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      Iatrogenic central retinal artery occlusion following retrobulbar anesthesia with adrenaline for vitreoretinal surgery: a case report

      case-report

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          Abstract

          Background

          We describe a patient presenting with central retinal artery occlusion (CRAO) of the right eye after retrobulbar anesthesia with adrenaline for macular pucker surgery.

          Case presentation

          The patient, a 67-year-old Caucasian man, developed a CRAO postoperatively by the next-day control likely due to the retrobulbar injection of a combination of Xylocaine and Bupivacaine with adrenaline as anesthetic.

          Conclusions

          The addition of adrenaline to the standard anesthetic solution could be a risk factor for serious complications, such as CRAO.

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          Most cited references34

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          Retrobulbar anesthesia and retinal vascular obstruction.

          The cases of three patients who developed combined central retinal artery/vein obstruction secondary to retrobulbar anesthesia are presented. In one case the obstruction was presumably present immediately after surgery, while in the other two it was observed to evolve over a period of several days. A dilated optic nerve sheath was demonstrated by contact B-scan ultrasonography in two cases and by computerized tomography in the third case, suggesting intravaginal sheath hemorrhage as a common underlying pathophysiologic process. Partial return of vision was evident in the latter case following orbitotomy with optic nerve sheath decompression.
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            Retinal vascular occlusion after vitrectomy with retrobulbar anesthesia-observational case series and survey of literature.

            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.
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              Central retinal artery occlusion after peribulbar anesthesia.

              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.
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                Author and article information

                Contributors
                filippo.confalonieri01@gmail.com
                Journal
                J Med Case Rep
                J Med Case Rep
                Journal of Medical Case Reports
                BioMed Central (London )
                1752-1947
                9 August 2022
                9 August 2022
                2022
                : 16
                : 303
                Affiliations
                [1 ]GRID grid.55325.34, ISNI 0000 0004 0389 8485, Department of Ophthalmology, , Oslo University Hospital, ; Kirkeveien 166, 0450 Oslo, Norway
                [2 ]GRID grid.5510.1, ISNI 0000 0004 1936 8921, Center for Eye Research, Department of Ophthalmology, , Institute for Clinical Medicine, University of Oslo, ; Kirkeveien 166, 0450 Oslo, Norway
                [3 ]Department of Biomedical Sciences, Humanitas Huniversity, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan Italy
                [4 ]GRID grid.38603.3e, ISNI 0000 0004 0644 1675, Department of Ophthalmology, , University of Split School of Medicine and University Hospital Centre, ; Split, Croatia
                Author information
                http://orcid.org/0000-0003-4079-8881
                Article
                3518
                10.1186/s13256-022-03518-0
                9361630
                35941712
                375bc204-d996-4411-a00c-25e594178551
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 7 April 2022
                : 4 July 2022
                Categories
                Case Report
                Custom metadata
                © The Author(s) 2022

                Medicine
                ophthalmology,retina,central retinal artery occlusion,anesthesia,adrenaline,ocular surgery
                Medicine
                ophthalmology, retina, central retinal artery occlusion, anesthesia, adrenaline, ocular surgery

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