271: Corneal Transplantation: Peribulbar Block is not associated with Ocular or Systemic Complications

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Treatment/management

Background and Aims: Peribulbar block (PBB) ensures anesthetic conditions with akinesia and promotes intraoperative and postoperative analgesia without the use of non-steroidal anti-inflammatory drugs and opioids; however, it may be associated with ocular or systemic complications, such as hematoma, nerve injury, or systemic toxicity, especially in elderly patients with comorbidities. The primary age group undergoing this surgery is over 65 years old, which implies an adjustment of the anesthetic technique, both due to age-related physiological changes. The study aims to compare the anesthetic technique for CT and to evaluate potential outcomes.

Methods: After institutional approval, this retrospective observational cohort study included 355 adult patients undergoing posterior CT (DSAEK/DMEK) between 2018 and 2023, with follow-up of 12 months or more. Urgent TC was excluded. Sociodemographic data, patients' comorbidities, anesthetic technique, surgical techniques, and postoperative outcomes were evaluated. Statistical analysis considered means and standard deviations, as well as absolute and relative frequencies. The variables were tested for normality (Kolmogorov-Smirnov), and the Kruskal-Wallis test was applied for quantitative variables that did not meet normality assumptions. Spearman's rho was used to establish a relationship between variables.

Results: Of the 355 patients, 63.4% were female. The mean age was 68 years old, with 63,1% ≥65 years old. Regarding anesthetic technique, 160 PBB (ropivacaine 1% 5-8mL), 34 GA, and 161 MAC were recorded. 213 patients presented at least one condition associated with a higher risk of general anesthesia (GA): only 12 (5,6%) underwent AG. Anesthetic technique was not associated with surgical duration (p=0.067) or graft failure (p=0.50). DMEK was associated with a higher risk of graft failure (p<0.001). 57 patients required retransplantation, with no association with the anesthetic technique (p=0.494), particularly PBB (p=0.1247). No ocular or systemic complications were described.

Conclusions: PBB has proven to be a safe technique as a part of multimodal analgesia, important in the elderly group, with lower consumption of opioids or anti-inflammatory drugs. PBB was not associated with longer surgical duration or a higher risk of ocular complications, such as retransplantation, compared with AG and MAC.

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Presenting Author: Margarida Abreu Pires
Submitting Author: Margarida Abreu Pires

Senior Author: Carla Cavaleiro

IASP 2026 Global Year theme of Neuropathic Pain: No

• Carla Cavaleiro: Consultant Anesthesiologist - Unidade de Local de Saúde de Santo António
• Humberto Machado: Senior Consultant Anesthesiologist - Unidade Local de Saúde de Santo António