia in Pterygium Excision with Conjunctival Autograft

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  1. Subtenon’s 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 • Subtenon’s anesthesia has been used in a number of different types of intraocular surgeries including cataract, trabeculectomy, posterior segment, and strabismus surgery. • Subtenon’s 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 subtenon’s anesthesia for pterygium excision with conjunctival autograft.

  4. Purpose • To determine if subtenon’s anesthesia in pterygium surgery provided pain control and akinesia. • To determine if subtenon’s anesthesia resulted in sight threatening complications.

  5. Methods • A retrospective review was conducted of consecutive eyes who had pterygium excision with conjunctival autograft with subtenon’s anesthesia.

  6. Methods • An incision was made in the inferonasal or inferotemporal quadrant opposite the location of the pterygium. • A 23 gauge Corbin subtenon’s anesthesia cannula (Katena) was inserted along the sclera and the 3 ml solution was injected into the subtenon’s space. • The 3 ml injection was a 1:1 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 • Subtenon’s 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.

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