[Local anesthesia in vitreoretinal surgery]

To compare general anesthesia [GA] with local anesthesia [LA] in terms of safety and patient satisfaction. In this interventional case series, 928 consecutive patients who underwent vitreoretinal surgery were included. Data for analysis were type of anesthesia and operation, patient compliance, operating conditions and pain scores. General anesthesia was provided with a standard method and local anesthesia was performed through peribulbar or retrobulbar routes. Selection of the type of anesthesia was determined by patient age and co-morbidities based on the surgeon's opinion. Patients were operated under local anesthesia in 343 [36.9%] and general anesthesia in 585 [63.1%] cases. Mean age was 68.8 +/- 7.3 [range 51-78] years in the LA group and 55.9 +/- 6.5 [range 43-70] years in the GA group [P= 0.041]. ASA [American Society of Anesthetics] physical status score in the LA group was higher than GA group. Patients were in appropriate condition in 96.4% and operating conditions were good or excellent in 98.8%. The majority of patients [97%] said they would choose local anesthesia for their next vitreoretinal procedures. Local anesthesia is a useful and flexible method of anesthesia for vitreoretinal surgery, with excellent patient tolerance, especially in old patients and those who suffer from concurrent diseases

[Topical sodium diclofenac during pan-retinal photocoagulation in patients with proliferative diabetic retinopathy]

To evaluate the analgesic effect of topical sodium diclofenac 0.1% during pan-retinal photocoagulation [PRP] in patients with proliferative diabetic retinopathy [PDR]. Two-hundred informed patients [102 male, 98 female] with PDR were enrolled in this randomized controlled double-masked clinical trial. The treatment group received sodium diclofenac 0.1% eye drops and controls received artificial tear 30, 60 or 90 minutes before laser therapy in a masked and random fashion. Pain level was evaluated immediately after PRP using the Scott's visual analogue scale. Mean patient age was 53.6 +/- 14.2 [range 20-82] years. Average pain level was 46% in the treatment group vs 77% in controls [P<0.0001, t-test]. Average pain level was 42% in female vs 46% in male subjects in the treatment group [P=0.014, t-test]. There was no correlation in either group between pain level and age, number of laser spots, time interval from application of the drops to laser treatment [30, 60 or 90 minutes] and using daily aspirin. Using topical sodium diclofenac 0.1% before PRP in patients with PDR is a useful method for pain reduction