Iatrogenic retinal traumas in ophthalmic surgery

Tognetto, Daniele; Lauro, Maria Teresa di; Fanni, Daniela; Zagidullina, A.; Michelone, L; Ravalico, Giuseppe

doi:10.1007/s00417-008-0879-3

Cited by 12 publications

(12 citation statements)

References 174 publications

(148 reference statements)

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“…In this situation, it is recommended to use blunt scissors and to consider another type of anesthesia when the cannula does not have an easy passage into the sub-Tenon's space [ 40 ]; access from another quadrant of the eye can also be attempted. Eyes with myopic staphyloma are at increased risk of globe perforation during peribulbar and retrobulbar injection [ 10 ] and, although sub-Tenon anesthesia may be safer, care must be taken with these eyes during a sub-Tenon approach. There are no reports of complications related to eyes with short axial length, and sub-Tenon anesthesia can be safely performed in these eyes [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Pain during pars plana vitrectomy following sub-Tenon versus peribulbar anesthesia: A randomized trial

Ribeiro

Abrão

et al. 2020

PLoS ONE

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Purpose To compare pain during pars plana vitrectomy (PPV) following topical lidocaine jelly and sub-Tenon anesthesia versus peribulbar anesthesia. Methods Prospective, single-center, randomized study. Patients scheduled for PPV for macular hole (MH) or epiretinal membrane (ERM) at the Retina and Vitreous Section of the Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo were randomly assigned to one of two groups in a 1:1 allocation ratio. Patients assigned to Group ST received topical anesthesia with 2% lidocaine jelly followed by sub-Tenon anesthesia with 2–4 ml of 1% ropivacaine. Patients assigned to PB received peribulbar anesthesia with 4–6 ml of 1% ropivacaine. After PPV, patients in both groups were asked to rate the level of pain they felt during the entire procedure (including anesthesia administration and PPV) by pointing at a 0–100 Visual Analogue Pain Scale (VAS). Data regarding demographics, patient characteristics and surgical features were also collected. Results Fifty-four patients were enrolled in the study (26 in Group ST and 28 in Group PB). Baseline characteristics, including age, gender, and presence of comorbidities, were similar in both groups. The surgery performed was PPV alone in 10 and 14 patients in the ST and PB groups, respectively, and combined phacoemulsification and PPV in 16 and 14 patients in the ST and PB groups, respectively (p = 0.39, Pearson). Surgery duration (mean ± SD minutes) was similar in the two groups (62 ± 12 for ST and 70 ± 20 for PB, p = 0.09, t-Test). No patients needed supplemental topical or intravenous anesthesia during surgery. No sight- or life-threatening complication was observed in either group. VAS score was significantly lower in the ST compared to the PB group (median (interquartile range) was 1 (2.25–0) in the ST group compared to 11.5 (29.75–5) in the PB group, p< 0.0001, Wilcoxon). Conclusion In this study of patients who underwent PPV for MH or ERM, topical followed by sub-Tenon anesthesia was more effective in controlling pain during the whole vitrectomy procedure than peribulbar anesthesia. Compared to peribulbar anesthesia which is administered with a sharp needle, sub-Tenon anesthesia administered with a blunt cannula may be associated with a reduced risk of such adverse events as globe perforation, retrobulbar hemorrhage, and inadvertent injection of anesthesia into the optic nerve sheath.

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Section: Discussionmentioning

confidence: 99%

Pain during pars plana vitrectomy following sub-Tenon versus peribulbar anesthesia: A randomized trial

Ribeiro

Abrão

et al. 2020

PLoS ONE

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“…In the course of vitreo-retinal surgery, many factors have to be considered that could be harmful to the retina, including: the source of endoillumination (5); the continuous flow of an irrigation solution (6); the mechanical manipulation of the retina; and the suppression of blood flow, which can potentially affect the neuronal tissue. All of these factors have been shown to have negative effects on the retina (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Testing the Biocompatibility of a Glutathione-containing Intraocular Irrigation Solution by Using an Isolated Perfused Bovine Retina Organ Culture Model — an Alternative to Animal Testing

et al. 2012

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The effects of a glutathione-containing intraocular irrigation solution, BSS Plus®, on retinal function and on the survival of ganglion cells in whole-mount retinal explants were studied. Evidence is provided that the perfused ex vivo bovine retina can serve as an alternative to in vivo animal testing. Isolated bovine retinas were prepared and perfused with an oxygen-saturated standard irrigation solution, and an electroretinogram was recorded to assess retinal function. After stable b-waves were detected, the isolated retinas were perfused with BSS Plus for 45 minutes. To investigate the effects of BSS Plus on photoreceptor function, 1mM aspartate was added to the irrigation solution in order to obtain a-waves, and the ERG trace was monitored for 75 minutes. For histological analysis, isolated whole retinal mounts were stored for 24 hours at 4°C, in the dark. The percentages of cell death in the retinal ganglion cell layer and in the outer and inner nuclear layers were estimated by using an ethidium homodimer-1 stain and the TUNEL assay. General swelling of the retina was examined with high-resolution optical coherence tomography. During perfusion with BSS Plus, no significant changes in a-wave and b-wave amplitudes were recorded. Retinas stored for 24 hours in BSS Plus showed a statistically significant smaller percentage (52.6%, standard deviation [SD] = 16.1%) of cell death in the retinal ganglion cell layer compared to the control group (69.6%, SD = 3.9, p = 0.0031). BSS Plus did not seem to affect short-term retinal function, and had a beneficial effect on the survival of retinal ganglion cells. This method for analysing the isolated perfused retina represents a valuable alternative for testing substances for their retinal biocompatibility and toxicity.

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“…TB is a vital dye with a good safety profile and a high affinity for the ERM but not for the ILM, making it suitable for ERM peeling but not for ILM peeling [14]. In contrast, BBG is an excellent stainer for visualizing the ILM.…”

Section: Introductionmentioning

confidence: 99%

“…This may result in a partial removal of the ERM and ILM and, in some cases, may lead to iatrogenic traumas to the retina [14].…”

Section: Introductionmentioning

confidence: 99%

The Combination of Trypan Blue and Brilliant Blue G-Assisted Vitrectomy for Macular Pucker: Histopathological Findings

et al. 2018

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Purpose: To report on the combined use of trypan blue (TB) and brilliant blue G (BBG) for staining the epiretinal membrane (ERM) and internal limiting membrane (ILM) during vitrectomy and to describe the histopathological findings. Methods: 10 surgical specimens were removed from 10 eyes with macular pucker during vitrectomy using a commercially available combination of TB and BBG for ERM and ILM staining and peeling. Specimens were evaluated using light and transmission electron microscopy. Results: In all cases the combination of TB and BBG was useful for identifying and delineating ERM and ILM. No complications related to the use of the dye were observed during or after surgery. Glial cells were present in all specimens. Hyalocytes were observed in 6 cases and myofibroblasts in 3 of them. In 7 cases native vitreous collagen fibrils were found on the ILM, while in 5 specimens newly formed collagen was present. No clinical evidence of toxicity was observed during the 3-month follow-up. Conclusion: The combined use of TB and BBG appeared to be very useful intraoperatively to improve the visualization of ERM and ILM, thus facilitating their complete removal. Anatomical and histopathological findings demonstrated the safety and the efficacy of this vital dye.

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Iatrogenic retinal traumas in ophthalmic surgery

Cited by 12 publications

References 174 publications

Pain during pars plana vitrectomy following sub-Tenon versus peribulbar anesthesia: A randomized trial

Pain during pars plana vitrectomy following sub-Tenon versus peribulbar anesthesia: A randomized trial

Testing the Biocompatibility of a Glutathione-containing Intraocular Irrigation Solution by Using an Isolated Perfused Bovine Retina Organ Culture Model — an Alternative to Animal Testing

The Combination of Trypan Blue and Brilliant Blue G-Assisted Vitrectomy for Macular Pucker: Histopathological Findings

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