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Gurtler N, Bughin A, Vaclavik V, Kaisari E, Guex-Crosier Y. Acute bilateral blindness due to diffuse outer retinopathy following clear lens exchange: a case report. BMC Ophthalmol 2023; 23:428. [PMID: 37872478 PMCID: PMC10594781 DOI: 10.1186/s12886-023-03171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND As the trend of refractive lens exchange for presbyopia continues to grow, our case report shows the first occurrence of an acute bilateral outer retinopathy following uncomplicated sequential clear lens extraction in an otherwise healthy individual. CASE PRESENTATION A 54-year-old male without significant medical history benefited from a sequential bilateral lens exchange for presbyopia. He then experienced a rapid vision loss in both eyes, accompanied by photopsias and myodesopsias, with symptoms appearing respectively 4 and 3 weeks after the surgeries. Multimodal imaging revealed a fulminant outer retinopathy, leading to a total loss of light perception within a few days. Immediate intravenous corticosteroid therapy was administered, permitting to recover a small area of central visual function in both eyes, enabling shape and color distinction. The primary diagnostic hypothesis is a presumed autoimmune retinopathy, triggered by the cataract extraction, while an alternative diagnosis could be a toxic reaction secondary to the use of intracameral cefuroxime and lidocaine during the surgery. CONCLUSION In this report, the authors describe the first recorded instance of outer retinopathy following cataract surgery. This occurrence raises the possibility of auto-immunization leading to retinal atrophy and vision loss as a potential outcome after undergoing cataract surgery.
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Affiliation(s)
- Nicolas Gurtler
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Alice Bughin
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Veronika Vaclavik
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Eirini Kaisari
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Yan Guex-Crosier
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland.
- Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1005, Lausanne, Switzerland.
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Gautam M, Gupta R, Singh P, Verma V, Verma S, Mittal P, Karkhur S, Sampath A, Mohan RR, Sharma B. Intracameral Drug Delivery: A Review of Agents, Indications, and Outcomes. J Ocul Pharmacol Ther 2023; 39:102-116. [PMID: 36757304 DOI: 10.1089/jop.2022.0144] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
An intracameral (IC) injection directly delivers the drug into the anterior chamber of the eye. This targeted drug delivery technique overcomes the ocular barriers and offers a high therapeutic concentration of medication at the desired site and consequently better clinical outcomes. IC drug delivery is a safe and effective modality with many advantages over topical delivery. These include excellent bioavailability, reduced systemic risk, and minimal ocular toxicity. Agents delivered via IC injection have shown promising results against infection, inflammation, ocular hypertension, and neovascularization. Current literature shows that IC antibiotics, including cefuroxime, vancomycin, and moxifloxacin, are routinely used for prophylaxis of endophthalmitis. Other drugs available for IC use are steroids, anesthetics, mydriatics, miotics, antivascular endothelial growth factor, antiglaucoma, and alkylating agents. Introduction of sustained-release devices containing dexamethasone or Bimatoprost in anterior chamber via IC route has the potential in treating ocular inflammation and raised intraocular pressure. The complications such as hemorrhagic occlusive retinal vasculitis and toxic anterior segment syndrome have been documented with IC prophylaxis but are rare. In this review, we provide an overview of available IC drugs, their pharmacokinetics, the spectrum of activity, dosage and preparation, prophylactic and therapeutic usage, clinical efficacy, and safety profiles.
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Affiliation(s)
- Megha Gautam
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Rituka Gupta
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Priti Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Vidhya Verma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Sunil Verma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Parul Mittal
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Samendra Karkhur
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Ananyan Sampath
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Rajiv R Mohan
- Department of Ophthalmology and Molecular Medicine, University of Missouri, Columbia, Missouri, USA
| | - Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
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Singh RB, Khera T, Ly V, Saini C, Cho W, Shergill S, Singh KP, Agarwal A. Ocular complications of perioperative anesthesia: a review. Graefes Arch Clin Exp Ophthalmol 2021; 259:2069-2083. [PMID: 33625566 DOI: 10.1007/s00417-021-05119-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/04/2021] [Accepted: 02/12/2021] [Indexed: 12/19/2022] Open
Abstract
Ocular complications associated with anesthesia in ocular and non-ocular surgeries are rare adverse events which may present with clinical presentations vacillating between easily treatable corneal abrasions to more serious complication such as irreversible bilateral vision loss. In this review, we outline the different techniques of anesthetic delivery in ocular surgeries and highlight the incidence and etiologies of associated injuries. The changes in vision in non-ocular surgeries are mistaken for residual sedation or anesthetics, therefore require high clinical suspicion on part of the treating ophthalmologists, to ensure early diagnosis, adequate and swift management especially in surgeries such as cardiac, spine, head and neck, and some orthopedic procedures, that have a comparatively higher incidence of ocular complications. In this article, we review the literature for reports on the clinical incidence of different ocular complications associated with anesthesia in non-ocular surgeries and outline the current understanding of pathophysiological processes associated with these adverse events.
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Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA.,Department of Ophthalmology, Leiden University Medical Center, ZA, 2333, Leiden, The Netherlands
| | - Tanvi Khera
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, MA, 02215, Boston, USA
| | - Victoria Ly
- University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Chhavi Saini
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA
| | - Wonkyung Cho
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA
| | - Sukhman Shergill
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, 06510, USA
| | | | - Aniruddha Agarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
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Shi Y, Huang Z, Chen W, Zhang G, Huang D, Lin G, Wang Y, Chen H, Zheng D, Zhang Q. Correlation between sub-Tenon's anesthesia and transient amaurosis during ophthalmic surgery. Int Ophthalmol 2020; 40:1955-1962. [PMID: 32318938 DOI: 10.1007/s10792-020-01369-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To verify the correlation between sub-Tenon's anesthesia and intraoperative visual loss in ophthalmic surgery. METHODS Sixty-four patients underwent phacoemulsification combined pars plana vitrectomy under sub-Tenon's anesthesia. Participants were investigated about their light perception at several time points: before anesthesia, immediately after anesthesia, 10 min after anesthesia without any surgical intervention or microscope illumination, and after the whole surgery. Intraoperative amaurosis was determined as that a patient could not see any light from their operative eye. The incidence rate of amaurosis at different time points and among different anesthetists was analyzed. RESULTS The rate of intraoperative amaurosis was 0%, 1.56%, 48.44%, and 95.31% at several time points, respectively: before anesthesia, immediately after anesthesia, 10 min after anesthesia without any surgical intervention or microscope light exposure during the interval, and immediately after the whole surgery, presenting a significantly time-dependent increase (P < 0.01). There was no correlation between the amaurosis and different diseases and anesthesiologists. The amaurosis was transient, and all operative eyes could perceive light on the first postoperative day. CONCLUSIONS Sub-Tenon's anesthesia contributes to the intraoperative amaurosis during operation. Temporary interruption of optic nerve conduction by the anesthetic could be a credible explanation. The amaurosis is transient and reversible, requires no additional treatment, and should not be considered as a surgical complication.
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Affiliation(s)
- Yi Shi
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, 515041, Guangdong Province, China
| | - Zijing Huang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, 515041, Guangdong Province, China
| | - Weiqi Chen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, 515041, Guangdong Province, China.
| | - Guihua Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, 515041, Guangdong Province, China
| | - Dingguo Huang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, 515041, Guangdong Province, China
| | - Guoqiao Lin
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, 515041, Guangdong Province, China
| | - Yifan Wang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, 515041, Guangdong Province, China
| | - Haoyu Chen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, 515041, Guangdong Province, China
| | - Dezhi Zheng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, 515041, Guangdong Province, China
| | - Qi Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, 515041, Guangdong Province, China
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Nebbioso M, Livani ML, Santamaria V, Librando A, Sepe M. Intracameral lidocaine as supplement to classic topical anesthesia for relieving ocular pain in cataract surgery. Int J Ophthalmol 2018; 11:1932-1935. [PMID: 30588425 DOI: 10.18240/ijo.2018.12.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 10/19/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate safety, efficacy, and patient adherence of intracameral lidocaine as supplement of classic topical anesthetic drops in cataract surgery. METHODS A prospective and controlled trial including a large cohort of 1650 individuals suffering with bilateral cataract not complicated, in program by phacoemulsification surgery, were randomly assigned to 2 different groups for the type of anesthesia received, 0.4% oxybuprocaine hydrochloride (INN) drops, and INN drops associated to intracameral 1% lidocaine hydrochloride monohydrate. At the end of surgery, tables were assigned to each patient indicating the degree of pain (0-3) felt during the operation. RESULTS Thirty-two percent of patients in group 1 declared to have not felt any pain against the 77% of patients in group 2. Fifty-nine percent of patients in group 1 complained about only a slight discomfort against 20% of group 2 patients. Only a small percentage of patients in group 1 (5%) admitted severe pain, while no patient in group 2 admitted severe pain. Four patients of group 2 reported an episode of transient amaurosis, lasting several hours after surgery. CONCLUSION Intracameral administration of lidocaine is a simple and secure method able to increase the analgesia during the cataract surgery, eliminating the discomfort and increasing also the cooperation of the patients during the steps of manipulation.
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Affiliation(s)
- Marcella Nebbioso
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome 00185, Italy
| | | | | | - Aloisa Librando
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome 00185, Italy
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Mohammadpour M, Riazi-Esfahani H. Transient complete visual loss and subsequent cystoid macular edema after intracameral lidocaine injection following uneventful cataract surgery. J Curr Ophthalmol 2018; 30:174-176. [PMID: 29988901 PMCID: PMC6034170 DOI: 10.1016/j.joco.2017.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 06/02/2017] [Accepted: 08/07/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose To report a case of transient visual loss following uncomplicated cataract surgery with unpreserved intracameral lidocaine. Methods A 61-year-old woman with nuclear sclerosis cataract underwent uncomplicated phacoemulsification and in-the-bag intraocular lens (IOL) implantation. Results After opening the eye patch on the first postoperative day, the patient complained of complete blindness. Her vision was no light perception (NLP) and the Marcus-Gunn was found to be 4+. Eight hours later, the patient's visual acuity improved to count fingers at 1 m. After two days, the vision improved surprisingly to 20/20 without any Marcus-Gunn. After 4 weeks, the vision decreased surprisingly to 20/80 without any Marcus-Gunn. On this day, macular optical coherence tomography (OCT) was performed, and cystoid macular edema was detected. Conclusion Transient visual loss after intracameral lidocaine has been reported after violation of posterior capsule during cataract surgery, and here, we report a case of transient visual loss despite uncomplicated cataract surgery.
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Affiliation(s)
- Mehrdad Mohammadpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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