Scleral perforation during retrobulbar and peribulbar anesthesia: risk factors and outcome in 50 000 consecutive injections

Edge, Roger; Navon, Sam

doi:10.1016/s0886-3350(99)00143-1

Cited by 106 publications

(46 citation statements)

References 32 publications

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“…He was able to subcategorize block-induced periocular bleeding into three groups: (1) minor hemorrhage caused by damage to a vein or small artery that produces a palpable elevation in intraocular pressure (IOP); (2) arterial hemorrhage producing rapid proptosis and raised IOP; and (3) concealed hemorrhage in which blood remains within the muscular cone and produces elevations in IOP without visible evidence of orbital hemorrhage. In a review of 50,000 eye blocks, Edge and Navon [5] found that myopia is only a significant risk factor for inadvertent perforation when associated with staphyloma.…”

Section: Retrobulbar Anaesthesiamentioning

confidence: 99%

Local Anaesthesia in Cataract Surgery

Reddy

Thevi

2017

International Journal of Ophthalmic Research

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nerves of the cornea and the conjunctiva (long and short ciliary nerves, nasociliary nerves). This technique eliminates the possible complications of injectable anesthesia. However, it does not eliminate pain sensitivity of the iris, the zonule, and the ciliary body which is achieved by intracameral technique of anesthesia with preservative free 1% lidocaine. In a constantly evolving arena, the sub-Tenon's block has gained popularity while the deep angulated intraconal (retrobulbar) block has been largely superseded by the shallower extraconal (peribulbar) approach. Hyaluronidase is a useful adjuvant because it promotes local anesthetic diffusion and hastens block onset time but there is a possibility of getting an allergic reaction. Ultrasound-guided eye blocks afford real-time visualization of needle position and local anesthetic spread. An advantage of sonic guidance is that it may eliminate the hazard of globe perforation by identifying abnormal anatomy, such as staphyloma. INTRODUCTIONThe ideal anaesthesia would be one that provides adequate pain relief during surgery and postoepratively, be easy to administer and have minimal complications. For doing cataract surgery, the anaesthesia could be local or general. Majority of cataract patients are operated under local anaesthesia (infiltration, topical, intracameral). The infiltration anaesthesia is given as retrobulbar or peribulbar or subTenon's block. Carl Koller first used cocaine as a topical anaesthetic for eye surgery in 1884 [1] . The general anaesthesia has its own complications in elderly cataract patients and most of them may have diabetes or hypertension or heart diseases or combination of them. No need of fasting before or after surgery, no need of intubation, no need of using any systemic medications are the advantages of local anaesthesia. However, cataract in children, patients with parkinsonism, deaf mute patients, mental retardation patients, patients ABSTRACTThere has been a significant evolution in surgical technique of cataract extraction. The technical advances in phaco machines, phacotips, and availability of ophthalmic viscoelastic devices have played a great role in cataract surgery to be faster and more controlled now than before. Similarly, local anesthesia techniques in cataract surgery have also advanced significantly from retrobulbar, peribulbar, sub-Tenon's, to topical anaesthesia. Even though, the sub-Tenon's anesthesia technique reduced the risk of complications of peribulbar/ retrobulbar anesthesia but the technique is still associated with a possibility of damage to optic nerve, retrobulbar hemorrhage, and ocular muscle injury. Topical anesthesia is used to block the afferent EDITORIAL

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Section: Retrobulbar Anaesthesiamentioning

confidence: 99%

Local Anaesthesia in Cataract Surgery

Reddy

Thevi

2017

International Journal of Ophthalmic Research

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“…The incidence is between 1 of 350 and 7 of 50,000 cases. 29,30 Main risk factors include inadequate experience of the physician and a highly myopic eye (ie, long eyeball). 30 In a 50,000 case experience, Edge and Navon 29 observed that myopic staphyloma was the greater risk factor.…”

Section: Figmentioning

confidence: 99%

Regional anesthesia for eye surgery

Ripart

Nouvellon

Chaumeron

2005

Regional Anesthesia and Pain Medicine

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“…Previous studies have suggested the following risk factors for globe perforation: posterior staphyloma, 8 long axial length 9 and inexperienced personnel. 10 None of the patients presented here had posterior staphyloma and only Case 1 had an axial length at the upper end of the normal range at 25.5 mm.…”

Section: Commentmentioning

confidence: 99%

“…Although the exact mechanism of action remains uncertain, it is likely that absorption of the contained sympathomimetic agents through the nasal mucosa (as has been reported for cocaine 7,8 ), aggravated by the patient sitting in a darkened room to relieve his photophobia, was the trigger factor in an, albeit low, hypermetropic patient to produce bilateral AACG. We would suggest that the packaging of such products should alert patients (and their doctors) to this risk.…”

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confidence: 99%

Globe perforation by the second peribulbar injection

Ball

Woon

Smith

2002

Eye

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Globe perforation by the second peribulbar injection JL Ball et al 663reported case where the use of a nasal decongestant has been linked to the development of bilateral AACG. Although the exact mechanism of action remains uncertain, it is likely that absorption of the contained sympathomimetic agents through the nasal mucosa (as has been reported for cocaine 7,8 ), aggravated by the patient sitting in a darkened room to relieve his photophobia, was the trigger factor in an, albeit low, hypermetropic patient to produce bilateral AACG. We would suggest that the packaging of such products should alert patients (and their doctors) to this risk.

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Scleral perforation during retrobulbar and peribulbar anesthesia: risk factors and outcome in 50 000 consecutive injections

Abstract: Eyes with posterior staphyloma sustained needlestick injuries at a rate of 1 in 760 compared with 0 injection perforations in more than 44,000 nonstaphylomatous eyes.

Cited by 106 publications

References 32 publications

Local Anaesthesia in Cataract Surgery

Local Anaesthesia in Cataract Surgery

Regional anesthesia for eye surgery

Globe perforation by the second peribulbar injection

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