Ocular complications of perioperative anesthesia: a review

Ocular surface complications in children undergoing general anaesthesia: A prospective observational study

OBJECTIVE

Ophthalmic complications frequently occur after procedures requiring general anaesthesia, but their incidence is widely variable and not well reported in the paediatric population. The aim was to identify the incidence and possible risk factors of postoperative ocular surface complications in a tertiary care centre.

METHODS AND ANALYSIS

This is a prospective study for paediatric patients undergoing general anaesthesia. An ophthalmologist performed the ocular examination after surgery. Parameters assessed were tear breakup time, punctate epithelial erosions and corneal abrasions. Multivariate logistic regression model was used to assess risk factors.

RESULTS

A total of 108 paediatric patients were recruited, 36.1% showed abnormal corneal finding: 32 (29.6%) had decreased tear breakup time, three (2.7%) had punctate epithelial erosions, three (2.7%) had both punctate epithelial erosions and decreased tear breakup time and one (0.9%) was found to have a unilateral corneal abrasion postoperatively. A higher rate of corneal complications was noted with younger age, prolonged surgery and surgery in the head and neck region.

CONCLUSION

The rate of postoperative corneal abnormalities in children undergoing general anaesthesia was 36.1%, associated with younger age, prolonged surgery and surgery in the head and neck region.

Perioperative Blindness in Spine Surgery: A Scoping Literature Review

Perioperative vision loss (POVL) is a devastating surgical complication that impacts both the recovery from surgery and quality of life, most commonly occurring after spine surgery. With rates of spine surgery dramatically increasing, the prevalence of POVL will increase proportionately. This scoping review aims to aggregate the literature pertinent to POVL in spine surgery and consolidate recommendations and preventative measures to reduce the risk of POVL. There are several causes of POVL, and the main contribution following spine surgery is ischemic optic neuropathy (ION). Vision loss often manifests immediately following surgery and is irreversible and severe. Diffusion weighted imaging has recently surfaced as a diagnostic tool to identify ION. There are no effective treatments; therefore, risk stratification for counseling and prevention are vital. Patients undergoing prone surgery of long duration and/or with significant expected blood loss are at greatest risk. Future research is necessary to develop effective treatments.

Risk stratification, prevention and management of perioperative corneal abrasion for non-ocular surgery: Systematic Review

Background

A corneal abrasion is a flaw in the cornea's epithelial surface, which is located in the front of the eye. It causes recurrent erosions, corneal inflammation, and chronic corneal defects. In a context with limited resources, the goal of this review was to provide an evidence-based procedure for perioperative risk stratification, prevention, and management of corneal abrasion during non-ocular surgery.

Methods

A medical search engines of PUBMED, GOOGLE SCHOLAR, COCHRANE REVIEW, and PUBMED CENTERAL to get access for current and updated evidence on procedures on risk stratification, prevention and management of corneal abrasion for non-ocular surgery. The authors formulate the key questions, scope, and articles written in English language, human study focuses on corneal abrasion, articles in the last 20 year was implemented to identify or filter high-level evidences were included. Reports contain corneal abrasion due to ocular surgery were excluded. All the research articles, which were identified from searches of electronic databases, were imported into Endnote software, duplicate were removed advanced search strategy of electronic sources from databases and websites was conducted using Boolean operators (cornea AND (abrasion OR injury OR laceration)) AND ("Perioperative Period" OR "general anesthesia"). Screening of literatures was conducted with proper appraisal checklist. This review was reported in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement.

Results

From 8767 identified articles, two hundred articles were removed for duplication and 7720 studies were excluded, 1205 articles were retrieved and evaluated for eligibility. Finally, 24 were included in this systematic review. Advanced age, Prominent eyes, exophthalmus, ocular surface abnormalities (dry eye), expected duration of surgery (>1 h), the favourable position of the surgery, prone,Trendelenburg and lateral, risk of bleeding, surgical site of the surgery(head /neck) and diabetes mellitus were risk for corneal abrasion. The use of appropriate intervention with pharmacological and Non-pharmacological strategies minimizes the occurrence of perioperative corneal abrasion was crucial for the quality of care.

Conclusion

Preventing and managing corneal abrasion improves patients' quality of life. However, there was insufficient evidence to draw conclusions, and high-quality trials of multimodal interventions matched to risk stratification and prevention of corneal abrasion needed to provide robust evidence to guide prevention and management of perioperative corneal abrasion.

Ultrasound-guided versus conventional peribulbar anaesthesia in cataract surgery: A randomised controlled study

BACKGROUND

Blind ophthalmic anaesthetic techniques may have serious complications.

AIM

To assess the safety of ultrasound as a guide in ophthalmic blocks.

METHODS

Fifty adult patients undergoing cataract surgery under peribulbar block anaesthesia were randomly assigned to ultrasound-guided and conventional block groups. In the ultrasound-guided block group, a large amount of the standard ultrasound gel was applied to the closed eyelids. The globes were scanned in both sagittal and transverse planes. The patients were asked to look straight ahead with closed eyes without clenching the eyelids. The depth and gain were adjusted before performing the block. The primary outcome was the rate of complications. Secondary outcomes included the volume of injected anaesthetics and surgeon and patients' satisfaction.

RESULTS

The local anaesthetic volume used was not significantly different between the two groups (7.08 ± 1.66 and 6.72 ± 1.97ml). The block onset, time and quality were comparable in both groups. No complications were reported, and there were no significant differences regarding surgeons' or patients' satisfaction with either procedure.

CONCLUSION

The ultrasound-guided local ophthalmic block is as safe as the conventional method. Although its use was not superior to the conventional procedure, direct visualisation with ultrasound may be important to avoid vulnerable structures such as staphylomas.

Perioperative Care of the Patient with Eye Pathologies Undergoing Nonocular Surgery

The authors reviewed perioperative ocular complications and implications of ocular diseases during nonocular surgeries. Exposure keratopathy, the most common perioperative eye injury, is preventable. Ischemic optic neuropathy, the leading cause of perioperative blindness, has well-defined risk factors. The incidence of ischemic optic neuropathy after spine fusion, but not cardiac surgery, has been decreasing. Central retinal artery occlusion during spine fusion surgery can be prevented by protecting eyes from compression. Perioperative acute angle closure glaucoma is a vision-threatening emergency that can be successfully treated by rapid reduction of elevated intraocular pressure. Differential diagnoses of visual dysfunction in the perioperative period and treatments are detailed. Although glaucoma is increasingly prevalent and often questions arise concerning perioperative anesthetic management, evidence-based recommendations to guide safe anesthesia care in patients with glaucoma are currently lacking. Patients with low vision present challenges to the anesthesia provider that are becoming more common as the population ages.