Cilioretinal artery occlusion associated with Sub‐Tenon's regional blockade

Fry, Robert A.; Ring, P. A.

doi:10.1111/j.1442-9071.2008.01686.x

Cited by 11 publications

(10 citation statements)

References 8 publications

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“…These findings provided evidence for the transient visual transduction block as a reasonable explanation for anesthesia-induced visual loss. Some others argued that injection of anesthetic fluid would increase intraocular pressure (IOP), resulting in ischemia of the retina and optic nerve and leading to visual loss [26,27]. In this study, however, we did not observe paleness of optic disc and retina or pulsation and narrowing of blood vessels which indicated ocular ischemia.…”

Section: Discussioncontrasting

confidence: 91%

Incidence and impact factors of intraoperative loss of light perception under sub-Tenon’s anesthesia in patients with macular diseases

Zheng

Huang

et al. 2019

Eye

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Purpose To investigate the incidence and impact factors of intraoperative loss of light perception (LP) under sub-Tenon's anesthesia in patients with macular diseases. Methods Eighty-five consecutive patients received standard phacoemulsification combined pars plana vitrectomy (PPV) under sub-Tenon's anesthesia. At several checkpoints during the surgery (the end of phacoemulsification, the end of vitrectomy, and the end of surgery), participants were interviewed about whether they had LP or not after removing the influence of contralateral eye and the photo-bleaching effect. In patients treated with retinal photocoagulation, visual experience on laser flashes was evaluated. Results Under routine draping, no patients reported loss of LP at all the checkpoints. When the contralateral eye was tightly covered, the rates of LP loss were 84.7%, 97.6%, and 87.1% at the end of phacoemulsification, the end of vitrectomy, and the end of surgery, respectively. When the photo-bleaching effect was also removed, the rates of LP loss were 61.2%, 82.4%, and 56.5% at each checkpoint, respectively, and there were 87.1% (74/85) of patients reporting visual loss in at least one checkpoint. In addition, 76.9% (50/65) of patients could not feel laser flashes during retinal photocoagulation. Conclusion Intraoperative loss of LP under sub-Tenon's anesthesia was a relatively common and reversible event. The conduction block of optic nerve by anesthetic mainly contributed to the visual loss during surgery. Photo-bleaching effect also has some effect on the LP evaluation. Surgeons need to inform and counsel the patients about the intraoperative loss of LP, to prevent any sudden panic attacks in them.

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Section: Discussioncontrasting

confidence: 91%

Incidence and impact factors of intraoperative loss of light perception under sub-Tenon’s anesthesia in patients with macular diseases

Zheng

Huang

et al. 2019

Eye

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“…It could presumably result from an increase in IOP exceeding the mean arterial pressure in the ophthalmic or central retinal artery, or because of increased IOP, which may interfere with the small vessels supplying the optic nerve. 57 However, the sub-Tenon's block does not appear to be associated with a significant increase in the IOP. 58 The manipulation of the globe may compromise the retinal perfusion because of spikes in IOP.…”

Section: Retinal Ischaemiamentioning

confidence: 99%

“…Recently, another episode of retinal arterial occlusion associated with subTenon's block has been reported. 57 The exact cause of the above complication following sub-Tenon's block is unknown. It could presumably result from an increase in IOP exceeding the mean arterial pressure in the ophthalmic or central retinal artery, or because of increased IOP, which may interfere with the small vessels supplying the optic nerve.…”

Section: Retinal Ischaemiamentioning

confidence: 99%

Sub-Tenon's anaesthesia: complications and their prevention

Kumar

Eid

Dodds

2011

Eye

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The advent of a new technique that is considered much safer than previously established one leads to its rapid adoption. This usually leads to the identification of previously unreported complications of the new technique, and a re-assessment of its position in clinical care, which is precisely the state of play with the sub-Tenon's block. The sub-Tenon's block was introduced into the clinical practice in early 1990. A systematic recent search of subject headings such as complications of sub-Tenon's block, subtenon, orbital block, orbital block complications, and orbital anaesthesia was performed in Medline, EMBASE, and Cochrane database. Indeed there are complications of sub-Tenon's block published as case reports and the exact incidence of these complications is not known. Management and preventive measures of these complications are described. Although the sub-Tenon's block appears to be relatively safer than needle-based blocks but a proper prospective, randomized, double-blind controlled trial is essential for scientific proof that sub-Tenon's block is better than needlebased blocks.

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“…Periocular anaesthesia has been associated with a reduction in ocular blood flow and retinal vaso-occlusive events, yet the mechanism behind this phenomenon remained unclear. [16,20] A direct compression of the retinal vessels as a result of intraocular pressure (IOP) spikes is unlikely, since sub-Tenon's anaesthesia does not appear to be associated with significant IOP changes. [28,33] Instead, it is hypothesized that the anaesthetics exert a pharmacological vaso-constrictive effect, thereby diminishing retinal blood supply.…”

Section: Effect Of Periocular Anaesthesia On Retinal Blood Flowmentioning

confidence: 99%

Volume‐rendered optical coherence tomography angiography during ocular interventions: Advocating for noninvasive intraoperative retinal perfusion monitoring

Enz

Maloca

Tschopp

et al. 2022

Journal of Biophotonics

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We aimed to test for feasibility of volume-rendered optical coherence tomography angiography (OCTA) as a novel method for assessing/quantifying retinal vasculature during ocular procedures and to explore the potential for intraoperative use. Thirty patients undergoing periocular anaesthesia were enrolled, since published evidence suggests a reduction in ocular blood flow.Retinal perfusion was monitored based on planar OCTA image-derived data provided by a standard quantification algorithm and postprocessed/volume-rendered OCTA data using a custom software script. Overall, imaging procedures were successful, yet imaging artifacts occurred frequently. In interventional eyes, perfusion parameters decreased during anaesthesia. Planar image-derived and volume renderingderived parameters were correlated. No correlation was found between perfusion parameters and a motion artifact score developed for this study, yet all perfusion parameters correlated with signal strength as displayed by the device. Concluding, volume-rendered OCTA allows for noninvasive threedimensional retinal vasculature assessment/quantification in challenging surgical settings and appears generally feasible for intraoperative use.

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Cilioretinal artery occlusion associated with Sub‐Tenon's regional blockade

Cited by 11 publications

References 8 publications

Incidence and impact factors of intraoperative loss of light perception under sub-Tenon’s anesthesia in patients with macular diseases

Incidence and impact factors of intraoperative loss of light perception under sub-Tenon’s anesthesia in patients with macular diseases

Sub-Tenon's anaesthesia: complications and their prevention

Volume‐rendered optical coherence tomography angiography during ocular interventions: Advocating for noninvasive intraoperative retinal perfusion monitoring

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