ABSTRACT
BACKGROUND: Retrobulbar anaesthesia in ocular surgery leads to a temporary sensory blockade of the nervus opticus. The purpose of this study was to investigate the effect and duration of this anaesthesia on the visual system and to find out whether there is any relation to the patient's age, oral premedication, time of oculopression and the axial length of the operated eye. MATERIALS AND METHODS: A total of 57 patients with a mean age of 77.4 +/- 9.5 years were included in the study. All patients received retrobulbar injection of 4cc Xylonest(R) 2 %/Dur-Anest(R) 1 % (3 : 1). Visual evoked potential (VEP) was recorded before and shortly after retrobulbar anaesthesia and several times after cataract surgery (45 min to 6 hours after surgery). The latency period and amplitude of the P100 deflection of the VEP were analysed. A possible correlation to the above-mentioned variables was evaluated statistically. RESULTS: Directly after retrobulbar injection of the anaesthetic and at the first postoperative VEP recordings the VEP recordings showed a decreased amplitude and an increased latency period. All measured values returned to normal within 2 hours after the retrobulbar injection, proving that the conductivity block of the optic nerve was temporary. There was a poor correlation between patients' age, ocular length of the operated eye and the degree of reduction of the recorded VEP. No correlation could be found between time of oculopression, premedication and the alteration of the VEP. CONCLUSION: Retrobulbar anaesthesia with 4cc of a mixture of Xylocain/Dur-Anest leads to a temporary conductivity block in the optic nerve for about 2 hours.
Subject(s)
Anesthesia, Local , Cataract Extraction , Evoked Potentials, Visual/drug effects , Lidocaine , Optic Nerve/drug effects , Age Factors , Aged , Aged, 80 and over , Electroencephalography/drug effects , Evoked Potentials, Visual/physiology , Female , Follow-Up Studies , Humans , Lenses, Intraocular , Male , Optic Nerve/physiopathology , Postoperative Complications/physiopathology , Reaction Time/drug effects , Reaction Time/physiology , Reference Values , Risk Factors , Synaptic Transmission/drug effects , Synaptic Transmission/physiologyABSTRACT
PURPOSE: To evaluate endothelial cell loss after phacoemulsification with posterior chamber intraocular lens implantation using peribulbar anesthesia or topical anesthesia combined with intracameral unpreserved lidocaine 1%. SETTING: Department of Ophthalmology, Charité, Humboldt-University of Berlin, Berlin, Germany. METHODS: Before and 20 months +/- 5.1 (SD) after surgery, specular microscopy was used to evaluate the number and morphology of endothelial cells in 78 eyes having peribulbar anesthesia or topical anesthesia combined with an intracameral injection of 0.15 cc unpreserved lidocaine 1%. RESULTS: The mean endothelial cell loss was 11.11% in the peribulbar group and 12.55% in the topical/lidocaine group. There was no statistically significant difference in the amount of endothelial cell loss or cell morphology between the 2 groups. CONCLUSION: The long-term postoperative endothelial cell course showed that topical anesthesia combined with an intracameral injection of 0.15 cc unpreserved lidocaine 1% is a safe alternative to peribulbar anesthesia.