Retinal vascular occlusion after vitrectomy with retrobulbar anesthesia-observational case series and survey of literature

Tappeiner, Christoph; Garweg, Justus (2011). Retinal vascular occlusion after vitrectomy with retrobulbar anesthesia-observational case series and survey of literature. Graefe's archive for clinical and experimental ophthalmology, 249(12), pp. 1831-1835. Berlin: Springer-Verlag 10.1007/s00417-011-1783-9

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BACKGROUND: Severe postoperative loss of vision has been occasionally reported as a rare complication of retrobulbar anesthesia, and several possible causes have been proposed in the literature. In this work, our own and other investigators' experiences with these complications are surveyed with a view to identifying its pathophysiology. PATIENTS: This observational case series refers to six patients who presented during a 3-month period with occlusion of either the central artery itself (n = 3) or a branch thereof (n = 3) 2-14 days after uneventful vitreoretinal surgery following retrobulbar anesthesia with a commercial preparation of mepivacaine (1% Scandicain®, Astra Chemicals, Sweden) containing methyl- and propyl parahydroxybenzoate as preservatives. RESULTS: Three of the patients carried risk factors, which were medically controlled. In three individuals, vasoocclusion was observed after a second vitreoretinal intervention, which was performed 3-12 months after uneventful primary surgery. Good visual recovery was observed in only one instance. CONCLUSIONS: In patients who were anesthetized with preservative-free mepivacaine, no vasoocclusion occurred. In individuals who were anesthetized with mepivacaine containing the preservatives methyl- and propyl parahydroxybenzoate, a tenfold increase in the incidence of eyes requiring re-operation was documented, with a 2- to 14-day lapse in the onset of vasoocclusion. These findings reveal a possible implication of preservatives contained in the local anesthetic solution for the vasoocclusive events. Due to this potential hazard, the use of preservative-free preparations of local anesthesia in ocular surgery is emphasized in order to prevent this sight-threatening complication.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ophthalmology

UniBE Contributor:

Tappeiner, Christoph and Garweg, Justus

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0721-832X

Publisher:

Springer-Verlag

Language:

English

Submitter:

Christoph Tappeiner

Date Deposited:

04 Oct 2013 14:16

Last Modified:

23 Oct 2019 15:10

Publisher DOI:

10.1007/s00417-011-1783-9

PubMed ID:

21850439

Web of Science ID:

000297751000013

BORIS DOI:

10.7892/boris.4539

URI:

https://boris.unibe.ch/id/eprint/4539 (FactScience: 208815)

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