Persistent diplopia after retrobulbar anesthesia

Han, Soo Kyung; Kim, Jeong Hun; Hwang, Jeong Min

doi:10.1016/j.jcrs.2003.09.064

Cited by 33 publications

(23 citation statements)

References 20 publications

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“…However, retrobulbar anaesthesia administration is an invasive procedure with possible vision threatening and systemic complications. 8,11,[20][21][22][23][24][25][26][27][28][29][30][31] Peribulbar anaesthesia is as effective as retrobulbar anaesthesia and appears to lead to fewer sight-and life-threatening complications. 9,11,32,33 Subtenon anaesthesia is another alternative with fewer risks, 10 but it is still an invasive treatment in patients.…”

Section: Discussionmentioning

confidence: 99%

Interventions for relieving pain associated with panretinal photocoagulation: a prospective randomized trial

Hsu

et al. 2005

Eye

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Section: Discussionmentioning

confidence: 99%

Interventions for relieving pain associated with panretinal photocoagulation: a prospective randomized trial

Hsu

et al. 2005

Eye

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“…Regionalblockaden zählt [18,20,22,38,50,58]. Dies mag sich v. a. dadurch erklären, dass skelettmuskuläre Schädigungen nach der Gabe von Lokalanästhetika zwar obligatorisch zu entstehen scheinen, in vielen Fällen jedoch funktionell inapparent bleiben und sich höchstwahrscheinlich innerhalb weniger Wochen zurückbil-den [14,28,29].…”

Section: Myotoxizität Von Lokalanästhetikaunclassified

“…Dies mag sich v. a. dadurch erklären, dass skelettmuskuläre Schädigungen nach der Gabe von Lokalanästhetika zwar obligatorisch zu entstehen scheinen, in vielen Fällen jedoch funktionell inapparent bleiben und sich höchstwahrscheinlich innerhalb weniger Wochen zurückbil-den [14,28,29]. Andererseits kommen verschiedene Studien und Fallberichte zu dem Schluss, dass bestimmte lokoregionäre Verfahren mit einer bemerkenswert hohen post operativen Inzidenz an klinisch relevanten Dysfunktionen der Skelettmuskulatur einhergehen, die wiederum eindeutig auf direkte myotoxische Effekte von Lokalanästhetika zurückzu-führen sind [20,22,38,45,50]. In diesem Zusammenhang sind in erster Linie Retro-bzw.…”

Section: Myotoxizität Von Lokalanästhetikaunclassified

“…Allerdings relativiert eine nicht unerhebliche Zahl von Studien und Fallberichten diese offensichtliche Diskrepanz. Diese kommen einhellig zu dem Schluss, dass bestimmte lokoregionäre Verfahren mit einer unerwartet hohen postoperativen Inzidenz an klinisch relevanten Dysfunktionen der Skelettmuskulatur einhergehen, die wiederum direkt auf myotoxische Effekte der verwendeten Lokalanästhetika zurückzu-führen sind [18,20,50]. Am häufigsten werden in diesem Zusammenhang Störungen der Augenmotilität nach Peri-bzw.…”

Section: Klinische Aspekteunclassified

“…Am häufigsten werden in diesem Zusammenhang Störungen der Augenmotilität nach Peri-bzw. Retrobulbärblo-ckaden bis hin zu persistierenden Diplopien beobachtet, die eindeutig auf einer direkten Schädigung der äußeren Augenmuskeln durch Lokalanästhetika (zumeist Mischungen aus Lidocain und Bupivacain) beruhen [17,18,20,23,42,45,50]. Diese toxizitätsbedingten Zwischenfälle sind insofern wenig überraschend, da die äußeren Augenmuskeln, deren Fasern im Vergleich zur Muskulatur des Kör-perstamms bzw.…”

Section: Klinische Aspekteunclassified

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Myotoxizität von Lokalanästhetika

et al. 2007

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Intramuscular injections of local anaesthetic agents regularly result in reversible muscle damage, with a dose-dependent extent of the lesions. All local anaesthetic agents that have been examined are myotoxic, whereby procaine produces the least and bupivacaine the most severe muscle injury. The histological pattern and the time course of skeletal muscle injury appear relatively uniform: hypercontracted myofibrils become evident directly after injection, followed by lytic degeneration of striated muscle sarcoplasmic reticulum myocyte edema and necrosis. Intriguingly, in most cases myoblasts, basal laminae and connective tissue elements remain intact which subsequently ensures complete muscular regeneration. Subcellular pathomechanisms of local anaesthetic myotoxicity are still not understood in detail. Increased intracellular Ca(2+) levels are suggested to be the most important element in myocyte injury, since denervation, inhibition of sarcolemmal Na(+) channels and direct toxic effects on myofibrils have been excluded as sites of action. Although experimental myotoxic effects are impressively intense and reproducible, only few case reports of myotoxic complications in patients after local anaesthetic administration have been published. In particular, the occurrence of clinically relevant myopathy and myonecrosis has been described after continuous peripheral blockades, infiltration of wound margins, trigger point injections, peribulbar and retrobulbar blocks.

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Usefulness of magnetic resonance imaging in a patient with diplopia after cataract surgery

Kim

Hwang

2010

Graefes Arch Clin Exp Ophthalmol

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Dear Editor, Binocular diplopia after cataract surgery could develop in patients with previously unrecognized cranial nerve palsy [1][2][3]. We found a 77-year-old man who developed diplopia for the first time in his life after bilateral phacoemulsification under topical anesthesia.A 77-year-old man with no history of strabismus or diplopia presented with persistent diplopia that developed after cataract surgery and persisted for over the 6 months after cataract surgery. Phacoemulsification and posteriorchamber intraocular lens implantation with a clear corneal incision were performed under topical anesthesia in the left eye; these procedures were performed in the right eye 5 weeks later at a local clinic. Bridle suture was not placed in either of the eyes. Subconjunctival gentamicin and subTenon's dexamethasone were administered inferotemporally. There was no past medical history of head trauma and no family history of strabismus.On examination, visual acuity was 20/20 in both eyes. He showed a head tilt to the left, and asymmetric face with the right fuller face. He had exotropia of 25 prism diopters (PD) and right hypertropia of 16 PD in the primary position, exotropia of 20 PD and right hypertropia of 16 PD in the right gaze, and exotropia of 25 PD and right hypertropia of 25 PD in the left gaze. With the head tilt to the right, he showed exotropia of 30 PD and right hypertropia of 18 PD, and with head tilt to the left, exotropia of 20 PD and right hypertropia of 16 PD. He showed right superior oblique underaction and inferior oblique overaction (Fig. 1).Magnetic resonance (MR) imaging by using a 3-Tesla system (Intera Achieva; Philips, Best, The Netherlands) with T2-weighted imaging of the orbit and high-resolution imaging of the cranial nerves in the brain stem was performed as previously described [4]. Severe hypoplasia of the right superior oblique muscle was observed (Fig. 2a-c), and the right trochlear nerve was not identified in the perimesencephalic cistern (Fig. 2d-f).Binocular diplopia after the cataract surgery could be attributable to the method of anesthesia [1-3]. Extraocular muscle damage may be the most common cause of binocular diplopia after local anesthesia, and decompensation of preexisting strabismus is the most common presentation after topical anesthesia [1][2][3]. In this patient, the cataract surgery was performed under topical anesthesia. Therefore, the possibility of local anesthetic-induced myotoxicity was eliminated. In addition, no dysfunction of the superior or inferior rectus muscles was noted; instead, decreased activity of the superior oblique muscle and increased activity of the inferior oblique muscle were evident. Further, the results of a three-step test were positive, and facial asymmetry suggesting a long-standing superior oblique palsy was noted. Whether the superior oblique palsy was congenital or acquired can be determined by identifying the trochlear nerve on high-resolution MR imaging of the cranial nerves.

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Persistent diplopia after retrobulbar anesthesia

Cited by 33 publications

References 20 publications

Interventions for relieving pain associated with panretinal photocoagulation: a prospective randomized trial

Interventions for relieving pain associated with panretinal photocoagulation: a prospective randomized trial

Myotoxizität von Lokalanästhetika

Usefulness of magnetic resonance imaging in a patient with diplopia after cataract surgery

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