RESUMO
Four patients had central retinal artery occlusions after retrobulbar anaesthesia with lidocaine HCl was administered before photocoagulation. One of these four had two separate episodes of closure. Only one had permanent visual loss and none had evidence of retrobulbar hemorrhage. Each patient had a severe hematologic or vascular disorder. We think that direct trauma to the central retinal artery behind the globe, the pharmacologic or compressive effects of the injected solution,or both caused the occlusions in these patients. (AU)
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Arteriopatias Oclusivas/fisiopatologia , Lidocaína/efeitos adversos , Retina/cirurgia , Artéria Retiniana/fisiopatologia , Anestesia Local/efeitos adversos , Arteriopatias Oclusivas/induzido quimicamente , Olho , Artéria Retiniana/efeitos dos fármacos , Artéria Retiniana/lesões , Doenças Retinianas/cirurgia , Injeções/efeitos adversos , Fotocoagulação/efeitos adversosRESUMO
In two patients with sickle cell disease (one hemoglobin SC and one hemoglobin SS), central retinal artery occlusion developed. In one case, the occlusion followed a retrobular injection of lidocaine hydrochloride. Although the central retinal artery reperfused in each patient, many secondary peripheral retinal ateriolar occlusions remained. During the subsequent days, multiple salmon-patch hemorrhages developed in the distribution of these occluded arterioles. In one patient, the salmon-patch hemorrhages evolved into atrophic schisis cavities. These unusual cases allowed us to document the origin of salmon-patch hemorrhages after peripheral retinal arteriolar occlusions. The development of the hemorrhages was a delayed phenomenon that occurred hours to days after the initial vascular occlusion. Reperfusion of the damaged ischemic vessels with a blowout of the walls of the vessels seems the most likely explanation for this phenomenon. (Au)
