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Profound vascular stasis of retina and optic nerve following retrobulbar anesthesia
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 o...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857805/ https://www.ncbi.nlm.nih.gov/pubmed/27199572 http://dx.doi.org/10.2147/IMCRJ.S98546 |
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author | Todorich, Bozho Hahn, Paul |
author_facet | Todorich, Bozho Hahn, Paul |
author_sort | Todorich, Bozho |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-4857805 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-48578052016-05-19 Profound vascular stasis of retina and optic nerve following retrobulbar anesthesia Todorich, Bozho Hahn, Paul Int Med Case Rep J Case Series 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. Dove Medical Press 2016-04-29 /pmc/articles/PMC4857805/ /pubmed/27199572 http://dx.doi.org/10.2147/IMCRJ.S98546 Text en © 2016 Todorich and Hahn. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Case Series Todorich, Bozho Hahn, Paul Profound vascular stasis of retina and optic nerve following retrobulbar anesthesia |
title | Profound vascular stasis of retina and optic nerve following retrobulbar anesthesia |
title_full | Profound vascular stasis of retina and optic nerve following retrobulbar anesthesia |
title_fullStr | Profound vascular stasis of retina and optic nerve following retrobulbar anesthesia |
title_full_unstemmed | Profound vascular stasis of retina and optic nerve following retrobulbar anesthesia |
title_short | Profound vascular stasis of retina and optic nerve following retrobulbar anesthesia |
title_sort | profound vascular stasis of retina and optic nerve following retrobulbar anesthesia |
topic | Case Series |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857805/ https://www.ncbi.nlm.nih.gov/pubmed/27199572 http://dx.doi.org/10.2147/IMCRJ.S98546 |
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