Case Selection

Anti-glaucoma surgeries performed under acupuncture anesthesia include angle-closure glaucoma, open-angle glaucoma, and secondary glaucoma. The oldest patient was 81 years old, and the youngest was 11 years old, with most patients aged between 50 and 65. Only a few children around 10 years old can cooperate with the surgery. Generally, acupuncture anesthesia is not suitable for children and mentally unstable individuals. Except for a few patients who undergo surgery on both eyes simultaneously, most surgeries are performed on one eye. The surgical methods for anti-glaucoma include iridectomy, iridosclerectomy, subscleral trephination, iridencleisis, and thermosclerostomy.

Acupuncture Anesthesia Method

There are four groups of acupoints, with the majority using Yangbai (GB14) through Yuyao (EX-HN4), Sibai (ST2) through Chengqi (ST1), or Hegu (LI4) and Zhigou (TE6) as two groups of acupoints. Under the same conditions, some patients underwent anti-glaucoma surgery using two groups of acupoints separately to compare the effects of acupuncture anesthesia. Among 11 observed cases, 6 had the same rating. Five cases using Hegu (LI4) and Zhigou (TE6) as acupoints resulted in a one-level decrease in rating. Additionally, direct stimulation of the Qiuhou (EX-HN7) acupoint with a single needle also showed good results. The method involves using a 2-inch filiform needle inserted from the lower orbital rim, moving along the orbital wall and slightly upward to reach Qiuhou (EX-HN7). The patient feels a sense of swelling and numbness in the eyeball, with an induction time of 5 minutes. During surgery, the needle is either retained or induced for 15-20 minutes without retaining the needle. Stimulating Qiuhou (EX-HN7) significantly reduces the sensation of the cornea and conjunctiva, providing analgesic effects. The advantage is that it uses only one needle and one acupoint without electrical stimulation, and the surgeon can operate it themselves. Observations from 101 eyes using Qiuhou (EX-HN7) for anti-glaucoma surgery showed an 89.4% rate of Grade I and II effectiveness. Ear acupuncture targeting the eye acupoint through Muliao combined with Hegu (LI4) for anti-glaucoma surgery had an 86.89% rate of Grade I and II effectiveness. This group of acupoints is not in the surgical field, thus not affecting the surgical operation.

For various glaucoma surgeries without the use of topical anesthetics, the overall rate of Grade I and II effectiveness is 80%. The effectiveness varies among different regions and hospitals. Except for acute angle-closure glaucoma, the differences in effectiveness among other types of glaucoma are not significant. Factors such as age, gender, occupation, and surgical methods do not significantly affect the effectiveness of acupuncture anesthesia. The effectiveness is poor during the acute stage of attack in acute angle-closure glaucoma. It is better to first reduce intraocular pressure and wait for the stimulation symptoms to subside before surgery, which aligns with the principles of anti-glaucoma surgery under drug anesthesia. Comparing the effectiveness between pre-operative eye congestion and non-congestion, the rate of Grade I and II effectiveness is 52% for congestion and 83% for non-congestion. Congestion refers to the presence of glaucoma-induced congestion in the surgical eye on the day of surgery. The significant difference in effectiveness between the two groups aligns with the lower rate of Grade I and II effectiveness in acute angle-closure glaucoma. The presence or absence of congestion has a significant relationship with the effectiveness of acupuncture anesthesia, as the sensory nerves in congestive glaucoma are in a sensitive state. Pre-operative auxiliary drugs should be administered to enhance the sedative effect.