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El-Jade M. [Iatrogenic Retinal Artery Occlusions Following Retrobulbar Anaesthesia]. Klin Monbl Augenheilkd 2024. [PMID: 38531371 DOI: 10.1055/a-2244-5449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Affiliation(s)
- Mohamed El-Jade
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Deutschland
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2
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Chua AW, Chua MJ, Harrisberg BP, Kumar CM. Retinal artery occlusion after ophthalmic surgery under regional anaesthesia: A narrative review. Anaesth Intensive Care 2024; 52:82-90. [PMID: 38041616 DOI: 10.1177/0310057x231215826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Two recent cases of central retinal artery occlusion under otherwise uncomplicated sub-Tenon's block that resulted in significant visual loss after cataract surgery prompted us to undertake a literature review of such cases. We identified 97 cases of retinal artery occlusion after ophthalmic surgery under regional anaesthesia that had no immediate signs of block-related complications. These occurred after various intraocular (87%) and extraocular (13%) operations, across a wide range of ages (19-89 years) on patients with (59%) or without (39%) known risk factors. The anaesthetic techniques included 40 retrobulbar blocks, 36 peribulbar blocks, 19 sub-Tenon's blocks, one topical anaesthetic and one unspecified local anaesthetic. Different strengths of lidocaine, bupivacaine, mepivacaine and ropivacaine, either alone or in various combinations, were used. The details of the anaesthetic techniques were often incomplete in the reports, which made comparison and analysis difficult. Only nine cases had their cause (optic nerve sheath injury) identified, while the mechanism of injury was unclear in the remaining patients. Various mechanisms were postulated; however, the cause was likely to be multifactorial due to patient, surgical and anaesthetic risk factors, especially in those with compromised retinal circulation. As there were no definite risk factors identified, no specific recommendations could be made to avoid this devastating outcome. We have provided rationales for some general considerations, which may reduce this risk, and propose anaesthetic options for ophthalmic surgery on the fellow eye if required, based both on our literature review and our personal experience.
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Affiliation(s)
- Alfred Wy Chua
- Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Matthew J Chua
- Department of Anaesthetics, Liverpool Hospital, Liverpool, Australia
| | - Brian P Harrisberg
- Department of Ophthalmology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Chandra M Kumar
- Newcastle University Medical School, EduCity, Johor, Malaysia
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Confalonieri F, Ladstein GE, Stene-Johansen I, Petrovski G. Iatrogenic central retinal artery occlusion following retrobulbar anesthesia with adrenaline for vitreoretinal surgery: a case report. J Med Case Rep 2022; 16:303. [PMID: 35941712 PMCID: PMC9361630 DOI: 10.1186/s13256-022-03518-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We describe a patient presenting with central retinal artery occlusion (CRAO) of the right eye after retrobulbar anesthesia with adrenaline for macular pucker surgery. CASE PRESENTATION The patient, a 67-year-old Caucasian man, developed a CRAO postoperatively by the next-day control likely due to the retrobulbar injection of a combination of Xylocaine and Bupivacaine with adrenaline as anesthetic. CONCLUSIONS The addition of adrenaline to the standard anesthetic solution could be a risk factor for serious complications, such as CRAO.
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Affiliation(s)
- Filippo Confalonieri
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway.
- Center for Eye Research, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway.
- Department of Biomedical Sciences, Humanitas Huniversity, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
| | - Gunn Elin Ladstein
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway
| | - Ingar Stene-Johansen
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway
- Center for Eye Research, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, Split, Croatia
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Jean YK, Kam D, Gayer S, Palte HD, Stein ALS. Regional Anesthesia for Pediatric Ophthalmic Surgery: A Review of the Literature. Anesth Analg 2020; 130:1351-1363. [PMID: 30676353 DOI: 10.1213/ane.0000000000004012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ophthalmic pediatric regional anesthesia has been widely described, but infrequently used. This review summarizes the available evidence supporting the use of conduction anesthesia in pediatric ophthalmic surgery. Key anatomic differences in axial length, intraocular pressure, and available orbital space between young children and adults impact conduct of ophthalmic regional anesthesia. The eye is near adult size at birth and completes its growth rapidly while the orbit does not. This results in significantly diminished extraocular orbital volumes for local anesthetic deposition. Needle-based blocks are categorized by relation of the needle to the extraocular muscle cone (ie, intraconal or extraconal) and in the cannula-based block, by description of the potential space deep to the Tenon capsule. In children, blocks are placed after induction of anesthesia by a pediatric anesthesiologist or ophthalmologist, via anatomic landmarks or under ultrasonography. Ocular conduction anesthesia confers several advantages for eye surgery including analgesia, akinesia, ablation of the oculocardiac reflex, and reduction of postoperative nausea and vomiting. Short (16 mm), blunt-tip needles are preferred because of altered globe-to-orbit ratios in children. Soft-tip cannulae of varying length have been demonstrated as safe in sub-Tenon blockade. Ultrasound technology facilitates direct, real-time visualization of needle position and local anesthetic spread and reduces inadvertent intraconal needle placement. The developing eye is vulnerable to thermal and mechanical insults, so ocular-rated transducers are mandated. The adjuvant hyaluronidase improves ocular akinesia, decreases local anesthetic dosage requirements, and improves initial block success; meanwhile, dexmedetomidine increases local anesthetic potency and prolongs duration of analgesia without an increase in adverse events. Intraconal blockade is a relative contraindication in neonates and infants, retinoblastoma surgery, and in the presence of posterior staphylomas and buphthalmos. Specific considerations include pertinent pediatric ophthalmologic topics, block placement in the syndromic child, and potential adverse effects associated with each technique. Recommendations based on our experience at a busy academic ophthalmologic tertiary referral center are provided.
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Affiliation(s)
- Yuel-Kai Jean
- From the Department of Anesthesiology, Perioperative Medicine and Pain Management, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida
| | - David Kam
- From the Department of Anesthesiology, Perioperative Medicine and Pain Management, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida
| | - Steven Gayer
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Howard D Palte
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Alecia L S Stein
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami Health System, Miami, Florida
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Merriam JC, Casper DS. The entry point of the central retinal artery into the outer meningeal sheath of the optic nerve. Clin Anat 2020; 34:605-608. [PMID: 32530060 DOI: 10.1002/ca.23637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/28/2020] [Accepted: 06/07/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The entry point of the central retinal artery (CRA) into the outer meningeal sheath of the optic nerve posterior to the globe has been studied and debated for more than one hundred years. The authors have supervised an orbital anatomy course for more than two decades. This article summarizes previous studies of the CRA and presents the results of dissections of 67 orbits. MATERIALS AND METHODS Heads were hemisected prior to dissection at the Vagelos College of Physicians and Surgeons of Columbia University. The authors measured the entry point of the CRA with a caliper and noted the meridional orientation of the CRA. RESULTS The mean entry point was 10.65 mm posterior to the globe, with a range of 5 to 18 mm. Most commonly, the CRA entered the sheath in the inferior meridian, but some entered slightly inferomedially or inferolaterally. CONCLUSIONS The entry point of the CRA into the sheath of the optic nerve is variable, and without detailed angiography the clinician cannot know the course of the CRA prior to performing invasive intraorbital procedures. Knowledge of common variations in CRA entry into the outer meningeal sheath of the optic nerve should help to minimize injury during surgery.
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Affiliation(s)
- John C Merriam
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Edward S. Harkness Eye Institute, Columbia University New York, New York, New York, USA
| | - Daniel S Casper
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Edward S. Harkness Eye Institute, Columbia University New York, New York, New York, USA
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Lee JS, Kim JY, Jung C, Woo SJ. Iatrogenic ophthalmic artery occlusion and retinal artery occlusion. Prog Retin Eye Res 2020; 78:100848. [PMID: 32165219 DOI: 10.1016/j.preteyeres.2020.100848] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/19/2023]
Abstract
Iatrogenic ophthalmic artery occlusion (IOAO) is a rare but devastating ophthalmic disease that may cause sudden and permanent visual loss. Understanding the possible etiologic modalities and pathogenic mechanisms of IOAO may prevent its occurrence. There are numerous medical etiologies of IOAO, including cosmetic facial filler injection, intravascular procedures, intravitreal gas or drug injection, retrobulbar anesthesia, intraarterial chemotherapy in retinoblastoma. Non-ocular surgeries and vascular events in arteries that are not directly associated with the ophthalmic artery, can also cause IOAO. Since IOAO has a limited number of treatment modalities, which lead to poor final visual prognosis, it is imperative to acknowledge the information regarding medical procedures that are etiologically associated with IOAO. We accumulated all searchable and available IOAO case reports (our cases and previous reported cases from the literature), classified them according to their mechanisms of pathogenesis, and summarized treatment options and responses of each of the causes. Various sporadic cases of IOAO can be categorized into three mechanisms as follows: intravascular event, orbital compartment syndrome, and increased intraocular pressure. Embolic IOAO, which is considered the primary cause of the condition, was classified into three subgroups according to the pathway of embolic movement (retrograde pathway, anterograde pathway, pathway through collateral channels). Despite the practical limitations of treating spontaneous (non-iatrogenic) retinal artery occlusion, this article will contribute in predicting and improving the prognosis of IOAO by recognizing the treatable factors. Furthermore, it is expected to provide clues to future research associated with the treatment of retinal artery occlusion.
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Affiliation(s)
- Jong Suk Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jun Yup Kim
- Department of Neurology, Seoul National University College of Medicine, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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7
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Cok OY, Seet E, Kumar CM, Joshi GP. Perioperative considerations and anesthesia management in patients with obstructive sleep apnea undergoing ophthalmic surgery. J Cataract Refract Surg 2019; 45:1026-1031. [PMID: 31174989 DOI: 10.1016/j.jcrs.2019.02.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/20/2019] [Indexed: 11/26/2022]
Abstract
Obstructive sleep apnea (OSA) is a disorder characterized by breathing cessation caused by obstruction of the upper airway during sleep. It is associated with multiorgan comorbidities such as obesity, hypertension, heart failure, arrhythmias, diabetes mellitus, and stroke. Patients with OSA have an increased prevalence of ophthalmic disorders such as cataract, glaucoma, central serous retinopathy (detachment of retina, macular hole), eyelid laxity, keratoconus, and nonarteritic anterior ischemic optic neuropathy; and some might require surgery. Given that OSA is associated with a high incidence of perioperative complications and more than 80% of surgical patients with OSA are unrecognized, all surgical patients should be screened for OSA (eg, STOP-Bang questionnaire) with comorbidities identified. Patients suspected or diagnosed with OSA scheduled for ophthalmic surgery should have their comorbid conditions optimized. This article includes a review of the literature and highlights best perioperative anesthesia practices in the management of ophthalmic surgical patients with OSA.
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Affiliation(s)
- Oya Y Cok
- Baskent University, School of Medicine, Department of Anesthesiology and Reanimation, Adana Education and Research Centre, Adana, Turkey
| | - Edwin Seet
- Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore
| | - Chandra M Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore.
| | - Girish P Joshi
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
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8
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Kumar A, Agarwal D, Balaji A. Commentary: A cluster of central retinal artery occlusions following cataract surgery. Indian J Ophthalmol 2019; 67:635. [PMID: 31007225 PMCID: PMC6498911 DOI: 10.4103/ijo.ijo_50_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Akshaya Balaji
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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9
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Sun V, Chan EW, Eldeeb M, Chen JC. Combined Central Retinal Artery and Vein Occlusion From a Presumed Arteriovenous Fistula After Retrobulbar Anesthesia. JAMA Ophthalmol 2018; 136:1307-1309. [PMID: 30178027 DOI: 10.1001/jamaophthalmol.2018.3224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Vincent Sun
- Department of Ophthalmology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Errol W Chan
- Department of Ophthalmology, McGill University Health Centre, Montreal, Quebec, Canada.,Montreal Retina Institute, Montreal, Quebec, Canada
| | - Mohab Eldeeb
- Montreal Retina Institute, Montreal, Quebec, Canada
| | - John C Chen
- Department of Ophthalmology, McGill University Health Centre, Montreal, Quebec, Canada.,Montreal Retina Institute, Montreal, Quebec, Canada
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10
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Optical Coherence Tomography Angiography of Combined Central Retinal Artery and Vein Occlusion. Case Rep Ophthalmol Med 2018; 2018:4342158. [PMID: 29619262 PMCID: PMC5829351 DOI: 10.1155/2018/4342158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 01/11/2018] [Indexed: 11/29/2022] Open
Abstract
Optical coherence tomography angiography (OCTA) is a new, noninvasive technology that enables detailed evaluation of flow in the retinal and choroidal vasculature. The authors believe this to be the first report to describe the optical coherence tomography angiography findings associated with combined central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO).
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11
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Vancomycin-Associated Hemorrhagic Occlusive Retinal Vasculitis. Ophthalmology 2017; 124:583-595. [DOI: 10.1016/j.ophtha.2016.11.042] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 11/23/2022] Open
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Behera UC, Panda L, Gupta S, Modi RR. Subconjunctival hemorrhage and vision loss after regional ocular anesthesia. Int Ophthalmol 2017; 38:1309-1312. [PMID: 28434070 DOI: 10.1007/s10792-017-0539-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 04/17/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To report two cases of retinal vascular occlusion and associated subconjunctival hemorrhage in needle optic nerve injury during local bulbar anesthesia. METHODS Surgical records of these two subjects who presented with acute vision loss after cataract extraction were studied, and systemic workup and ocular imaging were carried out to establish the cause. RESULTS Computerized tomography showed evidence of optic nerve injury. CONCLUSION Subconjunctival hemorrhage could be an associated clinical finding in hypodermic needle injury-related retinal vascular occlusion during ocular anesthesia.
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Affiliation(s)
| | - Lapam Panda
- L V Prasad Eye Institute, Patia, Bhubaneswar, Odisha, 751024, India
| | - Sumi Gupta
- Srikrishna Eye Institute, N-71 Shivalik Nagar, Haridwar, Uttarakhand, 249403, India
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Simmons NL, Joseph A, Baumal CR. Traumatic Branch Retinal Vein Occlusion With Retinal Neovascularization Following Inadvertent Retrobulbar Needle Perforation. Ophthalmic Surg Lasers Imaging Retina 2016; 47:191-3. [PMID: 26878456 DOI: 10.3928/23258160-20160126-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/11/2015] [Indexed: 11/20/2022]
Abstract
Retrobulbar injection of anesthesia is one of the most common procedures performed for ophthalmic surgery. Complications are rare but can be potentially serious, including retrobulbar hemorrhage, brainstem anesthesia, and inadvertent globe perforation. This is the preliminary report describing branch retinal vein occlusion (BRVO) secondary to accidental retrobulbar needle laceration with subsequent preretinal neovascularization.
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Todorich B, Hahn P. Profound vascular stasis of retina and optic nerve following retrobulbar anesthesia. Int Med Case Rep J 2016; 9:109-12. [PMID: 27199572 PMCID: PMC4857805 DOI: 10.2147/imcrj.s98546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION We aim to describe a mechanism of vision loss following vitrectomy surgery with retrobulbar block (RBB) associated with severe vascular stasis of the optic nerve and macula in order to improve safety of local anesthesia for ophthalmic surgery. CASE PRESENTATION We report three cases of patients who underwent pars plana vitrectomy (PPV) with retrobulbar anesthesia with no retrobulbar hemorrhage or elevated intraocular pressure (IOP). At the beginning, in each case, hypoperfusion of optic nerve and macula was noted. In the case of one patient with significant vasculopathic risk factors, the vascular stasis was severe, while in the other two cases, it was mild-to-moderate. In all cases, the perfusion of posterior pole began to improve almost immediately following the start of PPV. Because the IOP was not elevated and no retrobulbar hemorrhage was present, this suggested a compartment syndrome in the intraconal space. The patient with severe vascular stasis developed finger-counting vision but had normal postoperative angiogram findings and unrevealing cardiovascular workup. In the other two milder cases, the occurrence of ischemia was not visually significant. CONCLUSION Intraoperative ischemia should be considered in all cases of unexplained vision loss after ophthalmic surgery using RBB. Attention to vasculopathic risk factors and intra-operative hemodynamic parameters, in addition to the use of parabulbar block, may avoid this complication and permanent vision loss.
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Affiliation(s)
- Bozho Todorich
- Associated Retinal Consultants and Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA; Duke Eye Center, Duke University Medical Center, Durham, NC, USA
| | - Paul Hahn
- Duke Eye Center, Duke University Medical Center, Durham, NC, USA
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Jung EH, Park KH, Woo SJ. Iatrogenic Central Retinal Artery Occlusion Following Retrobulbar Anesthesia for Intraocular Surgery. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:233-40. [PMID: 26240507 PMCID: PMC4520866 DOI: 10.3341/kjo.2015.29.4.233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 01/05/2015] [Indexed: 11/25/2022] Open
Abstract
Purpose To present clinical features of central retinal artery occlusion (CRAO) following retrobulbar anesthesia for intraocular surgery. Methods This observational case series describes 5 consecutive patients with acute CRAO following retrobulbar anesthesia for intraocular surgery. Data collected for this study included subject characteristics, retrobulbar anesthesia technique, treatment type, initial and final best-corrected visual acuity, and other ophthalmologic examinations. Results Mean subject age was 67.0 ± 8.2 years (range, 53 to 72 years). All patients had one or more vascular risk factors (e.g., hypertension, cerebral infarction, carotid artery stenosis) and presented with acute vision loss 1 day after uneventful intraocular surgery (cataract surgery in 2 eyes and vitrectomy in 3 eyes). All 5 patients received retrobulbar anesthesia during surgery, 4 of which involved the use of a sharp needle. No immediate complications were noted during intraocular surgery. Final visual prognosis was poor (from finger count to no light perception) although intraocular thrombolysis was attempted in 3 patients. Conclusions Iatrogenic CRAO is a potential complication of retrobulbar anesthesia for intraocular surgery in elderly patients with vascular risk factors. Unfortunately, this complication can lead to severe vision loss. We conclude that retrobulbar anesthesia for intraocular surgery should be performed with great care and special consideration for elderly patients with vascular risk factors.
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Affiliation(s)
- Eun Hye Jung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Abstract
A retrobulbar block is a regional anesthetic nerve block in the retrobulbar space. Optic neuropathy following retrobulbar injection is a well-recognized and rare complication of the procedure with an unknown incidence. This article reviews the relevant literature regarding vision loss following this procedure. Mechanisms of injury to the optic nerve as well as methods that can be employed to minimize the risk of optic neuropathy will be explored, including alternatives to retrobulbar anesthesia.
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Affiliation(s)
- Andrew Gross
- Department of Ophthalmology, Harvard Medical School , Boston, Massachusetts , USA
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17
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Abstract
PURPOSE To report 2 cases of central retinal artery occlusion (CRAO) that occurred within 24 hours of routine phacoemulsification cataract surgery using peribulbar anesthesia. METHODS Case 1: An otherwise well 76-year-old woman with right pseudoexfoliation syndrome and bilateral open angle glaucoma presented with right visual acuity of counting fingers on the first postoperative day after cataract surgery. The CRAO was noted on fundoscopy. Emergency measures to reduce intraocular pressure (IOP) and hyperbaric oxygen treatment were performed. Case 2: A 59-year-old man with a history of non-Hodgkin's lymphoma, hypertension, hyperlipidemia, and ischemic stroke was similarly diagnosed with CRAO on the first postoperative day, with left visual acuity of counting fingers. RESULTS The final visual acuity remained at counting fingers in both cases. CONCLUSION Central retinal artery occlusion after routine cataract surgery is unusual. We review the literature on CRAO after routine intraocular procedures and propose three hypotheses regarding the potential mechanisms involved. A vasoconstrictive effect of the anesthetic agent on the central retinal artery, a rise in lOPs after anesthesia administration resulting in closure of the central retinal artery, and a mechanical effect of the volume of anesthetic on the central retinal artery are considered as plausible mechanisms, with a mechanical effect being the favored hypothesis.
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Topical anesthesia for cataract surgery: the patients' perspective. PAIN RESEARCH AND TREATMENT 2014; 2014:827659. [PMID: 25050180 PMCID: PMC4094730 DOI: 10.1155/2014/827659] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 06/11/2014] [Indexed: 11/18/2022]
Abstract
Purpose. To evaluate the analgesic efficacy of 0.5% propacaine hydrochloride as topical anesthesia during phacoemulsification surgery. Methods. Intraoperative pain intensity was assessed using a 5-category verbal rating scale during each of three surgical stages. Pain scores from each surgical stage and total pain scores were compared for the factors of patient age, gender, cataract laterality, and type. Results. In comparison of cataract type subgroups, the mean total pain scores and mean stage 2 pain scores in both white mature cataract (WMC) and corticonuclear plus posterior subcapsular cataract (CN + PSC) groups were significantly higher than in the PSC-only (PSC) group (P < 0.05). Conclusion. Phacoemulsification with topical anesthesia is not a completely painless procedure. Pain intensity varies with cataract type and stage of surgery.
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Fiess A, Kehrein S, Cal Ö, Frisch I, Steinhorst UH. [Loss of visual acuity after cataract surgery]. Ophthalmologe 2013; 111:471-4. [PMID: 24292161 DOI: 10.1007/s00347-013-2955-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- A Fiess
- Klinik für Augenheilkunde, Dr.-Horst-Schmidt-Kliniken Wiesbaden, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Deutschland,
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20
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Schmidt D. Comorbidities in combined retinal artery and vein occlusions. Eur J Med Res 2013; 18:27. [PMID: 23947749 PMCID: PMC3751822 DOI: 10.1186/2047-783x-18-27] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 07/26/2013] [Indexed: 11/10/2022] Open
Abstract
Background Several general diseases cause blindness in patients with simultaneous combined retinal artery and vein occlusion. Methods/patients We examined 14 patients with acute unilateral visual loss due to combined retinal artery and venous occlusions. All 14 patients presented at the Polyclinic over a period of about 3 years. Fluorescein angiography was carried out in 12 patients to confirm the diagnosis. Ten patients underwent Doppler sonography and 11 echocardiography. Results Concerning systemic diseases, 11 of our 14 patients presented several cardiovascular risk factors, i.e., immunocytoma and arterial hypertension and hypercholesterolemia in one patient; another patient had chronic bronchitis, tachycardia and hypercholesterolemia. Six patients presented coagulation anomalies, and eight patients had arterial hypertension. Doppler sonography revealed normal carotid arteries in nine of ten patients. In 8 of 11 patients, echocardiography displayed no cardiac abnormalities. Ophthalmoscopy revealed no emboli in any of these patients. Conclusion Unilateral simultaneous combined incomplete retinal artery and venous occlusions should be considered as one entity. Eleven of our patients presented comorbidities reflecting several cardiovascular risk factors. Immunological diseases, malignancies and coagulopathies can cause this ocular disorder, resulting in blindness. No emboli were found in any of these patients. Patients suffering from acute visual loss must be examined for the presence of systemic diseases to enable therapy at an early stage.
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Affiliation(s)
- Dieter Schmidt
- University-Augenklinik, Killianstr, 5, Freiburg D-79106, Germany.
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Aghadoost D, Fazel MR, Fakharian E. Comparing remifentanil versus propofol effect on pain and homodynamic change of patients undergoing phacoemulsification with topical anesthesia. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:424-7. [PMID: 24349732 PMCID: PMC3838654 DOI: 10.5812/ircmj.2316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 04/08/2012] [Accepted: 04/21/2012] [Indexed: 12/21/2022]
Abstract
Introduction The purpose of this study was to compare remifentanil versus propofol effect on pain and homodynamic in patients undergoing phacoemulsification with topical anesthesia. Materials and Methods A double blind clinical trial was conducted to research following the approval of the ethical committee research of the university. One hundred volunteer subjects were randomly assigned into two equal groups (n = 50). The subjects in the propofol group received 3mg/kg/hr while the patients in the remifentanil drug received 3 µg/kg/hr of this medication. Phaco time, blood pressure and heart rate before and after surgery, respiratory depression (O2 sat < 90%) and vomiting, pain scores, ophthalmologist satisfaction and demographic data were recorded. Results The results of analysis showed that there were no significant differences between the age, sex, and duration of operation of the two treatment groups. Systolic, diastolic blood pressure and heart rate were significantly lower in the propofol group .The propofol group complained of pain than the remifentanil group (P = 0.001) while the surgeon satisfaction was higher for the remifentanil condition (P = 0.01). No significant differences were found between the two groups with respect to respiratory depression .No patient suffered from nausea and vomiting. Conclusions The results of this study indicated that using appropriate dose of remifentanil instead of propofol results in less pain, more stable homodynamic condition, and satisfaction of surgeon without no respiratory depression or perioperative nausea and vomiting.
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Affiliation(s)
- Dawood Aghadoost
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mohammad Reza Fazel
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mohammad Reza Fazel, Matini Hospital, Amirkabir Avenue. Kashan, IR Iran. Tel: +98-9132760380, Fax: +98-3615342025, E-mail:
| | - Esmaiel Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
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Uchida A, Shinoda K, Matsumoto CS, Kawai M, Kawai S, Ohde H, Ozawa Y, Ishida S, Inoue M, Mizota A, Tsubota K. Acute Visual Field Defect following Vitrectomy Determined to Originate from Optic Nerve by Electrophysiological Tests. Case Rep Ophthalmol 2012; 3:396-405. [PMID: 23275796 PMCID: PMC3531943 DOI: 10.1159/000345507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To present our findings on the cause of an acute visual field defect (VFD) that developed in a patient on the day after vitrectomy for proliferative diabetic retinopathy. Case A 50-year-old man complained of a blind area in the superior visual field that developed one day after vitrectomy. The patient had undergone uncomplicated vitrectomy for a long-duration vitreous hemorrhage associated with proliferative diabetic retinopathy. Residual vitreous hemorrhage hampered a clear view of the fundus. Goldmann perimetry showed a horizontal VFD in the superior field. The area corresponding to the VFD was examined by multifocal electroretinograms (mfERGs) and multifocal visual evoked potentials (mfVEPs). The amplitudes of the mfVEPs were reduced with prolonged implicit times especially when the superior hemifield was stimulated, while the amplitudes and implicit times were within the normal range when other parts of the visual field were stimulated. In addition, the full-field photopic ERGs and photopic negative responses were attenuated in the right eye. These findings suggested that the VFD did not originate from alterations in the retinal inner and middle layer but in the ganglion cells. The visual acuity improved to 1.2 but his optic disc became pale and the VFD remained unchanged more than 12 years after the surgery. Conclusion We suggest that vitrectomy can cause ischemic optic neuropathy by interfering with the circulation associated with diabetes mellitus. Evaluations by mfERGs, mfVEPs, and full-field photopic ERGs were helpful in making the diagnosis.
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Affiliation(s)
- Atsuro Uchida
- Department of Ophthalmology, Keio University School of Medicine, University Hospital Itabashi, Tokyo, Japan
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Jain N, McCuen BW, Mruthyunjaya P. Unanticipated vision loss after pars plana vitrectomy. Surv Ophthalmol 2012; 57:91-104. [PMID: 22337337 DOI: 10.1016/j.survophthal.2011.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 08/27/2011] [Accepted: 09/08/2011] [Indexed: 02/08/2023]
Abstract
Although advances in vitreoretinal surgical techniques and technology have helped to minimize the risks associated with surgical manipulation of the retina, retinal pigment epithelium, and optic nerve, unanticipated or unexplained visual loss still occurs. We review causes of vision loss encountered after pars plana vitrectomy, including retinal toxicities, vascular events, and optic neuropathies, and we suggest strategies to limit or prevent them.
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Affiliation(s)
- Nieraj Jain
- Duke University, Department of Ophthalmology, Durham, North Carolina, USA
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Dogan R, Karalezli A, Sahin D, Gumus F. Comparison of sedative drugs under peribulbar or topical anesthesia during phacoemulsification. Ophthalmic Surg Lasers Imaging Retina 2012; 43:121-7. [PMID: 22320409 DOI: 10.3928/15428877-20120102-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 01/09/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare dexmedetomidine and midazolam+fentanyl sedation primarily based on patient satisfaction during phacoemulsification under topical and peribulbar anesthesia. PATIENTS AND METHODS Prospective, randomized, and double-blind study of 80 American Society of Anesthesiology grade I-II patients who underwent phacoemulsification with local anesthesia under sedation. Patients were divided into four groups (20 patients for each): dexmedetomidine and topical anesthesia, dexmedetomidine and peribulbar anesthesia, midazolam+fentanyl and topical anesthesia, and midazolam+fentanyl and peribulbar anesthesia. Patient and surgeon satisfaction were determined on a 5-point scale. The pain was determined by verbal pain scale intraoperatively and postoperatively. Drugs were given to a Ramsay sedation scale of 3. Topical and peribulbar anesthesia were performed by an ophthalmologist. Hemodynamic, respiratory, and intraocular pressure monitoring was done. Operative and recovery times were recorded. RESULTS In the midazolam+fentanyl groups, better patient and surgeon satisfaction scores were obtained (P < .005), verbal pain scale scores were significantly lower (P < .001), and patients needed less postoperative analgesia. Ramsay sedation scale scores were between 3 and 4 in all patients and there were no significant differences. Intraocular pressure alterations were similar between groups. Recovery time was longer in the dexmedetomidine groups (P < .05). CONCLUSION The study demonstrated that the midazolam+fentanyl combination provided high-level patient satisfaction scores, low-level pain scores, and shorter recovery time. Also, both of the peribulbar and topical anesthesia procedures showed similar efficiency.
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Affiliation(s)
- Rafi Dogan
- Anesthesiology Department, Baskent University, Ankara, Turkey
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25
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Retinal vascular occlusion after vitrectomy with retrobulbar anesthesia–observational case series and survey of literature. Graefes Arch Clin Exp Ophthalmol 2011; 249:1831-5. [DOI: 10.1007/s00417-011-1783-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 07/03/2011] [Accepted: 07/28/2011] [Indexed: 10/17/2022] Open
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Saumier N, Lorne E, Dermigny F, Walkzak K, Daelman F, Jezraoui P, Mahjoub Y, Milazzo S, Dupont H. [Safety of "needle" regional anaesthesia for anterior segment surgery under antiplatelet agents and anticoagulants therapies]. ACTA ACUST UNITED AC 2010; 29:878-83. [PMID: 21112731 DOI: 10.1016/j.annfar.2010.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 08/31/2010] [Indexed: 11/19/2022]
Abstract
INTRODUCTION cataracts preferentially affect the elderly. More than 560,000 procedures are performed annually in France on vulnerable patients that are exposed to cardio-circulatory conditions requiring antiplatelet and/or anticoagulants. Haemorrhagic complications resulting from cataract surgery and/or eye regional anaesthesia are rare but can lead to serious damage to eye function. PATIENTS AND METHODS in this study, we compared the management care of two types of antiplatelet and/or anticoagulants successively utilizing the following procedure: first, the cessation of antiplatelet agents and anticoagulants were relayed with rapid elimination agents (constituting our reference "before" cohort [November 2004-May 2005]), then the antiplatelet or anticoagulant management was continued without stint according to recent data from literature (constituting our "after" cohort (April 2007-March 2008)). RESULTS a reference population, consisting of 229 patients, was operated on exclusively with "surgical" sub-Tenon's anaesthesia. A second group, consisting of 178 patients, was operated on using "needle" regional anaesthesia. In both populations, nearly 33% of patients received antiplatelet or anticoagulant treatment. The incidence of subconjonctival haemorrhage occurred more frequently when anticoagulants agents were relayed (33% vs 0%; P<0,05), but there was no significant difference with antiplatelet agents (23% vs 8%; NS). The most common non-bleeding event was Chemosis and related to the type of anaesthetic technique utilized, although not serious it tended to jeopardize surgical comfort (anticoagulants: 35% vs 36% (NS), antiplatelet agents: 38% vs 40%; NS). CONCLUSION the technical changes do not explain fully that occurrence of the HSC, in patients under anticoagulant treatment, decreased in the second period. The achievement of "needle" regional anaesthesia in the anterior segment eye surgery is a safe technique that does not require stopping antiplatelet treatment or anticoagulation.
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Affiliation(s)
- N Saumier
- Pôle d'anesthésie-réanimation, centre hospitalier universitaire d'Amiens, université Jules-Verne-de-Picardie, avenue René-Laennec, 80054 Amiens cedex, France
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Semmer AE, Lee MS, Taban M, Smith S, Kosmorsky G. The operation was a success, but the patient cannot see. Surv Ophthalmol 2009; 54:708-13. [PMID: 19733885 DOI: 10.1016/j.survophthal.2009.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 06/03/2009] [Indexed: 10/20/2022]
Abstract
A 71-year-old African American woman presented with severe vision loss in her left eye one day following trabeculectomy with mitomycin C and retrobulbar anesthesia. She had a new left relative afferent pupillary defect and macular whitening. The optic disc appeared normal. Intraocular pressure and fluorescein angiography were normal. Westergren erythrocyte sedimentation rate and C-reactive protein were elevated. Temporal artery biopsy was positive for giant cell arteritis.
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Affiliation(s)
- Anne E Semmer
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota, USA
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29
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Duker JS. Retinal Arterial Obstruction. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00089-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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30
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Lim HW, Ko BW, Song Y, Park YS, Lee BR. Combined Central Retinal Vein and Artery Occlusion After Retrobulbar Anesthesia: A Case Report. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.6.1013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Han Woong Lim
- Department of Ophthalmology, College of Medicine, Hanyang University, Seoul, Korea
| | - Byung Woo Ko
- Department of Ophthalmology, College of Medicine, Hanyang University, Seoul, Korea
| | - Yumi Song
- Department of Ophthalmology, College of Medicine, Hanyang University, Seoul, Korea
| | - Young Sook Park
- Department of Ophthalmology, College of Medicine, Hanyang University, Seoul, Korea
| | - Byung Ro Lee
- Department of Ophthalmology, College of Medicine, Hanyang University, Seoul, Korea
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Mercieca K, Mercieca F. Side effects of postoperative administration of methylprednisolone and gentamicin into the posterior sub-Tenon's space. J Cataract Refract Surg 2007; 33:815-8. [PMID: 17466854 DOI: 10.1016/j.jcrs.2007.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Accepted: 01/29/2007] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the incidence of postoperative emetic side effects after the administration of methylprednisolone and gentamicin into the posterior sub-Tenon's space at the end of routine cataract surgery. SETTING St. Luke's Hospital, Gwardamangia, Malta. METHODS A double-blind double-armed prospective study comprised 40 patients who had uneventful sutureless phacoemulsification under sub-Tenon's local infiltration of 3 mL of plain lignocaine. At the end of the procedure, Group A (n = 20) had 20 mg/0.5 mL of methylprednisolone and 10 mg/0.5 mL of gentamicin injected into the posterior sub-Tenon's space and Group B (n = 20) had the same combination injected into the anterior sub-Tenon's space. Postoperatively, all patients were assessed for symptoms of nausea, vomiting, and headache. A chi-square test was used to assess the statistical significance of results. RESULTS Sixty percent in Group A developed postoperative emetic symptoms, headache, or both; 1 patient in Group B developed symptoms. CONCLUSIONS The administration of methylprednisolone and gentamicin in the posterior sub-Tenon's space was related to a high incidence of side effects including nausea, vomiting, and headache. All adverse effects were self-limiting.
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Affiliation(s)
- Karl Mercieca
- Manchester Royal Eye Hospital, Manchester, United Kingdom.
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32
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Kiliç A, Gürler B. Subtenon lidocaine vs topical proparacaine in adult strabismus surgery. ACTA ACUST UNITED AC 2007; 38:201-6. [PMID: 17416954 DOI: 10.1007/s12009-006-0005-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 10/23/2022]
Abstract
Intraoperative subtenon 2% lidocaine and topical 0.5% proparacaine in patients undergoing strabismus surgery were compared. No additional systemic analgesics and sedatives were used. Mean and total pain scores intraoperatively and postoperatively were not different. Each anesthetic agent provides good intraoperative anesthesia and postoperative analgesia. Topical 0.5% proparacaine may be preferred because of its easy administration and fewer side effects, lack of hospital admission, and immediate and predictable alignment of the eyes.
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Affiliation(s)
- Adil Kiliç
- Harran University Research Hospital Eye Clinic, Sanliurfa, Turkey.
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Chuang LH, Yeung L, Ku WC, Yang KJ, Lai CC. Safety and efficacy of topical anesthesia combined with a lower concentration of intracameral lidocaine in phacoemulsification. J Cataract Refract Surg 2007; 33:293-6. [PMID: 17276272 DOI: 10.1016/j.jcrs.2006.10.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2006] [Accepted: 10/24/2006] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess the safety and efficacy of phacoemulsification under a topical anesthesia combined with intracameral lidocaine 0.5%. SETTING Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, China. METHODS A prospective randomized double-blind study was designed in which patients had phacoemulsification performed under topical anesthesia (4 drops of nonpreserved lidocaine 2%) with 0.15 mL intracameral placebo (balanced salt solution) in 1 eye (Group 1) and topical anesthesia with intracameral nonpreserved lidocaine 0.5% in the other eye (Group 2). Endothelial changes, including cell density, coefficient variation of cell size, and percentage of hexagonal cells, were measured by noncontact specular microscopy. Preoperative and postoperative best corrected visual acuity was also documented. The degree of pain throughout surgery was ranked on a 10-point visual analog pain scale. RESULTS Thirty-three patients were recruited. There was no significant difference in preoperative and postoperative mean endothelial parameters between the 2 groups. Furthermore, mean endothelial cell loss was similar. Mild or no pain (score 0 to 1) was reported by 48.5% in Group 1 and 90.9% in Group 2. Patients reported less pain with combined topical and intracameral lidocaine anesthesia (P = .001, Mann-Whitney test). Vision was significantly improved in both groups. However, 1 patient in Group A developed vitreous loss as a result of involuntary eye movement. CONCLUSION Combining topical anesthesia with intracameral lidocaine 0.5% [corrected] anesthesia was safe and effective in phacoemulsification with intraocular lens implantation.
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Affiliation(s)
- Lan-Hsin Chuang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, and Chang Gung University College of Medicine, Taiwan, China
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34
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Snir M, Bachar M, Katz J, Friling R, Weinberger D, Axer-Siegel R. Combined propofol sedation with sub-Tenon's lidocaine/mercaine infusion for strabismus surgery in adults. Eye (Lond) 2006; 21:1155-61. [PMID: 16732214 DOI: 10.1038/sj.eye.6702426] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIMS To evaluate the safety and efficacy of propofol sedation combined with sub-Tenon's anaesthesia for strabismus surgery in adults. METHODS Thirty-two consecutive patients aged 31-85 years underwent strabismus surgery under general (n=16) or local (n=16) anaesthesia. In the local anaesthesia (study) group, sedation was induced with a loading dose of midazolam, fentanyl, and propofol, followed by continuous infusion of propofol, 3-6 mg/k/h to deep sedation. A nasal tube was inserted to prevent airway obstruction. Sub-Tenon's anaesthesia included infusion of a 3-4 ml mixture (50 : 50) of lidocaine 2%/mercaine 0.5%. General anaesthesia consisted of premedication with midazolam, followed by fentanyl, esmeron-bromate, propofol, and tracheal intubation. Duration of surgery and anaesthesia, intraoperative oculocardiac reflex and arrhythmias, time to discharge, postoperative pain, nausea and vomiting, and patient and surgeon satisfaction were evaluated. RESULTS The local anaesthesia group had a significantly shorter operative and anaesthesia time, fewer episodes of oculocardiac reflex or arrythmia/bradycardia requiring treatment, fewer early or late episodes of nausea and vomiting, and less pain. The patients and surgeon in this group reported higher satisfaction. CONCLUSION Propofol sedation with local sub-Tenon's injection of lidocaine/mercaine is recommended for the induction and maintenance of anaesthesia during unilateral or bilateral strabismus surgery in adults. The method is quick and effective, without systemic or ocular side effects.
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Affiliation(s)
- M Snir
- Pediatric Ophthalmology and Strabismus Unit, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel.
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Carrillo MM, Buys YM, Faingold D, Trope GE. Prospective study comparing lidocaine 2% jelly versus sub-Tenon's anaesthesia for trabeculectomy surgery. Br J Ophthalmol 2004; 88:1004-7. [PMID: 15258014 PMCID: PMC1772259 DOI: 10.1136/bjo.2003.035063] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To compare the analgesic properties of lidocaine 2% jelly versus sub-Tenon's anaesthesia with lidocaine 2% without adrenaline (epinephrine) for trabeculectomy surgery. METHODS A prospective randomised clinical trial. 59 consecutive patients scheduled for trabeculectomy at the Toronto Western Hospital were randomly assigned to topical unpreserved lidocaine 2% jelly or sub-Tenon's anaesthesia with 2% lidocaine. Both groups received a standardised sedative consisting of midazolam, fentanyl. and/or propofol. The visual analogue scale was utilised to measure intraoperative pain. Patient comfort, physician assessment of intraoperative patient compliance, volume of local anaesthetic used, need for supplemental anaesthesia, and any complications were recorded. The two groups were compared using the Student's t test. RESULTS The sub-Tenon's anaesthesia group and the lidocaine 2% jelly group did not vary significantly in subjective pain score (18.3 (SD 16.2) v 19.8 (12.4) respectively, p = 0.739) and surgeons' satisfaction scale (3.6 (0.7) and 3.8 (0.6) respectively, p = 0.328). Four patients required additional anaesthesia, all of them in the sub-Tenon's group. CONCLUSION Topical lidocaine 2% jelly is as effective as sub-Tenon's anaesthesia for pain control in patients undergoing trabeculectomy. Lidocaine 2% jelly is similar to sub-Tenon's anaesthesia in patient comfort and surgeon satisfaction.
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Affiliation(s)
- M M Carrillo
- University Health Network, Toronto Western Hospital, University of Toronto, Ontario, Canada
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36
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Soliman MM, Macky TA, Samir MK. Comparative clinical trial of topical anesthetic agents in cataract surgery. J Cataract Refract Surg 2004; 30:1716-20. [PMID: 15313296 DOI: 10.1016/j.jcrs.2003.12.034] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2003] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess the efficacy of lidocaine gel, bupivacaine drops, and benoxinate drops as topical anesthetic agents in cataract surgery. SETTING Kasr El-Aini Hospital, Cairo University, Cairo, Egypt. METHODS This prospective randomized study comprised 90 patients scheduled for routine cataract extraction. Patients were randomized into 3 groups of 30 each based on which anesthetic agent they received: lidocaine 2% gel, bupivacaine 0.5% drops, or benoxinate 0.4% drops. Subjective pain at application of the agent and intraoperatively was quantified by the patients using a verbal pain score (VPS) scale from 0 to 10. The duration of discomfort at application, duration of surgery, rate of supplemental sub-Tenon's anesthesia, and complications were recorded. RESULTS The mean VPS at application was 2.97, 1.53, and 1.03 in the lidocaine, bupivacaine, and benoxinate groups, respectively; the VPS in the lidocaine group was statistically significantly higher than in the other 2 groups (P<.001). The mean duration of pain at application was 25 seconds, 14 seconds, and 6 seconds in the lidocaine, bupivacaine, and benoxinate groups, respectively, and was statistically significantly higher in the lidocaine group (P<.001). The mean VPS during surgery was 1.6, 4.1, and 7.1 in the lidocaine, bupivacaine, and benoxinate groups; the lidocaine group had a statistically significantly lower mean VPS than the other 2 groups (P<.001). The incidence of supplemental sub-Tenon's injection was 3.3%, 10.0%, and 73.3%, respectively, and was statistically significantly lower in the lidocaine and bupivacaine groups than in the benoxinate group (P<.001). The patients' overall satisfaction was statistically significantly higher in the lidocaine and bupivacaine groups than in the benoxinate group (93.3%, 83.3%, and 33.3%, respectively) (P<.001). Three patients in the lidocaine group had corneal haze at the time of surgery, which was not statistically significant (P>.1). CONCLUSIONS Lidocaine gel was a better topical anesthetic agent than bupivacaine and benoxinate drops. Bupivacaine drops were effective in providing deep topical anesthesia.
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Affiliation(s)
- Mahmoud M Soliman
- Department of Ophthalmology, Kasr El Aini Hospital, Cairo University, El-Manial, 16 Sherif Street, Cairo 11111, Egypt.
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Segev F, Voineskos AN, Hui G, Law MSH, Paul R, Chung F, Slomovic AR. Combined Topical and Intracameral Anesthesia in Penetrating Keratoplasty. Cornea 2004; 23:372-6. [PMID: 15097132 DOI: 10.1097/00003226-200405000-00011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The standard of care for penetrating keratoplasty (PKP) is either retrobulbar or peribulbar anesthesia combined with seventh cranial nerve akinesia or general anesthesia. These methods are known to be associated with rare but potentially serious adverse ocular and systemic events. PURPOSE To determine the safety and efficacy of combined topical and intracameral anesthesia in addition to intravenous sedation for repeat penetrating keratoplasty (PKP). SETTING Tertiary-care university hospital. METHODS In this prospective study, combined topical tetracaine 0.5% and 0.2 cc intracameral 1% lidocaine along with i.v. sedation with midazolam and fentanyl were used for patients undergoing repeat PKP in 15 eyes of 15 selected patients. The indication for surgery was failed corneal graft. Verbal pain scale (VPS, 0-3) was recorded preoperatively, intraoperatively at 3 time-points (after trephination, after placing 8 interrupted sutures, and after placing the running suture), and postoperatively (1 hour postoperatively, overnight pain, and 1 day postoperatively). Patient and surgeon satisfaction were assessed postoperatively using a scale (1-5). After surgery patients were asked for their preferences comparing the current use of topical anesthesia compared with retrobulbar anesthesia used for their initial PKP. RESULTS The mean intraoperative VPS score was 0.51 +/- 0.32 (range 0-1.33), and the mean postoperative VPS score was 0.47 +/- 0.50 (range 0-1.67). There were no serious intraoperative or postoperative complications. All patients reported high mean satisfaction score of 4.67 +/- 0.49 (range 4-5). The mean satisfaction score reported by the surgeon was 4.47 +/- 0.63 (range 3-5). All patients but 1 (93.3%) preferred combined topical over retrobulbar anesthesia, which they had in their previous surgery. CONCLUSIONS We found combined topical and intracameral anesthesia to be safe and effective in our selected group of patients undergoing repeat PKP, and it may provide a satisfactory alternative anesthetic modality for patients in whom general, retrobulbar, or peribulbar anesthesia may be contraindicated.
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Affiliation(s)
- Fani Segev
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Vinerovsky A, Rath EZ, Rehany U, Rumelt S. Central retinal artery occlusion after peribulbar anesthesia. J Cataract Refract Surg 2004; 30:913-5. [PMID: 15093661 DOI: 10.1016/j.jcrs.2003.08.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe the development of central retinal artery occlusion (CRAO) in 2 patients after peribulbar (periconal) anesthesia during uneventful phacoemulsification. Although peribulbar anesthesia avoids direct optic-nerve injury, indirect injury presenting as CRAO may occur from vasospasm in response to the injection.
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Affiliation(s)
- Albert Vinerovsky
- Department of Ophthalmology, Western Galilee-Nahariya Medical Center, 22100 Nahariya, Israel
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Abstract
Complications of ophthalmologic nerve blocks are rare, but they can have serious life- and sight-threatening consequences. Knowledge of the potential complications is essential for the anesthesiologist who performs ophthalmologic nerve blocks. However, most anesthesiologists are unfamiliar with these complications because the majority have been reported in the ophthalmology literature. We review the complications that may occur during the placement of ophthalmologic blocks and their appropriate prompt treatment.
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Affiliation(s)
- Shireen Ahmad
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Feibel RM, Guyton DL. Transient central retinal artery occlusion after posterior sub-Tenon's anesthesia. J Cataract Refract Surg 2003; 29:1821-4. [PMID: 14522307 DOI: 10.1016/s0886-3350(02)01975-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Two cases of transient central retinal artery occlusion were observed preoperatively after uneventful sub-Tenon's infusion of local anesthetic for cataract surgery and intraocular lens implantation. In these eyes, the retinal circulation reperfused spontaneously before surgery and there were no visual sequelae. A third case was observed in an eye after strabismus surgery with sub-Tenon's anesthesia. The patient was left with profound visual loss in this eye. The cause of this complication is unknown, but possible factors include mechanical pressure from the bolus of the anesthetic solution or localized vasoconstriction from the anesthetic, producing a decrease in ocular blood flow. Suggestions to avoid this problem include not inserting the cannula too posteriorly, not injecting forcibly against resistance, and using the minimum volume of anesthetic possible.
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Affiliation(s)
- Robert M Feibel
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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Aydin ON, Kir E, Ozkan SB, Gürsoy F. Patient-controlled analgesia and sedation with fentanyl in phacoemulsification under topical anesthesia. J Cataract Refract Surg 2002; 28:1968-72. [PMID: 12457671 DOI: 10.1016/s0886-3350(02)01429-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the effects of intravenous (IV) patient-controlled sedation/analgesia with fentanyl during phacoemulsification surgery under topical anesthesia. SETTING Adnan Menderes University Medical School, Departments of Ophthalmology and Anesthesiology and Reanimation, Aydin, Turkey. METHODS In this double-blind randomized study, 68 patients were randomly allocated to 2 groups. In the fentanyl group comprising 34 patients, fentanyl was administered by patient-controlled analgesia (PCA) equipment in 5 microg bolus doses with a lockout period of 5 minutes after an IV loading dose of 0.7 microg/kg in 2 mL balanced salt solution. In the control group comprising 34 patients, a balanced salt solution was given without an analgesic drug by PCA equipment. Verbal pain scale (VPS) and sedation scores were recorded preoperatively and 5, 10, 15, 20, and 30 minutes after the start of surgery. Patient comfort and surgeon satisfaction were assessed postoperatively. RESULTS The sedation score was higher in the fentanyl group than in the control group at 5 and 10 minutes (P =.006 and P =.012, respectively). The VPS scores were higher in the control group than in the fentanyl group at 15 and 20 minutes (P =.02 and P =.016, respectively). Patients pressed the button for additional analgesia 2.6 times +/- 3.9 (SD) in the control group and 0.9 +/- 1.6 times in the fentanyl group (P =.025). Patient and surgeon satisfaction were higher in the fentanyl group than the control group (P =.023 and P =.018, respectively). CONCLUSIONS The results of this study suggest that IV PCA with fentanyl has supplemental effects on analgesia and sedation during cataract surgery under topical anesthesia and increases patient comfort and surgeon satisfaction.
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Affiliation(s)
- Osman Nuri Aydin
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
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Abstract
The wide variety of peripheral blocks makes for a difficult endeavor in trying to grasp their many potential complications. However, the common features of these complications makes it possible to use the construct presented here, in combination with one's knowledge of anatomy, to be able anticipate many, if not most, of the complications of any particular peripheral regional anesthetic.
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Affiliation(s)
- Bruce Ben-David
- University of Pittsburgh, A 1305 Scaife Hall, 3550 Terrace Street, Department of Anesthesiology, Pittsburgh, PA 15261, USA.
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Abstract
Neuro-ophthalmologic complications from cataract surgery are uncommon and include central nervous system toxicity, binocular diplopia, traumatic optic neuropathy and ischemic optic neuropathy. Retrobulbar blocks may be accidentally injected into the subarachnoid space with diffusion to the brainstem. This leads to cardiovascular, respiratory, and mental status compromise. Most patients have complete recovery with adequate support. Post-operative, binocular diplopia may occur secondary to anisometropia or previously unrecognized misalignment. Periocular injection may cause paresis or fibrosis of extraocular muscles. Anterior or posterior ischemic optic neuropathy can occur in the first 6 weeks after cataract surgery with or without periocular injection. The risk to the other eye is high with subsequent contralateral cataract extraction. Post-operative vision loss associated with direct traumatic needle injury is recognized immediately. Therefore, an orbital MRI may be warranted for a patient with an optic neuropathy in the first 24 hours after cataract surgery using periocular anesthesia. If evidence of needle injury is present on neuroimaging, a trial of steroids should be considered.
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Affiliation(s)
- Michael S Lee
- Neuro-ophthalmology Unit at the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
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Zabriskie NA, Ahmed IIK, Crandall AS, Daines B, Burns TA, Patel BCK. A comparison of topical and retrobulbar anesthesia for trabeculectomy. J Glaucoma 2002; 11:306-14. [PMID: 12169967 DOI: 10.1097/00061198-200208000-00006] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the safety and efficacy of topical versus retrobulbar anesthesia for primary trabeculectomy METHODS A prospective study of 36 consecutive patients undergoing trabeculectomy who were randomized to receive topical (n = 18) or retrobulbar (n = 18) anesthesia. Operating conditions, patient comfort, and surgical outcome were evaluated. SETTINGS Tertiary-care university hospital ambulatory surgical center. RESULTS There were no differences in operating conditions (P = 0.14), pain during (P = 0.54) or after (P = 0.76) surgery, or supplemental anesthesia required (P = 0.34) between the two groups. Very few patients in either group were bothered by touch sensation, tissue manipulation, or the microscope light. Chemosis, subconjunctival hemorrhage and eyelid hemorrhage were seen exclusively in the retrobulbar group (P <0.03), and were all attributable to the injection. Inadvertent eye movement was present more frequently in the topical group (P = 0.01), although this did not pose a problem to the surgeon. No surgical complications were encountered in either group. CONCLUSION Topical anesthesia is a safe and effective alternative to retrobulbar anesthesia for primary trabeculectomy.
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Affiliation(s)
- Norman A Zabriskie
- John A. Moran Eye Center and Department of Anesthesia, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA
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Yepez JB, de Yepez JC, Azar-Arevalo O, Arevalo JF. Topical Anesthesia With Sedation in Phacoemulsification and Intraocular Lens Implantation Combined With 2-Port Pars Plana Vitrectomy in 105 Consecutive Cases. Ophthalmic Surg Lasers Imaging Retina 2002. [DOI: 10.3928/1542-8877-20020701-07] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
PURPOSE To study the safety and efficacy of topical anesthesia alone, without systemic sedation, in phacotrabeculectomy for cataract and primary open-angle glaucoma. METHODS In this prospective study, topical anesthesia with 2% lidocaine hydrochloride jelly without systemic sedation was used for combined phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy in consecutive patients with primary open-angle glaucoma and concurrent cataract at the United Christian Hospital, Kowloon, Hong Kong, from September 2000 to May 2001. Visual analog pain score and change in vital signs were used to assess the intraoperative pain experience. Other outcome measures included postoperative visual acuity and intraocular pressure at 3 months. RESULTS Twenty-two eyes of 22 consecutive patients were included in the study. The mean intraoperative pain score was 0.9 (range, 0-3). Three patients reported discomfort intraoperatively. No injection of supplementary anesthetic was required in any of the eyes. None of the patients had significant increase of pulse rate or blood pressure during the whole surgical procedure. Six patients required oral analgesic for postoperative discomfort. The mean preoperative medically treated IOP was 20.3 +/- 5.9 mm Hg and the mean postoperative IOP at 3 months was 14.4 +/- 4.7 mm Hg. All except two patients had improved visual acuity. There was no serious intraoperative or postoperative complication. CONCLUSION Topical 2% lidocaine hydrochloride jelly without systemic sedation may be a safe and effective anesthetic method in phacotrabeculectomy for patients with primary open-angle glaucoma with coexisting cataract.
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Affiliation(s)
- Jimmy S M Lai
- Department of Ophthalmology, United Christian Hospital, Kowloon, Hong Kong.
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Ahmed IIK, Zabriskie NA, Crandall AS, Burns TA, Alder SC, Patel BCK. Topical versus retrobulbar anesthesia for combined phacotrabeculectomy: prospective randomized study. J Cataract Refract Surg 2002; 28:631-8. [PMID: 11955903 DOI: 10.1016/s0886-3350(01)01249-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the safety and efficacy of topical and retrobulbar anesthesia for combined phacotrabeculectomy. SETTING Tertiary-care university hospital ambulatory surgical center. METHODS In this prospective study, 40 consecutive patients having combined phacotrabeculectomy were randomized to receive topical (n = 20) or retrobulbar (n = 20) anesthesia. Operating conditions, patient comfort, and surgical outcome were evaluated. RESULTS There was no significant between-group difference in operating conditions (P =.56), pain during (P =.41) or after (P =.23) surgery, or supplemental anesthesia required (P =.49). Few patients in either group were bothered by tissue manipulation or the microscope light, although more patients in the topical group were slightly bothered by touch sensation (P =.05). Chemosis, subconjunctival hemorrhage, and eyelid hematoma were seen almost exclusively in the retrobulbar group (P <.05). Inadvertent eye movement was present more frequently in the topical group (P =.04), although this did not pose a problem to the surgeon. CONCLUSION Topical anesthesia is a safe and effective alternative to retrobulbar anesthesia for combined phacotrabeculectomy.
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Affiliation(s)
- Iqbal Ike K Ahmed
- John A. Moran Eye Center, University of Utah Health Sciences Center, Utah, Salt Lake City 84132, USA
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Lim BA, Ang CL. Purtscher-Like Retinopathy After Retrobulbar Injection. Ophthalmic Surg Lasers Imaging Retina 2001. [DOI: 10.3928/1542-8877-20011101-08] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pianka P, Weintraub-Padova H, Lazar M, Geyer O. Effect of sub-Tenon's and peribulbar anesthesia on intraocular pressure and ocular pulse amplitude. J Cataract Refract Surg 2001; 27:1221-6. [PMID: 11524193 DOI: 10.1016/s0886-3350(01)00797-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the effect of peribulbar and sub-Tenon's anesthesia on intraocular pressure (IOP) and ocular pulse amplitude (OPA) in the injected eye and the fellow noninjected (control) eye. SETTING Tel Aviv Medical Center, Tel Aviv, Israel. METHODS This prospective study measured IOP and OPA at baseline and 1 and 10 minutes after administration of lidocaine anesthesia in 40 consecutive adult patients having elective cataract surgery. RESULTS The IOP remained stable throughout the study with both modes of anesthesia. One minute after injection of the anesthetic agent, the OPA was significantly decreased in the injected eyes in both the sub-Tenon's (24%; P < .05) and peribulbar (25%; P < .05) groups. The decrease in the OPA in the sub-Tenon's group (14%; P < .05) was detectable after 10 minutes in the control eyes. In the peribulbar anesthesia group, the OPA in the control eyes increased significantly (9%; P < .05) 1 minute after injection of the anesthetic agent, returning to preinjection levels 10 minutes after the injection. CONCLUSIONS The OPA in the eyes in which lidocaine was injected decreased significantly in both the sub-Tenon's and peribulbar groups. These findings have implications for the management of patients whose ocular circulation may be compromised.
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Affiliation(s)
- P Pianka
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Jacobi PC, Dietlein TS, Jacobi FK. Cataract surgery under topical anesthesia in patients with coexisting glaucoma. J Cataract Refract Surg 2001; 27:1207-13. [PMID: 11524191 DOI: 10.1016/s0886-3350(01)00875-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate and compare levels of patient discomfort and complications during phacoemulsification with implantation of a foldable intraocular lens (IOL) under topical lidocaine hydrochloride in patients with and without various forms of chronic open-angle and chronic angle-closure glaucoma. SETTING Two university eye centers in Germany. METHODS This prospective nonrandomized comparative study comprised 176 eyes of 176 patients with various forms of chronic open-angle glaucoma and chronic angle-closure glaucoma. Eyes with cataract and without a glaucoma diagnosis or history of intraocular surgery served as a control group (n = 212). All patients received a minimum of 5 doses (2 drops per dose) of topical lidocaine hydrochloride 2% before standard temporal clear corneal phacoemulsification and foldable IOL implantation. No intracameral anesthetic injection was given, and no systemic sedatives were used. The main outcome measures were the number of complications and adverse events. RESULTS The intraoperative complication rate in all patients (n = 388) was capsule tear, 1.3%; zonule tear, 1.8%; vitreous loss, 1.0%; iris prolapse, 0.8%. No statistically significant differences in intraoperative or early postoperative complications were found between the glaucoma and control groups. The mean pain scores of patients were 0.38 +/- 1.1 (SD) in the glaucoma group and 0.36 +/- 0.8 in the control group (P =.21) Patient preference for cataract surgery under topical anesthesia was similar in both groups. CONCLUSIONS Surgery-related complications and patient discomfort were similar in patients with and without glaucoma who had phacoemulsification and IOL implantation under topical anesthesia. These results indicate that topical anesthesia is safe for routine phacoemulsification with foldable IOL implantation in patients with glaucoma and does not compromise patient comfort.
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Affiliation(s)
- P C Jacobi
- Department of Ophthalmology, University of Cologne, Cologne, Germany.
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