Bo Wang

Objective: Local anesthesia represents an alternative to general anesthesia in selected patients undergoing repair for open globe injuries. This study aimed to evaluate and compare visual acuity and clinical outcomes in such patients. Methods: A systematic literature search was conducted across PubMed, Embase, Scopus, Cochrane Library, and Google Scholar. Adults (≥18 years) hospitalized with open globe injuries were included. Out of 551 articles screened, four observational studies met the inclusion criteria. Standardized Mean Differences (SMD) for continuous and Risk Ratios (RR) for dichotomous outcomes were pooled using the Inverse Variance method with a Random Effects model. Outcomes included visual acuity, wound location, wound length, and operative time. Results: Four retrospective case series comprising 1,690 patients were included. All studies had low risk of bias per the Newcastle-Ottawa Scale. No significant difference was observed in best corrected visual acuity between groups (MD = −0.18; 95% CI: −0.45 to 0.08; p = 0.17; I² = 55%). Patients in the local anesthesia group had more anterior wound locations (MD = 1.33; 95% CI: 1.06–1.66; p = 0.01; I² = 65%). Wound length (MD = −4.97; 95% CI: −5.95 to −3.98; p < 0.00001; I² = 0%) and operative time (MD = -33.32; 95% CI: −40.82 to −25.82; p < 0.00001; I² = 0%) were significantly shorter. Conclusion: Local anesthesia was associated with more anterior wounds, shorter wound length, and reduced operative time without compromising visual outcomes. It may be a safe and effective alternative to general anesthesia in selected open globe injuries.

Micropulse cyclophotocoagulation (MPCPC) has been shown in adults to offer a favorable post-operative safety profile compared to continuous wave transscleral cyclophotocoagulation (CWCPC) in the management of glaucoma. The purpose of this study is to evaluate the long term efficacy, safety, and effectiveness of MPCPC in the management of pediatric glaucoma when compared to CWCPC. IRB approved retrospective chart review of patients with pediatric glaucoma that underwent MPCPC and CWCPC at 2 separate institutions. Success was defined as intraocular pressure (IOP) between 5 and 21mmHg on any number of topical glaucoma medication without requiring additional surgical intervention or oral IOP lowering medication. Of the 48 patients in the study, 22 (26 eyes) underwent MPCPC and 26 (30 eyes) underwent CWCPC. At 1 year, 7 out of 26 eyes (26.9%) achieved success in the MPCPC group compared to 13 out of 30 eyes (43.3%) in the CWCPC group. Survival analysis unveiled a statistically significant difference in success between the two groups (p = 0.03). In pediatric glaucoma patients undergoing cyclophotocoagulation procedures, CWCPC outperformed MPCPC using default settings in terms of achieving long-term IOP control. Additional studies are required to evaluated augmented MPCPC settings in pediatric glaucoma patients.