Reactions 1376 - 5 Nov 2011

★ SBupivacaine

Vision loss and angle closure glaucoma (firstreport) following inadvertent intracameraladministration in an elderly patient: case report

A 68-year-old woman developed vision loss and angleclosure glaucoma following inadvertent intracameraladministration of bupivacaine.

The woman underwent upper eyelid blepharoplasty. Sheinadvertently received an intracameral injection of amixture of 50:50 lidocaine 2% with 1:100 000 epinephrineand bupivacaine 1.5% buffered with sodium bicarbonate.Immediately after the injection, she developed pain.Examination revealed pupillary dilation and cornealoedema.

The anterior chamber was washed out with a balancedsalt solution. The woman received dorzolamide/timolol,methazolamide, bimatoprost and brimonidine for elevatedintraocular pressure (IOP) of up to 52mm Hg. Five weeksafter surgery, her visual acuity was 20/200 in the affectedeye. Examination showed a 0.6 log unit relative afferentpupillary defect, with an IOP of 45mm Hg. Slit-lampexamination revealed diffuse microcystic corneal oedema,a centered posterior chamber intraocular lens, a superiorlyand inferiorly retracted iris, and dense pigment on theepithelium. Central corneal thickness in the affected eyewas 532µm. Gonioscopy showed 270° of peripheralanterior synechiae; angle structures were visible in thesuperior quadrant only. Following seton placement 2 dayslater, her visual acuity improved to 20/50 and her IOPbecame stable. Mild corneal haze remained, and specularmicroscopy disclosed endothelial cell loss (471 cells/mm2).

Author comment: "[W]e postulate that bupivacaine and/orthe preservative was the inciting factors responsible for angleclosure and endothelial damage."Parikh M, et al. Vision loss after inadvertent corneal perforation during lidanesthesia. Ophthalmic Plastic and Reconstructive Surgery 27: e141-e142, No. 5,Oct 2011. Available from: URL: http://dx.doi.org/10.1097/iop.0b013e31822d5d6d -USA 803062133

» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous case reports of angleclosure glaucoma associated with bupivacaine. The WHOADR database contained 2 reports of glaucoma associatedwith bupivacaine.

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Reactions 5 Nov 2011 No. 13760114-9954/10/1376-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved