Retrobulbar Research Articles

Ultrasonographic features of intraocular lymphoma

Objective To describe the ultrasonographic features of intraocular lymphoma. Methods It was a retrospective analysis of 19 patients (26 eyes) with intraocular lymphoma at the department of ophthalmology, Beijing Tongren Hospital from January 2015 to December 2017. The diagnosis was established by tissue biopsy in 4 patients with diagnostic vitrectomy and 8 with enucleation, and other 7 cases were clinically diagnosed followed by pathological examination of central nervous system lymphoma. The ultrasonographic features of all patients were analyzed. Results Of the 19 patients (26 eyes) with intraocular lymphoma, 12 cases (19 eyes) of vitreoretinal lymphoma accounted for 63.2%, of which 7 cases were bilateral eyes, and 7 cases (7 eyes) of uveal lymphoma accounted for 36.8%, all of which were monocular. Ultrasonography of vitreoretinal lymphoma included vitreous opacity, posterior vitreous detachment, partial retinal detachment, irregular hypoechoic lesions under the retina, and CDFI detected blood flow signals in the lesion. There were two different types of ultrasound findings in uveal lymphoma. Five cases (5 eyes) showed diffuse thickening of the uveal membrane with low echo, and irregular hypoechoic mass around the optic nerve and the ball wall, in which CDFI detected abundant blood flow signals. Ultrasound biological microscope examination showed that the iris-ciliary body thickened and the internal echo decreased. This ultrasound finding accounted for 71.4% of uveal lymphoma. Two cases (2 eyes) showed a solitary ciliary-choroid choroidal hypoechoic mass, combined with retinal detachment and blood flow signals with CDFI, accounting for 28.6% of uveal lymphoma. Conclusions The ultrasonography of intraocular lymphoma is various. The ultrasound findings of vitreoretinal lymphoma are not specific, while the diffuse thickened uvea and retrobulbar hypoechoic lesions encircled optic nerve and eye wall suggest the possibility of uveal lymphoma. Key words: Ultrasonography, Doppler, color; Uvea diseases; Intraocular lymphoma

Assessing “Cell Therapy” Clinics Offering Treatments of Ocular Conditions using Direct-to-Consumer Marketing Websites in the United States

"Cell therapy" is becoming increasingly available to the public via online direct-to-consumer advertisement within the United States (U.S.). The current study investigates the scope of "cell therapy" clinics across the U.S.that advertise and offer "cell therapy" for ocular conditions based on information provided on their websites. Cross-sectional study. The study included companies that are U.S.-based, participate in direct-to-consumer online marketing, have websites that can be data-mined with content analysis, and advertise therapy for ocular conditions. Using a systematic, extensive keyword-based Internet search, content analysis of company websites was utilized to identify, document, and analyze U.S. businesses marketing "cell therapy" for ocular conditions as of September 16,2017. Clinic locations, source of stem cells used, route of administration, marketed ocular conditions, and cost of treatment. Forty companies with 76 clinics use "cell therapy" to treat ocular conditions. California (23), Florida (12), and Illinois (10) contain the most clinics. All 40 companies specified sources of cells, which included autologous adipose-derived stem cells (35; 67%), autologous bone marrow-derived stem cells (8; 15%), amniotic stem cells (2; 4%), peripheral blood-derived stem cells (2; 4%), umbilical cord blood stem cells (2; 4%), allogenic bone marrow-derived stem cells (1; 2%), placental stem cells (1; 2%), and xenocells (1; 2%). The most commonly marketed ocular conditions included macular degeneration (35), optic neuritis (18), retinitis pigmentosa (17), and diabetic retinopathy (16). The most common routes of administration were intravenous (22) and "unspecified" (12); however, other companies listed more ocular-specific routes such as intravitreal injections (2), retrobulbar injections (2), eye injections (2), retrofundal injection (1), sub-Tenon injection (1), intraocular injection with vitrectomy (1), and eye drops (1). The cost of advertised "cell therapy" ranged from $4000 to $10 500. "Cell therapy" for ocular conditions is readily available via direct-to-consumer marketing strategies across the United States. The "cells" are harvested from numerous sources and administered through different methods for multiple ocular conditions at these "cell therapy" clinics. Limited data for these treatments necessitates advocating caution to physicians and patients about treatments offered at commercial "cell therapy" clinics.

Brainstem Anaesthesia after Retrobulbar Block.

Regional anaesthesia techniques in ophthalmology are usually utilized for day case surgery. During various procedures, profound akinesia of the eye and anaesthesia of the surgical site are required, both of which are achieved with retrobulbar block. Due to the anatomy of the eye, life-threatening complications are possible. An 82-year-old female with secondary post-herpetic uveitic glaucoma of the right eye presented at the Department of Ophthalmology for an elective trans-scleral laser cyclophotocoagulation. She was given a retrobulbar block to the right eye with 2 mL of 0.5% levobupivacaine and 2 mL of 2% lidocaine. The procedure was technically performed without any issues. 2-3 minutes after the injection she became lethargic and 5 minutes later she lost consciousness and developed severe hypotension with bradycardia and respiratory arrest. She was successfully intubated and resuscitated, using mechanical ventilation, vasoactive medications, fluid therapy and intravenous lipid emulsion. There are three mechanisms for local anaesthetic (LA) to reach the central nervous system after a retrobulbar block: systemic absorption of LA, direct intra-arterial injection and retrograde flow into the cerebral circulation, and injecting LA into the subdural space via puncturing the dural optic nerve sheath, the latter being most common. The clinical picture of our patient was very consistent with subdural anaesthesia after exposure of the pons, midbrain and cranial nerves to LA, i.e. brainstem anaesthesia. Following appropriate life support measures taken in our case, there was a successful outcome. To minimize the chance for brainstem anaesthesia after retrobulbar block, we recommend low volume with low concentration of LA and block performance by an experienced ophthalmologist or anaesthesiologist with proper technique. Patients receiving retrobulbar anaesthesia should be carefully monitored at least 20 minutes after the block. Life support equipment should be available before performing retrobulbar block.

Efficacy of Care for Blind Painful Eyes.

Pain relief for a blind painful eye often follows an escalating paradigm of interventions. This study compares the efficacy of common interventions. A retrospective chart review of blind painful eye cases was conducted at a single tertiary institution from April 2012 to December 2016. Demographics, etiology, treatment, and pain level were assessed. Among 99 blind painful eyes, 96 eyes initially received medical therapy (topical steroids, cycloplegics, and/or hypotensives), with pain relief in 39% of eyes. Minimally invasive interventions (laser cyclophotocoagulation, retrobulbar injection, or corneal electrocautery) were performed 41 times in 36 eyes, 34 of which had failed medical therapy, and led to pain relief in 75% of eyes. Evisceration or enucleation was performed in 28 eyes, and long-term pain relief was achieved in 100% of eyes. Surgery allowed discontinuation of oral analgesics in 100% of cases versus 20% for minimally invasive therapy (p = 0.005) and 14% for medical therapy (p = 0.0001). Compared with medical therapy, minimally invasive therapy was 2.5 times more likely to achieve lasting pain relief (p = 0.003) and surgical therapy 35.6 times more likely to achieve lasting pain relief (p = 0.011). High initial pain score was associated with nonsurgical treatment failure. Medical therapy provides pain relief in a moderate number of patients with a blind painful eye. When medical therapy fails, minimally invasive therapy and surgical interventions are successively more effective in relieving ocular pain. High initial pain score is a risk factor for nonsurgical therapy failure and may merit an earlier discussion of surgical intervention.

Efficacy of Preoperative Administration of Acetaminophen and Melatonin on Retrobulbar Block Associated Pain in Cataract Surgery: A Letter to Editor.

Efficacy of Preoperative Administration of Acetaminophen and Melatonin on Retrobulbar Block Associated Pain in Cataract Surgery: A Letter to Editor.

Reduction of oculocardiac reflex with Tetracaine eye drop in strabismus surgery

ABSTRACTIntroduction: Recently, to reduce the incidence of oculocardiac reflex (OCR) in strabismus surgery, retrobulbar block and anticholinergic drugs or local anesthesia are also used. The present study evaluated the effects of Tetracaine eye drop as a topical nerve blocker on OCR during strabismus surgery.Methods and materials: In this randomized trial, 70 strabismus surgery candidates were randomly divided into placebo or synthetic teardrop (E) and Tetracaine eye drop (T) groups, so 3 drops of each solution were dropped in four directions of patients’ eye immediately after applying anesthesia and before surgery. The incidence and severity of OCR during the stages of muscle release and incision (cutting), hemodynamic changes, the required time for OCR recovery and atropine dose were assessed.Results: OCR was more seen in release phase compared to cutting phase. There were no significant differences between two group regarding the incidence and severity of OCR in the release phase (p > 0.05), but the incidence and severity of OCR in the cutting phase was more in group E than group T (p = 0.02, for both). The duration of OCR improvement (p-value = 0.74) and Atropine consumption (p-value = 0.92) did not differ between the groups.Conclusion: Tetracaine eye drop only reduces the incidence and severity of OCR during the incision stage of strabismus surgery.

Retrobulbar dexmedetomidine in pediatric vitreoretinal surgery eliminates the need for intraoperative fentanyl and postoperative analgesia: A randomized controlled study

Purpose:This study evaluated the efficacy of retrobulbar ropivacaine plus dexmedetomidine compared with systemic fentanyl in pediatric vitreoretinal (VR) surgery.Methods:This prospective double-blind, randomized controlled study was performed in 60 children undergoing VR surgery, age from 2 to 7 years. After general anesthesia, the following procedure was administrated: (1) retrobulbar block with 0.5% ropivacaine plus dexmedetomidine 1 μg/kg (group RD, n = 20), (2) retrobulbar block with 0.5% ropivacaine (group RB, n = 20), and (3) control group with general anesthesia only (group F, n = 20). Hemodynamics, postoperative pain scores, anesthetics consumption (remifentanil, propofol, fentanyl), and emergence agitation were recorded.Results:Respiratory depression was observed in 7 of the 20 patients in group F after the laryngeal mask airway was removed in the operating room, compared with none in groups RD and RB. All patients in group F required intraoperative rescue fentanyl (average intraoperative fentanyl consumption, 26.6 ± 12.6 μg per patient). Some rescue fentanyl was required in group RB (three patients required one dose of rescue fentanyl). Patients in group RD required none. Groups RD and RB reported lower pain scores than group F at 4 h postoperatively (RD group: P < 0.001; RB group: P =0.002); pain scores in group RD were lower than that in group F at 6 h postoperatively (P < 0.001).Conclusion:Retrobulbar dexmedetomidine as an adjuvant to ropivacaine is a safe and effective alternative to systemic fentanyl. This regimen provides better pain management, hemodynamic stability, and stress response suppression in pediatric VR surgery.

Unilateral blindness after percutaneous injection sclerotherapy of orbital venous malformation presenting as orbital cellulitis

This study pertains to a case of central retinal artery occlusion (CRAO) and complete unilateral blindness after intralesional injection of a sclerosing agent into orbital venous malformation (VM) presenting as orbital cellulitis. A 20-year-old female underwent a direct injection of 6 mg of bleomycin with a 23G needle into an orbital VM infiltrating the retrobulbar area and compressing the optic nerve. She was discharged without any complication after 24 h but reported back after 15 days with complete loss of vision in the right eye. Her visual acuity in the right eye was reduced only to perception of light. Fundoscopy of the right eye revealed signs of CRAO. Magnetic resonance imaging of the orbit showed a decrease in the size and enhancement of orbital VM. After 2 weeks, her visual acuity remained up to light perception. Permanent visual loss should be kept in mind as a disastrous complication of sclerosing therapy in a patient with orbital and paraorbital VM encroaching the retrobulbar area. In addition, orbital venolymphatic malformations may present as orbital cellulitis.

Efficacy and Safety of a Novel Blunt Cannula Trans-Sub-Tenon's Retrobulbar Block for Vitreoretinal Surgery.

PURPOSE:To evaluate a novel trans-sub-Tenon's retrobulbar block (TSTRB) compared to sub-Tenon's block (STB) and peribulbar block (PBB) anesthesia for vitreoretinal surgery.METHODS:This study was a prospective evaluation of cases undergoing TSTRB, STB, or PBB. The Kallio scale and Brahma scales were used to score hemorrhage and extraocular motility, respectively. Pain was documented on a visual analog score graded (1–10) at induction, intraoperatively, and postoperatively, any confounding variables were noted.RESULTS:Seventy eyes have been used in this analysis, of which TSTRB was used in 37% (n = 26), PBB in 34% (n = 24), and STB in 29% (n = 20). Postoperative analgesia was required by 10% (n = 2) of STB and 8% (n = 2) of PBB; none of the TSTRB cases required analgesia (P = 0.003). The mean volume required with each technique was as follows: TSTRB, 4.8 ml; STB, 5.3 ml; and PBB, 10.4 ml (P = 0.030). The volume of anesthesia was correlated with the level of proptosis and even more important affected the ease of surgery most (P = 0.005). Akinesia was greatest with TSTRB > PBB > STB (P = 0.040). There were no complications such as brainstem anesthesia, globe perforation, or retrobulbar hemorrhage.CONCLUSION:Intentionally extending a STB into the retrobulbar space, via a TSTRB fenestration utilizes a familiar skill set. TSTRB produced the best levels of reduced kinesia during surgery and increased duration of postoperative analgesia. The technique uses a small-volume anesthesia.

The Effect of Prostaglandin Analogue Bimatoprost on Thyroid-Associated Orbitopathy.

PurposeWe characterize the effect of bimatoprost on orbital adipose tissue in thyroid-associated orbitopathy (TAO) with clinicopathologic correlation.MethodsOrbital adipose-derived stem cells (OASCs) from types 1 and 2 TAO and control patients with and without exposure to 1 μm bimatoprost were examined via immunohistochemistry, RT-PCR, and Western blot for cell viability, migration capacity, lipid content, adipocyte morphology, mitochondrial content, and levels of adipogenic markers. A retrospective chart review was performed for clinicopathologic correlation. In mice, optical coherence tomography and pattern electroretinography were performed at baseline and at 1 month following a retrobulbar injection of bimatoprost, followed by orbital exenteration for histopathologic examination.ResultsTypes 1 and 2 TAO-derived cells had a significantly higher migration capacity and lipid content than those of healthy controls. With the addition of bimatoprost, types 1 and 2 TAO and control adipocytes exhibited a significant decrease in lipid content with morphologic transformation into smaller and multilocular lipid droplets, and an increase in mitochondrial load and UCP-1 expression consistent with an increase in brown adipose tissue turnover. Retrobulbar injection of bimatoprost in mice did not alter the gross morphology, retinal thickness, or ganglion cell function in vivo.ConclusionsBimatoprost inhibits adipogenesis in OASCs and upregulates pathways involved in the browning of adipocytes. Furthermore, retrobulbar injection of bimatoprost is tolerated without immediate adverse effects in mice. Our results suggest a potential future application of prostaglandin analogues in the treatment of TAO.

The Influence of Aging on the Relationship between Retrobulbar Blood Flow and Retinal Microcirculation in Glaucoma Patients

Background and Hypothesis: Glaucoma is a multifactorial disease; therefore, different patient populations may be more susceptible to developing glaucoma due to distinct factors. The hypothesis of this study was that the relationship between retrobulbar blood flow velocity and the amount of avascular area in the peripapillary retina in glaucoma patients differs based on patient age. &#x0D; Project Methods: Data from 18 glaucoma patients aged ≥70 years old (75.9±5.4) and 24 glaucoma patients aged &lt;70 (60.5±8.6) were used in this analysis. Peak systolic and end diastolic velocities (PSV/EDV) of nasal and temporal posterior ciliary arteries (N/TPCA) were measured using color Doppler imaging (CDI) in order to assess retrobulbar blood flow velocities. Heidelberg Retinal Flowmetry (HRF) was used to quantify the amount of superior avascular area (SAA) and inferior avascular area (IAA) of the peripapillary retina. &#x0D; Results: In patients ≥70 years of age, a negative correlation was detected between retrobulbar blood flow velocity and IAA (r=−0.45 for NPCA-PSV, r=−0.36 for NPCA-EDV, r=−0.35 for TPCA-PSV, r=−0.45 for TPCA-EDV). This is in contrast to the positive correlation seen in patients &lt;70 years of age (r=0.45 for NPCA-PSV, r=0.39 for NPCA-EDV, r=0.55 for TPCA-PSV, r=0.69 for TPCA-EDV). Correlation coefficients between the two age groups were significantly different (p&lt;0.01, p&lt;0.05, p&lt;0.01, and p&lt;0.0001 respectively). &#x0D; Conclusion and Potential Impact: The relationship between blood vessels supplying the eye and retinal microcirculation is significantly different based on patient age. This suggests that different age populations may have distinct risk profiles for glaucoma. A more complete understanding of population dependent risk factor profiles may assist glaucoma screening and early detection. &#x0D;

Real-time ultrasound-guided retrobulbar block vs blind technique for cataract surgery (pilot study).

BackgroundRetrobulbar regional eye block aims to ensure eye globe akinesia and anesthesia during ophthalmic surgery, and despite the rarity of occurrence of complications due to the blind needle passage while performing either peribulbar or retrobulbar block, some of them are serious and may be life threatening.AimThe aim of this study was to estimate the accuracy and safety of real-time ultrasound-guided retrobulbar regional anesthesia in comparison with the blind technique for cataract surgery.DesignThis was a prospective randomized controlled trial.MethodologyA total of 30 patients who met the inclusion criteria were registered in our research and were divided into two groups: 15 patients received real-time ultrasound-guided retrobulbar block compared to 15 patients who received the block using the blind technique.ResultsOne patient out of the 30 was excluded from the analysis, and no statistically significant differences were observed between the two groups regarding the onset of akinesia, numeric pain rating scores, rate of complications, and degree of patient and physician satisfaction.ConclusionThere were no statistically significant difference between real-time ultrasound-guided and blind retrobulbar regional eye blocks concerning the onset of action, total volume of injected local anesthetic solution, supplemental injection required, pain scores, and degree of patient satisfaction.

Research on retrobulbar hemodynamics in senile patients with ischemic ophthalmopathy measured by color Doppler ultrasound

Objective To investigate the retrobulbar hemodynamic changes in elderly patients with ischemic ophthalmopathy(IOP). Methods Three groups of 35 elderly unilateral IOP(n=35 patients), 32 elderly normal eye(n=32 volunteers)and 30 non-elderly normal eye(n=30 volunteers)were recruited in our hospital for the IOP or not, for elderly(aged≥60)or not(aged <60). The peak systolic velocity(PSV), end-diastolic velocity(EDV), resistance index(RI), color Doppler blood stream spectrum form and arm-retinal circulation time(A-RCT)in both ophthalmic artery(OA)and central retinal artery(CRA)were measured on three groups by color Doppler flow imaging(CDFI)and fundus fluorescein angiography(FFA). Results Compared with elderly normal eye group, or with non-elderly normal eye group, the elderly unilateral IOP group showed that PSV and EDV of both OA and CRA were decreased, RI was increased, CD blood stream spectrum form was changed and A-RCT was prolonged(all P 0.05), while CD blood stream spectrum form was changed(P<0.05). Conclusions In the elderly unilateral IOP patients, PSV and EDV of both OA and CRA are decreased, RI is increased, blood stream spectrum form is changed, and A-RCT is prolonged.The color Doppler ultrasound-detected hemodynamic changes are displayed clearly so that CDFI can provide a reliable evidence for clinical diagnosis of IOP. Key words: Senile ischemic ophthalmopathy; Ultrasonography; Hemodynamics

Efficacy of Preoperative Administration of Acetaminophen and Melatonin on Retrobulbar Block Associated Pain in Cataract Surgery.

BackgroundRetrobulbar block is one of the chosen methods for local anesthesia in cataract surgery. Since it is a painful procedure, using analgesic and sedative drugs is recommended. Current medications have side effects and evaluating of new drugs or new uses of existing safer drugs is necessary.ObjectivesThe aim of this study was to compare the administration of melatonin and acetaminophen on pain and hemodynamic changes during retrobulbar block.MethodsIn a double-blinded randomized trial, 180 patients undergoing cataract surgery were randomly divided into three groups: Melatonin group (received melatonin 6 mg), acetaminophen group (received acetaminophen 500 mg), and control group (received placebo). All drugs were administered orally 60 min before arrival to the operating room by nurses blinded to the drugs administered. All patients received fentanyl 0.5 μg/kg before retrobulbar block intravenously. Hemodynamic variables and pain score in each patient were evaluated on arrival in the operating room, during retrobulbar block, during surgery, 20 min after operation, at the end of surgery, and in the recovery room. In case of pain score more than three, additional fentanyl was administered. All data were recorded in structured data sheets.ResultsData analysis indicated no significant differences among the groups at baseline on any of the demographic variables. Both acetaminophen and melatonin reduced the pain score significantly compared with control during retrobulbar block (P < 0.05 and P < 0.01, respectively). Administration of additional fentanyl was significantly lower in the melatonin group than the control group (P < 0.05). Hemodynamic changes were not significantly different among all groups.ConclusionsFor the first time, as far as we have studied, the analgesic effect of acetaminophen on the retrobulbar block was indicated. We also showed that melatonin can reduce pain during retrobulbar block leading to reduction of additional fentanyl during operation. It seems that both melatonin and acetaminophen may have a beneficial effect on pain control in the retrobulbar block.

Profil du glaucome néovasculaire chez les patients sénégalais

To describe the etiologies, clinical presentation and therapeutic management of neovascular glaucoma (NVG) in Senegalese patients. We retrospectively studied the records of patients followed for NVG between 1993and 2016. We included eyes with Iridis rubeosis with or without ocular hypertension. We recorded age, sex, medical and ophthalmologic history, results of the eye examination, treatment modalities broken up into hospitalisation, procedural interventions and number of antiglaucoma medications prescribed. The data analysis was performed by epi-info 7. Forty-eight eyes of 44patients were included. The mean age was 59.7years and sex ratio 2.1. Etiologies were type 2diabetes in 31.8% cases and central retinal vein occlusion in 16.6% cases. All eyes were blind. Eye pain was present in 75% of eyes, a limbal flush in 29.1% of eyes and mydriasis in 31.25% of eyes. Mean intraocular pressure was 49.7mmHg. Corneal edema occured in 54.1% of eyes. Fundus examination showed proliferative retinopathy in 14.5%. Treatment required hospitalisation for 43.75% of patients. Therapeutic procedures were cyclocryoapplication for 31.25% of eyes, retrobulbar xylo-alcohol injection for 14.5% of eyes and panretinal laser photocoagulation (PRP) for 12.5% eyes. Antiglaucoma preparations were used in dual therapy for 29% of eyes, in triple therapy and quadruple therapy for 25% of eyes each. The etiologies are comparable to those described in the literature. The diagnosis was late and treatment limited by adverse economic conditions. NVG in Senegalese patients is an affection of men in their sixties. It is responsible for irreversible painful blindness for which treatment is difficult - thus the interest in prevention by strict monitoring and prompt treatment of any retinal ischemia.

Anesthetic effect of Dexmedetomidine added to Ropivacaine in prosthesis implantation

Objective To evaluate the anesthetic effect of Dexmedetomidine added to Ropivacain in one-stage prosthesis implantation. Methods Thrity-two eyes of 32 cases who received prosthesis implantation under retrobulbar anesthes with Dexmedetomidine of 0.5 μg/kg added to 0.75% Ropivacaine for and subtascia loacl anesthesia in one-stage prosthesis implantation. Results The vital signs were stable during operation. No pain or intolerable phenomenon occurred. The pain, chemosis, nausea and vomiting after surgery were very slighter. Conclusion Dexmedetomidine added to Ropivacaine for the retrobulbar anesthesia in one-stage prosthesis implantation can accelerate the onset time of sensory and motor blocks, prolong the duration of sensory and motor blocks, and provide more effective postoperative analgesia. Key words: Ropivacaine; Dexmedetomidine; Implantation, prosthesis

Effects of retrobulbar or intravitreal injection of triamcinolone acetonide combined with laser photocoagulation for diabetic macular edema

Effects of retrobulbar or intravitreal injection of triamcinolone acetonide combined with laser photocoagulation for diabetic macular edema

Comparison of preemptive analgesic effect of retrobulbar block and intravenous fentanyl in pediatric strabismus surgery

The aim of this study was to compare the analgesic effect of the retrobulbar block with IV Fentanyl in children undergoing strabismus surgery.

Magnesium sulphate versus Dexmedetomidine as adjuvants for local anasthetics in peribulbar block for eye surgeries: Clinical comparative study

Background: Regional anesthesia is a preferred technique for ophthalmic surgery. It is safe, inexpensive and provides efficient ocular anesthesia for ophthalmic surgery. It is associated with less hemodynamic instability, less respiratory depression, better postoperative pain relief, and less nausea and vomiting compared to general anesthesia. Among regional blocks, peribulbar block is safer in comparison with retrobulbar block due to a lesser incidence of serious complications such as brain stem anesthesia, globe perforation, and retrobulbar hemorrhage. Objective: The aim of the study was to compare the safety and efficacy of the use of Magnesium sulfate versus that of Dexmedetomidine as an adjuvant to the local anesthetic in peribulbar anesthesiaas for inducing optimal operating conditions for eye surgery in terms of akinesia (as a primary end point), analgesia, incidence of complications, as well as patient and surgeon satisfaction (as secondary end points). Patients and Methods: The present study included 50 patients (females and males) aged 20-80 years. Materials: Anesthetic drugs, Needles size: 25 gauge, Intravenous cannula 22 G, Drugs for premedications: intravenous midazolam (5mg/ml, Mediathetic, Amoun, Egypt) (0.01mg/kg) and Fentanyl Citrate (50µg/ml, Fentanyl- Janssen, Belgium) (25 µg)was administrated 5minutes before the block, Monitors for vital signs registration were done for each of the following: Electrocardiograph (ECG), non-invasive blood pressure (NIBP), heart rate (HR) and oxygen saturation (SpO2), respiratory rate (RR), Anesthetic machine, resuscitation equipment and drugs. Results: The current study was carried on 75 patients divided into Three equal groups: first group (control group), second group (dexmedtomedine group) and third group (magnesium sulphate group). All patients were scheduled for surgery. Conclusion: Addition of 50 mg of magnesium 10% or 15 mic of dexmedetomidine to local anesthetic mixture for peribulbar anesthesia in the operations of phacoemulsification of cataract and intraocular lens implantation accelerated onset of globe anesthesia, akinesia of the globe and the lid, prolonged the duration of globe akinesia, lid akinesia, time to 1st analgesic request, and enhanced the satisfaction of the patients and quality of the operative conditions.

Comparative Study between Effects of Addition of Fentanyl versus Dexmedetomidine to Local Anesthetic Mixture for Peribulbar Block for Cataract Surgery

Background: regional anesthesia is currently more preferable than general anesthesia in ophthalmic surgery and include many types as; peribulbar (extraconal) and retrobulbar (intraconal) anesthesia. Peribulbar block is commonly used because there is reduced risk of globe perforation and optic nerve damage in different to retrobulbar block, but it needs sometimes block supplementations to improve the quality of the block such as clonidine and hyaluronidase. Also, fentanyl and dexmedetomidine was added in this study as an adjuvant to local anesthetics in peribulbar block for cataract surgery. Objective: the aim of this study was to evaluate and compare the effect of adding fentanyl and dexmedetomidine as adjuvants to local anaesthetic mixture in peribulbar block as regards duration (anesthesia and akinesia), efficacy and pain relief. Patients and Methods: in this study sixty patients of ASA I-III of both gender, aged 30-60 years arranged into three equal groups (group S, group F and group D) received peribulbar block for phacoemulsification with intraocular lens implantation operation. Group F and group D received fentanyl and dexmedetomidine respectivly with local anaethetics (LA) solution and showed statistically significant difference in onset and duration of globe akinesia respectively compared to group C which received local anaethetics (LA) solution only. Results: the onset of globe analgesia was significant in group F and group D compared to Group S. Postoperative pain was assessed by using a 5-points verbal rating score and recorded data showed significant difference between the three groups with better postoperative pain control in group F and group D. There was no statistical significant difference between the two groups as regarding the hemodynamics (MBP, HR and SPO2) and the incidence of complications. Conclusion: the current study concluded that adding fentanyl or Dexmedetomidine to local anaethetics (LA) in peribulbar block significantly reduced the time of onset of globe akinesia and analgesia and reduced the need for second injection. Also, it increased the duration of globe akinesia and analgesia with better postoperative pain control.