Reactions 1262 - 25 Jul 2009

SMepivacaine/ropivacaine

Central retinal artery occlusion followingperibulbar anaesthesia: 3 case reports

A 77-year-old woman (patient 1), a 71-year-old woman(patient 2) and a 58-year-old man (patient 3) developedcentral retinal artery occlusion following peribulbaranaesthesia with mepivacaine or ropivacaine.

Patient 1, who had a history of hypertension anddepressive syndrome, both of which were treated, and a1-week history of loss of vision in her right eye, wasscheduled for retinal detachment repair. She receivedperibulbar anaesthesia with 17mL of ropivacaine and acompression with a Honan’s balloon was maintained at30mm Hg for 30 minutes. Patient 2, who had a history ofmental depression that was treated, was scheduled forcataract surgery. She received peribulbar anaesthesia with14mL of mepivacaine and compression was maintained at30mm Hg for 10 minutes. Patient 3, who hadRecklinghausen’s disease, was scheduled for removal of apterygium of his left eye; he lost the vision in his right eyebecause of an optic nerve neurofibroma. He receivedperibulbar anaesthesia with 13mL of ropivacaine. All threepatients reported loss of vision after surgery [time to onsetnot clearly stated]. Fundoscopy showed whitening of theretina in the posterior pole, consistent with a typicalocclusion of the central retinal artery, which was laterconfirmed by angiography. [Patient outcomes not stated.]

Author comment: "[T]he involved mechanism is not clear.The high injected volume, the speed of injection, a prolongedexternal compression of the ocular globe at a high pressure,and, finally, an eventual intrinsic vasoconstricting effect ofropivacaine and mepivacaine may be cited."Calenda E, et al. Central retinal artery occlusion after peribulbar anesthesia: reportof 3 cases. Acta Anaesthesiologica Belgica 60: 47-50, No. 1, 2009 -France 801146138

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Reactions 25 Jul 2009 No. 12620114-9954/10/1262-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved