title: Severe adverse events associated with local anaesthesia in cataract surgery: 1 year national survey of practice and complications in the UK.
abstract: BACKGROUND
  Recent years have seen a major change in practice of local anaesthesia (LA) for cataract surgery.
  
  
  OBJECTIVE
  (1) To estimate current usage of LA techniques for cataract surgery, (2) to estimate the incidence of severe adverse events associated with each LA technique, (3) to compare with our previous 2003 study.
  
  
  METHODS
  This was a prospective, observational study of routine practice. For 13 months in 2012-2013, the British Ophthalmological Surveillance Unit sent monthly mailings to all senior British ophthalmologists, asking for reports of 'potentially sight-threatening or life-threatening complications of LA for cataract surgery'. Current practice was assessed by questionnaire.
  
  
  RESULTS
  Cataract surgery comprised 3.4% general anaesthesia, 92.5% LA alone and 4.1% LA with sedation. Techniques for the estimated 357 000 LA cataracts were: 8.8% peribulbar, 1.3% retrobulbar, 50.5% sub-Tenon's, 1.4% subconjunctival, 13.8% topical, 24.2% topical-intracameral LA. Severe sight-threatening complications included seven globe perforations, one cilioretinal artery occlusion and one severe corneal oedema. Severe life-threatening complications included one profound vasovagal episode, one silent myocardial infarction, one anaphylactic reaction and one supraventricular tachycardia. Under-reporting means that more complications probably occurred.
  
  
  CONCLUSIONS
  There has been a large swing towards 'non-injection' LA in recent years. Serious adverse events were reported with all techniques except topical-intracameral and subconjunctival LA, though the incidence appears lower for 'non-injection' LA.
authors.affiliation: Department of Ocular Biology and Therapeutics, Institute of Ophthalmology, London, UK.
authors.forename: Richard M H
authors.initials: RM
authors.lastname: Lee
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: John R
authors.initials: JR
authors.lastname: Thompson
authors.affiliation: Department of Ophthalmology, Norfolk & Norwich University Hospital, Norwich, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Eke
mesh_terms: D000772:Anesthesia, Local / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D002387:Cataract Extraction / Q000009:adverse effects / Q000379:methods*; D004812:Epidemiologic Methods; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D009885:Ophthalmology / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000779:Anesthetics, Local
keywords: Anterior chamber; Drugs; Treatment Surgery