Severe adverse events associated with local anaesthesia in cataract surgery: one year national survey of practice and complications in the United Kingdom

Background: Recent years have seen a major change in practice of local anaesthesia (LA) for cataract surgery. Aims: (i) To estimate current usage of LA techniques for cataract surgery, (ii) to estimate the incidence of severe adverse events associated with each LA technique, (iii) to compare with our previous 2003 study. Methods: This was a prospective, observational study of routine practice. For 13 months in 2012-3, 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, 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% sub-conjunctival, 13.8% topical, 24.2% topical-intracameral LA. Severe sight-threatening complications included 7 globe perforations, 1 cilioretinal artery occlusion and 1 severe corneal oedema. Severe life-threatening complications included 1 profound vasovagal episode, 1 silent myocardial infarction, 1 anaphylactic reaction and 1 supraventricular tachycardia. Under-reporting means that more complications probably occurred. Conclusions: There has been a large swing toward ‘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.