TransPRK in general anesthesia-An alternative for anxious patients

Abstract

The aim was to analyze and compare the refractive results of anxious patients treated with transepithelial photorefractive keratectomy (TransPRK) while under general anesthesia (ITN) versus patients treated under local anesthesia (TRO). The TransPRK treatment was performed with the AMARIS 1050 RS laser (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany) in agroup of patients with ITN and agroup of patients, treated as usual with TRO. The method used an aspheric aberration neutral ablation profile, as well as SmartPulse technology and 7D eyetracking. In ITN propofol and rocuronium were injected intravenously. The artificial respiration was via aresuscitation bag after intubation with alaryngeal mask. To achieve pain insensitivity in the group of patients in TRO three drops of Conjucain Edo 0.4% were instilled at intervals of afew minutes. Follow-up examinations were performed after1 and 4days and after1 and 3months. Atotal of 35consecutive TransPRK laser treatments under ITN were retrospectively compared with agroup of 699 eyes treated with TransPRK under TRO in the period from February 2017 to December 2021. The preoperative sphere had arange of -5.50 to -1.0 dpt, the average cylinder was 1.19 dpt and cylinders were treated up to 4.75 dpt. The results after 3months follow-up showed apredictability of 100% eyes within the target correction of less than 0.5 dpt in ITN and in TRO 97%. The astigmatic correction showed 91% of eyes in ITN with less than 0.5 dpt and an angle of error of 83% within ±5°. In TRO 96% of eyes showed astigmatic correction with less than 0.5 dpt and an angle of error of 77% within ±5°. After 3months 83% of eyes treated in ITN reached avisual acuity of 1.0 or more and 84% of eyes treated in TRO. The TransPRK performed in ITN led to equal refractive results than when treated as usual in TRO. For anxious patients there is the possibility of laser vision correction in ITN. Because of shorter treatment time and accordingly shorter time under general anesthesia, TransPRK is an advantage for LASIK surgery.