Amaurosis and contralateral cranial nerve pairs III and VI paralysis after peribulbar block – Case report

Leme, Fábio Caetano Oliveira; Moro, Eduardo Toshiyuki; Ferraz, Alexandre Alberto Fontana

doi:10.1016/j.bjane.2016.07.003

Cited by 3 publications

(5 citation statements)

References 18 publications

(18 reference statements)

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“…Ocular penetration can lead to many serious complications such as retinal breaks, vitreous hemorrhage (VH), subretinal hemorrhage (SRH), and RD [ 21 ] Identifying a globe perforation at the time of the injection is not easy. A previous paper reported that globe perforations were noticed in 18 of 20 eyes within one week after, and such as our case, globe perforation was identified on the first day after surgery due to VH in 15 eyes [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Inverted ILM Flap for a Needle Injury to the Macula after Peribulbar Anaesthesia: A Case Report and Literature Review

Scampoli

Governatori

Bernardinelli

et al. 2023

Life

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Globe perforation following peribulbar anesthetic injection is a rare but dreaded complication that often results in poor visual outcomes. This case report is on a female patient who sustained vitreous hemorrhage, retinal detachment, and macular breaks due to a peribulbar block administered in the setting of cataract extraction. The retina was repaired with pars plana vitrectomy, endolaser of the peripheral retinal break only, and an internal limiting membrane inverted flap for the macular breaks to avoid the endolaser on the macular area, achieving stable visual outcomes. The authors discussed various modes of local anesthesia for vitreoretinal surgery, risks for globe perforations, and how to approach retinal detachment secondary to needle perforations, which are complex cases at high risk for proliferative vitreoretinopathy. Early recognition and intervention in eyes with an inadvertent perforation can lead to a good outcome. Eyes with a longer axial length, superior, and multiple perforations are at higher risk of developing complications such as retinal detachment and vitreous hemorrhage. Complications such as retinal detachment, macular injury, and vascular occlusion are risk factors for poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Inverted ILM Flap for a Needle Injury to the Macula after Peribulbar Anaesthesia: A Case Report and Literature Review

Scampoli

Governatori

Bernardinelli

et al. 2023

Life

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“…Accidental ocular perforation can be caused by many risk factors including long axial length, posterior staphyloma, the use of inappropriate instruments, uncooperative patients, and inexperienced personnel administering the block. Ocular perforation can lead to many serious complications, such as retinal break, VH, SRH, and RRD [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…These techniques are straightforward, easy, and safe to perform by trained ocular surgeons or anesthetists [ 1 ]. PBA is considered safer and easier to administer than intraconal retrobulbar anesthesia [ 2 ]. However, although PBA is a relatively safe technique, it is not impervious to risks [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…PBA is considered safer and easier to administer than intraconal retrobulbar anesthesia [ 2 ]. However, although PBA is a relatively safe technique, it is not impervious to risks [ 2 ]. Some rare intraocular complications do result from mechanical injury of the needle, such as retinal breaks, hemorrhage around retinal breaks, vitreous hemorrhage (VH), retinal detachment (RD), or subretinal hemorrhage (SRH) [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Optic Nerve Injury, Vitreous Hemorrhage, and Rhegmatogenous Retinal Detachment Following Long Needle Peribulbar Anesthesia: A Case Report and Article Review

Alrajhi¹,

Almalki²,

Alqahtani³

2022

Cureus

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Rhegmatogenous retinal detachment (RRD) following retrobulbar or peribulbar anesthetic injection is a rare but serious complication that often results in poor visual outcomes. Thus, extreme caution should be exercised while administering local ocular anesthesia due to the potential complications arising from local orbital anesthesia. These complications may occur locally or systemically and may arise immediately or be delayed. This case report is on a female patient who sustained optic nerve injury and RRD due to a peribulbar block administered in the setting of cataract extraction and, subsequently, experienced retinal detachment and vitreous hemorrhage at another hospital before being referred to our hospital. The retina was repaired with pars plana vitrectomy, 360 endolaser of the peripheral retina and around tears, and gas injection, achieving stable visual outcomes.

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“…Although peribulbar anaesthesia is considered to be a safer alternative to retrobulbar anaesthesia for cataract surgery, transient or serious complications have been reported in the literature such as amaurosis and contralateral cranial nerve III (ptosis, and medium-sized pupils unresponsive to light stimulus) and VI nerve paralysis after peribulbar block which recovered completely after four hours [46] , Purtscher-like retinopathy (ischemic retinal whitening in a peripapillary pattern) [47] , central retinal artery occlusion [48][49][50] , transient complete visual loss and a partial third nerve palsy in the contralateral eye (probably due to trans optic nerve sheath spread of injected anaesthetic drug) [51] . Periocular necrotizing fasciitis after local retrobulbar anesthesia injection and facial block for cataract surgery in the left eye and canthotomy/cantholysis for treatment of moderate retrobulbar hemorrhage in the same eye was reported by Gelaw and Abateneh [52] .…”

Section: Complicationsmentioning

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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Amaurosis and contralateral cranial nerve pairs III and VI paralysis after peribulbar block – Case report

Cited by 3 publications

References 18 publications

Inverted ILM Flap for a Needle Injury to the Macula after Peribulbar Anaesthesia: A Case Report and Literature Review

Inverted ILM Flap for a Needle Injury to the Macula after Peribulbar Anaesthesia: A Case Report and Literature Review

Optic Nerve Injury, Vitreous Hemorrhage, and Rhegmatogenous Retinal Detachment Following Long Needle Peribulbar Anesthesia: A Case Report and Article Review

Local Anaesthesia in Cataract Surgery

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