I operate almost exclusively at Woodburn Surgical Center at INOVA Fairfax Hospital. Surgery is performed on an outpatient basis and go home soon after surgery is completed.
Let me also note that the choice of anesthesia is usually determined between YOU and the anesthesiologist. While I may suggest a preference, the decision is really up to the anesthesiologist.
This is probably the most common choice of anesthesia. This is also called “twilight” due to the sedation given through the intravenous line (I.V.).
Before numbing your eye with a “local” injection, you are given medication through the I.V. for sedation. You will be sedated for a few minutes while I numb your eye with either a retrobulbar or parabulbar injection. I usually prefer retrobulbar injections.
For a retrobulbar injection, I usually use 3-5 cc’s of numbing medicine such as Lidocaine.
The injection will both numb the eye and keep it still for surgery. Once the sedation wears off, patients are usually awake, but very, very comfortable.
On occasion, additional sedation can be given during the operation.
General anesthesia using a laryngeal mask airway (LMA) can also be used. General anesthesia is an option if the anesthesiologist feels it is safe enough for you. Sometimes patients are not healthy enough for this method.
I like to use general anesthesia when placing a scleral buckle for repair of a retinal detachment. The scleral buckle is placed on the outside of your eye and requires manipulation of your eye muscles. This can be painful despite a successful retrobulbar block.
While it is possible to start a scleral buckle operation with local anesthesia and then “convert” to general, it’s more difficult once the operation has started.
Even with general anesthesia, I also use a retrobulbar block – it lasts several hours after surgery.
With modern operating techniques, this operation can often be completed in less than an hour requiring minimal amounts of anesthesia so that going home shortly after surgery is usual. (Sometimes with long operations under general anesthesia, recovery from the anesthesia is prolonged.)
Some patients will want to go to sleep for the operation.
On occasion, I have patients who do not want any sedation and request only the retrobulbar injection.
What Does This Mean?
No matter what technique is used for your retina surgery, the main goal is to keep you comfortable and without pain or discomfort.
It is also our job to keep you safe and healthy. I want to operate knowing you will be comfortable and cooperative, too. Sometimes this will impact our choice of anesthesia if patients are to fidgety, talkative or anxious.
Efficient operating times allow for reduced anesthesia. This, in turn, allows you to recover from the anesthesia much quicker and avoid health concerns with longer operations.