Central retinal artery occlusion after peribulbar anesthesia

Abstract

We describe the development of central retinal artery occlusion (CRAO) in 2 patients after peribulbar (periconal) anesthesia during uneventful phacoemulsification. Although peribulbar anesthesia avoids direct optic-nerve injury, indirect injury presenting as CRAO may occur from vasospasm in response to the injection.

Vision loss and partial third nerve palsy following contralateral peribulbar anesthesia

“…Central retinal artery occlusion following peribulbar anesthesia presumably secondary to vasospasm in response to the injection, not from optic nerve sheath penetration, has also been reported. 6 Our patient had no significant brainstem signs besides the vision loss and partial third nerve palsy, and the CT of the brain and orbits was normal. The variation in symptoms and CT findings likely relates to individual anatomic variations, the force and volume of the anesthetic injection, and the depth of needle penetration.…”

An unusual complete fragmentation of a central venous catheter

“…To the Editor: Clinical reports have described resistance to muscle relaxants in a patient receiving testosterone therapy [1] or one who was diagnosed with testicular feminization [2]. Chronic elevation of circulating testosterone may lead to reduced sensitivity to steroidal nondepolarizing muscle relaxants.…”

Paracentral acute middle maculopathy as a finding in patients with severe vision loss following phacoemulsification cataract surgery

“…Small case series and several anecdotal case reports have been published describing central retinal artery occlusion (CRAO) or transient retinal artery occlusion (TRAO) following cataract surgery under local anaesthesia using retrobulbar, peribulbar or sub‐Tenon's techniques . We present a series of cases of immediate ‘patch‐off’ vision loss on day one post routine phacoemulsification cataract surgery.…”