To evaluate the safety of topical anaesthesia (TA) versus peribulbar anaesthesia (PBA) in patients undergoing routine cataract surgery on the basis of systemic adverse events.
In this retrospective ...study, a total of 2,020 consecutive cases of cataract surgery performed by one surgeon on 1,621 patients with PBA (n = 1,010; between 1998-1999) or TA (n = 1,010; between 1999-2001) were evaluated on the basis of intra-operative and early postoperative adverse events requiring medical intervention.
The rate of pre-existing risk factors in patients undergoing cataract surgery is high (97%). Complications are significantly less frequent in TA than in PBA in the intra-operative (p < 0.001) and postoperative (p = 0.022) courses. The incidence of intra-operative complications is higher in elderly patients (>or=65 years of age) than in younger patients (p < 0.001).
The results from the present study indicate that intra-operative complications are less likely in patients that receive TA, suggesting the use of TA for routine cataract surgery both in young patients and particularly in elderly patients when there are no contraindications in the individual case.
Introduction
Intravitreal dexamethasone and anti-vascular endothelial growth factor (anti-VEGF) medications have revolutionized ocular disease management and favorable ocular safety profiles, but few ...studies have compared their systemic adverse events (SAEs). This study investigated the SAEs of intravitreal dexamethasone and anti-VEGFs by using real-world data.
Methods
This retrospective cohort study sourced medical records from the largest multi-institutional database in Taiwan. Patients who received intravitreal dexamethasone (
n
= 137) or anti-VEGFs (
n
= 10,345) between 2014 and 2019 were enrolled. Propensity score matching was performed to achieve homogeneity between the two groups. Subdistribution hazard ratios (SHRs) and 95% confidence intervals (CIs) were calculated using the Fine–Gray model. Systemic as well as ocular clinical events and systemic biomarkers after 1-year follow-up were compared.
Results
Both groups demonstrated comparable risks of major cardiac adverse events (SHR 1.57, 95% CI 0.29–8.55), heart failure (SHR 0.62, 95% CI 0.07–5.33), major bleeding (SHR 0.23, 95% CI 0.03–1.77), all-cause admission (SHR 0.73, 95% CI 0.41–1.30), and all-cause death (SHR 2.11, 95% CI 0.35–12.71). There were no significant differences in longitudinal changes in systolic and diastolic blood pressure, glycated hemoglobin, low-density lipoprotein, estimated glomerular filtration rate, or alanine aminotransferase between the groups. Both groups had a similar incidence of cataract surgery. Although the dexamethasone group exhibited a relatively high prevalence of antiglaucomatous medication use, there was not a significantly higher incidence of glaucoma surgery.
Conclusion
Intravitreal dexamethasone and anti-VEGF medications had comparable systemic safety profiles in our study. Both drugs represent efficacious and safe therapies for ocular diseases.
