A comparison of general anesthesia versus local anesthesia in open globe injuries: A systematic review and meta-analysis

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.