Retrobulbar Research Articles

Perioperative analgesic effects of a modified supratemporal retrobulbar block in dogs undergoing corneal and endocular surgery.

To evaluate the perioperative efficacy of a modified supratemporal retrobulbar block in dogs undergoing ocular surgery. In this prospective randomized clinical trial, dogs were premedicated with dexmedetomidine (1 mcg/kg im) and methadone (0.1 mg/kg im), induced with propofol to effect and maintained with isoflurane (FE'Iso 1.1%). In the retrobulbar group a mixture of lidocaine 2% (5.5 mL) and ropivacaine 0.75% (2 mL) was administered at 0.1 mL/kg, via a modified supratemporal technique using a Tuohy needle. No block was performed in the controls. When heart rate or mean arterial pressure increased above 30% of the pre-incisional values, fentanyl (1 mcg/kg iv) was administered. Propofol (1 mg/kg iv) was injected when anaesthesia was deemed too light. After a total of three administrations regardless of the type of drugs (fentanyl/propofol), a constant rate infusion of fentanyl (5 mcg/kg/h iv) was started. Quality of recovery (blindly assessed using a descriptive score scale), postoperative eye rubbing and complications were studied. Eighteen dogs were included. The retrobulbar group (nine) dogs had significantly less risk of receiving fentanyl than controls (nine) (Relative risk: 0.142, 95% CI: 0.021 to 0.936) and a recovery score > 2 (RR: 0.058, 95% CI: 0.003 to 0.887). The median amount of fentanyl (mcg/kg) was statistically lower in the retrobulbar group than in the controls: 0 mcg/kg (range, 0 to 1) versus 2 mcg/kg (range, 0 to 8.49), respectively. Only controls showed eye rubbing. The modified supratemporal retrobulbar block reduced the intraoperative rescue analgesia and improved the quality of recovery.

Клиническое наблюдение гипоталамического ожирения у ребенка с нейрофиброматозом I типа и глиомой хиазмально-селлярной области

Neurofibromatosis (NF) is a genetic disorder characterized by the development of various types of benign or malignant tumors affecting ether the central or the peripheral nervous systems and manifested also on the skin in the form of “café au lait” spots as well as other signs sometimes. Thus, this disorder requires multidisciplinary approach. The clinical case observed in the Article is no exception.: a patient with coffee-colored spots all over the body from an early age was described with similar familial symptoms in the patient’s father, two brothers. At the age of 4 months old, after the first DTaP vaccination, nystagmus appeared, after the second vaccination - progressive deterioration of vision, and at the age of 3 to 4 years old the hearing loss joined in. For the 6 years the patient was observed by pediatrician, ophthalmologist, otolaryngologist and neurologist and received courses of retrobulbar injections of vascular-metabolic drugs, hardware treatment and physiotherapy with slightly positive effect. The first MR imaging of the brain was performed at the age of 7 y/o when a glioma was detected in the chiasmatic-sellar region. Starting the age of 7 y/o the patient gradually developed and increased hypothalamic obesity with subsequent metabolic complications in the forms of impaired glucose tolerance, hyperinsulinism and insulin resistance, arterial hypertension and non-alcoholic fatty liver disease. At the age of 12 a heterozygous mutation in the NF1 gene (deletion of 4 nucleotides) in exon 5 was detected: c.495_498delTGTT:p.T165fs, which made it possible to establish a diagnosis of NF type 1. This case reflects the multifaceted nature of the disease, the importance of a multidisciplinary approach and its early diagnosis.

Brainstem anesthesia as a complication of retrobulbar block (a case report)

The aim of this article is to present a clinical case of brainstem anesthesia after retrobulbar block. Local anesthesia is widely used and an effective method in ophthalmic surgery. It’s based on relatively simple technique of nerve blocks and their safety. However, there is a risk of both local and systemic complications after local anesthesia. Brainstem anesthesia is one of life-threatening systemic complications after retrobulbar block. Implementation of preventive measures described in this article can decrease the risk of this severe complication and emergency care in brainstem anesthesia can save patient’s health and life.

Local anesthesia in 23-gauge vitreoretinal surgery: A comparison of efficacy between retrobulbar and sub-Tenon’s injection

This study aimed to compare sub-Tenon’s and retrobulbar blocks during vitreoretinal surgery in terms of postoperative pain and surgeon experience. This prospective study included 53 patients scheduled for 23-gauge pars plana vitrectomy under local anesthesia. Patients were nonrandomly assigned to receive a xylocaine injection through either the transconjunctival sub-Tenon’s or retrobulbar routes, supplemented with intravenous (IV) sedation (midazolam + fentanyl). A sharp needle was used for both techniques. In the sub-Tenon’s group, anesthetic injection was initiated through subconjunctival administration after prepping and draping. Pain was assessed immediately postsurgery and the following day using a standardized questionnaire. Patient and surgeon satisfaction levels, along with complications in each group, were recorded. Of the 53 patients, 42 (79%) received the sub-Tenon’s block and 11 (21%) received the retrobulbar block. No statistically significant differences in pain scores, patient satisfaction, or surgeon satisfaction were found between the groups. Postoperative pain and surgeon satisfaction were negatively correlated in both groups (B = −0.465; P < 0.001), and a moderate-to-high correlation was observed between patient and surgeon satisfaction (B = 0.686; P < 0.001). Overall, sub-Tenon’s and retrobulbar blocks showed comparable effectiveness in terms of postoperative pain and patient and surgeon satisfaction in vitreoretinal surgery, with no significant differences in outcomes or complication rates.

Safety of a Medicinal Product Based on Human Glial Progenitor Cells: A Pilot Study of Retrobulbar Administration in C57BL/6J Mice

INTRODUCTION. Stem cell therapy is a promising treatment method for various diseases and injuries, but its safety has yet to be determined. Therefore, studying the safety of administering a xenogeneic cell-based medicinal product (CBMP) into the retro-orbital venous sinus is essential for developing protocols for further studies of potential medicinal products for neurological conditions.AIM. The aim of the study was to determine the optimal dose of a CBMP derived from glial progenitor cells (GPCs) and to evaluate its safety during retrobulbar administration in C57BL/6J mice.MATERIALS AND METHODS. GPCs were derived from human induced pluripotent stem cells by stepwise differentiation and cultured in DMEM/F12 supplemented with epidermal growth factor and ciliary neurotrophic factor. Matrigel was used as a substrate. GPCs were injected into the retro-orbital venous sinus of male C57BL/6J mice under isoflurane anaesthesia once a week for two months. The study analysed changes in biochemical blood parameters and behaviour. The quantities of activated astrocytes and glial cells were determined by postmortem immunohistochemical staining.RESULTS. The administration of GPCs at a dose of 500×103 cells/mouse, which was selected using literature data, induced an increase in the plasma levels of ala nine aminotransferase and aspartate aminotransferase. This could indicate cell damage and the development of inflammatory reactions. At doses reduced to one-third the initial GPC concentration or lower, the biochemical blood parameters of the treatment groups did not differ significantly from those of the control group. There were no significant differences in neuroinflammatory markers between the groups receiving GPCs at different doses, except for an increase in astrocyte activation at a dose of 150×103 cells/mouse, which could potentially indicate inflammatory processes in the brain. The study detected no pathological changes in the brain or cell damage markers in the blood of mice after retrobulbar GPC injections of 15×103 or 50×103 cells/mouse.CONCLUSIONS. The study results indicate that long-term therapy with GPCs is potentially safe for mice if the dose is optimal. The authors suggest using the optimal doses and the administration route established in this study for further research into the safety of intravenous administration of CBMPs for neurological conditions.

Ultrasound-guided Auriculopalpebral and Retrobulbar Nerve Blocks in Donkeys

Ultrasound-guided Auriculopalpebral and Retrobulbar Nerve Blocks in Donkeys

Biomechanical changes of tree shrew posterior sclera during experimental myopia, after retrobulbar vehicle injections, and crosslinking using genipin

Myopia is a common ocular condition characterized by biomechanical weakening revealed by increasing creep rate, cyclic softening scleral thinning, change of collagen fibril crimping, and excessive elongation of the posterior sclera resulting in blurred vision. Animal studies support scleral crosslinking as a potential treatment for myopia control by strengthening the weakened sclera and slowing scleral expansion. While multiple studies investigated aspects of the biomechanical weakening and strengthening effects in myopia and after scleral crosslinking, a comprehensive analysis of the underlying mechanical changes including the effect of vehicle injections is still missing. The purpose of this study was to provide a comprehensive analysis of biomechanical changes by scleral inflation testing in experimental myopia, after retrobulbar vehicle injections and scleral crosslinking using genipin in tree shrews. Our results suggest that biomechanical weakening in myopia involves an increased creep rate and higher strain levels at which collagen fibers uncrimp. Both weakening effects were reduced after scleral crosslinking using genipin at doses that were effective in slowing myopia progression. Vehicle injections increased mechanical hysteresis and had a small but significant effect on slowing myopia progression. Also, our results support scleral crosslinking as a potential treatment modality that can prevent or counteract scleral weakening effects in myopia. Furthermore, vehicle solutions may cause independent biomechanical effects, which should be considered when developing and evaluating scleral crosslinking procedures.

A modified supraorbital surgical approach for enucleation- exenteration in dromedary camels (camelus dromedarius): Clinical study.

Enucleation and exenteration are widely utilized ophthalmic procedures in veterinary field. Enucleation in camels is like other large animals, typically performed under the influence of heavy sedation and loco-regional analgesia. The aim of the current study was to introduce a new surgical approach to enucleate the eye of camels through supraorbital fossa approach. for that purpose, the technique was applied to seven camels referred to the King-fisal teaching veterinary hospital for unilateral enucleation. Assessment of applicability, safety and feasibility of this technique was done. All procedures were performed in the kush (sitting) position under the influence of heavy sedation with Xylazine HCl in combination with retrobulbar nerve block. A "C" shaped skin incision was made in the skin and fascia of the supraorbital fossa to enter the orbital cavity, after which the periorbital fat was gripped, dissected and removed. Bleeding controlled by electrocautery and visible large blood vessels were ligated. After ligation the optic nerve and ophthalmic blood vessels, the eyeball was dissected sharply and freed from the orbital bony attachment. Finally, the orbital fascia and skin were sutured with simple interrupted pattern separately. The approach proved successful in all camels, with the enucleation procedure being both feasible and easily performed. The mean surgical time was approximately 46.6±12.4 minutes. The minimal occurrence of short and long-term complications was encouraging, and the cosmetic outcomes were notably improved. The supraorbital approach is a safe and effective technique for camel ophthalmic surgery, showing advantages in exposure and minimal complications. Further research is needed for validation and broader clinical applications.

COMPARISON OF MEAN POSTOPERATIVE PAIN BETWEEN TOPICAL ANAESTHESIA AND RETROBULBAR ANAESTHESIA IN PATIENTS WITH PHACOEMULSIFICATION PROCEDURE FOR CATARACT SURGERY.

The purpose of the study was to compare the mean post-operative pain in patients undergoing phacoemulsification for cataract with topical anaesthesia vs. retrobulbar anaesthesia. An interventional study was carried out in a tertiary care hospital of Islamabad. The study duration was from 30th March 2021 to 29th September 2021. The adopted sampling technique was consecutive sampling. The sample size was 180 subjects divided into two groups of 90 each. Through the use of a lottery, patients were split into two groups of 90 each. Patients in group A received topical anaesthesia, whereas individuals in group B received retrobulbar anaesthesia. An Ophthalmologist performed a retrobulbar block on Group B using a 23-gauge needle and 5 mL of 2% Lidocaine. The researcher observes the patients for post-operative pain. SPSS 25 version was used for statistical analysis. The research study included 180 patients in total. Participants ranged in age from 40 to 70, with a mean age of 56.26±6.31 years, and 46% male vs. 54 % females. The study found the post-operative pain at 45 minutes after topical anaesthesia was 0.60±0.67 and after retrobulbar anaesthesia was 1.40±0.90 in patients undergoing phacoemulsification for cataract surgery. The results showed that Group A feel less pain compare to Group B and the significance value was (p .0001). The study concluded that topical anaesthesia is usually a best alternative for retrobulbar anaesthesia. The patient feel less pain with topical compared to retrobulbar anaesthesia.

Interventional Management Of Neuropathic Ocular Pain – A Scoping Review

Neuropathic Ocular Pain (NOP) is a debilitating and refractory pain condition. This scoping review is the first to summarize the current evidence of efficacy of interventional treatment options for NOP. Databases were searched for studies published up to March 31, 2023. Two reviewers screened and extracted data, and performed the risk of bias analysis. Twelve studies were included, consisting of 4 cohort studies and 8 case series/reports, with a total of 87 patients. Eight interventions were defined: stellate ganglion block (n=1), trigeminal nerve blocks (n=3), retrobulbar block (n=1), pulsed radiofrequency of sphenopalatine ganglion (n=1), Onabotulinum-Toxin A(n=1), trigeminal nerve stimulation (n=1), intrathecal drug delivery (n=1) and transcutaneous electrical trigeminal nerve stimulation (n=3). Procedures were found to be safe and demonstrated analgesic effect. Follow-up ranged from 24h to 12 months. Substantial heterogeneity across studies was found, and quality was deemed low and of moderate risk of bias. High-quality studies are urgently needed.

Comparison of the therapeutic effects of photodynamic therapy, transpupillary thermotherapy, and their combination on circumscribed choroidal haemangioma

ObjectiveTo characterize the clinical and imaging features of circumscribed choroidal hemangioma (CCH), and to evaluate individualized treatment efficiency of photodynamic therapy (PDT), transpupillary thermotherapy (TTT), or their combination, followed by retrobulbar injection of betamethasone on CCH resolvement. MethodsForty-nine patients with CCHs who underwent PDT, TTT or PDT+TTT treatments were retrospectively analyzed. Their treatment efficacy was compared by analyzing the change of best corrected visual acuity (BCVA), subretinal fluid (SRF) and CCH lesion characteristics. ResultsPDT, TTT and PDT+TTT were respectively administrated in 17, 11 and 21 patients. No significant difference in age, gender, affected eyes and tumor location across the three groups. Baseline BCVA were 0.41 ± 0.28, 0.62 ± 0.30 and 0.24 ± 0.24 for PDT, TTT and PDT+TTT groups, respectively (F = 6.572, P = 0.003). CCH treated by three strategies showed significant difference in maximum tumor basal diameter, SRF areas and macula involvement prior to the treatment (P < 0.05). Patients receiving PDT+TTT exhibited larger tumor basal diameter, more SRF, higher ratio of macular involvement than other groups. A total of 38 (77.6 %) cases had good visual acidity with final BCVA ≥0.5 after treatments. PDT and PDT+TTT treatment groups acquired more vision improvement (0.27 ± 0.23 and 0.31 ± 0.26) in BCVA than TTT group (0.09 ± 0.13). All SRF were resolved within two weeks of treatment and no recurrent SRF were found. ConclusionThe three treatments showed good performance in improving visual function and controlling SRF, and individualized treatment should be selected primarily by the tumor location, and then the tumor size and presence of SRF.

Comparison of preoperative retrobulbar bupivacaine and postoperative subcutaneous liposome-encapsulated bupivacaine on postoperative analgesia in dogs undergoing enucleation.

To compare the effectiveness of preoperative bupivacaine inferotemporal retrobulbar blocks to postoperative liposome-encapsulated bupivacaine (Nocita) line blocks for analgesia following enucleation. 39 client-owned dogs (40 eyes) presenting to the Ophthalmology Service for enucleation. Dogs were randomly assigned to receive either a preoperative inferotemporal retrobulbar block with 0.5% bupivacaine or a peri-incisional line block with liposome-encapsulated bupivacaine (Nocita) at closure. Patients underwent unilateral enucleation and were hospitalized for 24 hours after surgery. Pain scores were performed by a masked observer with the Glasgow Composite Measure Pain Scale and the University of Wisconsin Ocular Pain Scale at 0.25, 0.5, 1, 2, 4, 6, 8, and 24 hours following surgery. Intraoperative use of blood pressure and anesthetic support mediations as well as need for rescue pain control were recorded and compared between groups. There was no significant difference in rescue rates between treatment groups. When comparing the use of medical intraoperative heart rate, blood pressure, or anesthetic plane support, there were no significant differences in use between groups. Use of preoperative bupivacaine retrobulbar blocks and postoperative Nocita line blocks were equally effective at postoperative pain control with similarly low complication rates.

Systemic Treatment for Postnatal, Juvenile, and Runted Adult Mice by Retrobulbar Sinus Injection.

While tail vein injections are frequently used as a systemic route of delivery in adult mice, retrobulbar injections are an alternative method for systemic delivery with fewer limitations. First, tail vein injections (TVIs) are limited to adult mice where the size of the tail vein is suitable for access. Being restricted to treating adult mice can be problematic when dealing with mouse models that do not survive to adulthood. Second, TVIs are not feasible for mouse models with growth retardation phenotypes where the mice never achieve the size of adult wildtype mice. Therefore, retrobulbar injections can be successfully used to treat both young and small adult mice. Lastly, retrobulbar injections are performed under anesthesia, which is less stressful on the mice than TVIs that are commonly performed without anesthesia. This article presents a protocol and detailed instructions for retrobulbar injections that can be used for systemic delivery to small and young mice.

Comparative efficacy of low-volume retrobulbar anesthesia using three commercial local anesthetics in adult horses.

To compare the efficacy of low-volume (5-mL) locoregional retrobulbar anesthesia ("retrobulbar block") by use of 3 commercial local anesthetic formulations. 8 healthy adult mares. A block-randomized, masked, controlled design was used. A single ultrasound-guided retrobulbar block was performed with 2% lidocaine, 2% mepivacaine, or 0.5% bupivacaine (n = 5 eyes/group). Contralateral eyes served as untreated controls. End points performed at baseline and time intervals up to 24 hours postblock included the following: assessment of neurophthalmic reflexes/responses, intraocular pressure, and vertical pupil diameter measurement, corneal and periocular esthesiometry, and observation for adverse effects. Low-volume block did not result in increased intraocular pressure or other adverse effects at any time point in any treatment group. Statistically significant corneal anesthesia (P < .001) was observed 1 minute after block in all groups, persisting through 4 hours after lidocaine or mepivacaine block and through 24 hours after bupivacaine block. Clinically significant periocular anesthesia was not observed in any group. Significant vertical pupil diameter increase (P < .05) was observed for up to 4 hours after lidocaine or mepivacaine block and 6 hours after bupivacaine block. Low-volume retrobulbar block with any of the 3 local anesthetic drugs evaluated was not associated with adverse effects. In terms of efficacy, mepivacaine block showed no clinical advantage over lidocaine block. However, bupivacaine block induced comparatively rapid and sustained corneal anesthesia. In comparison to published findings using a larger injection volume, low-volume retrobulbar block with lidocaine produced clinically comparable corneal anesthesia. However, periocular soft tissue anesthesia was not achieved with any local anesthetic drug at low volume.

Blind supratemporal retrobulbar block in cats: a feasibility cadaveric study and its efficacy in a group of subjects undergoing corneal or intraocular surgery.

The supratemporal retrobulbar block (RB) has not been comprehensively described in cats. Cadaveric study: a modified supratemporal retrobulbar injection of 0.1 ml/kg of iomeprole and saline (1:3) was executed using a Tuohy needle in recently deceased cats. Cadavers underwent computed tomography before and following injections. Injectate distribution within the intraconal space was evaluated. Extraconal injections were considered a failure. Clinical study: cats undergoing corneal/intraocular surgery were included. After intramuscular premedication with methadone 0.3 mg/kg, dexmedetomidine 3 mcg/kg and alfaxalone 2 mg/kg and induction with intravenous (IV) alfaxalone to effect, isoflurane anesthesia was maintained with a target end-expired fraction of 1.1%. Cats were randomly allocated in the retrobulbar group [RG, receiving a modified supratemporal RB with 0.1 ml/kg of a mixture of 2% lidocaine (5.5 ml) and 0.75% ropivacaine (2 ml)] or control group (CG). When heart rate or mean arterial pressure increased above 20% of the pre-incisional values, fentanyl (1 mcg/kg IV) was administered. Alfaxalone (0.5 mg/kg IV) was injected when anesthesia was deemed too light. After a total of 3 interventions regardless the type of drugs (fentanyl/alfaxalone), a constant rate infusion of fentanyl (5 mcg/kg/h IV) was started. Anesthetist interventions, quality of recovery (blindly assessed using a descriptive score scale), postoperative eye rubbing, complications were studied. In the cadaveric study 8 eyes were included (success rate = 87%). The contrast agent spread was scored "moderate-to-large" or "large" in 85.7% of cases and a median 360° (180-360) distribution around the optic nerve was reported. In the clinical study 12 cats were included (6 in RG, 6 in CG). The median time to perform the RB was 35 s (20-50). Only the controls required anesthetist interventions [total amount of 6 (p = 0.0276): fentanyl (3/6) and alfaxalone (2/6)]. The RG had a significantly better recovery score (p = 0.0012) than CG. Only controls showed eye rubbing (3/6). The modified supratemporal RB is an achievable and rapidly performed technique. In this study it reduced intraoperative drug administration and improved recovery quality in cats undergoing corneal or intraocular surgery.

Comparison of Levobupivacaine over Lignocaine for Peribulbar Anesthesia in Cataract Surgery – A Randomized Control Study in a Tertiary Care Hospital

Abstract Introduction: Regional anesthesia is a better alternative whenever general anesthesia is undesirable or contraindicated. Peribulbar block is considered preferable over retrobulbar block in achieving anesthesia for intraocular and extraocular surgeries. It is widely used because it is easier to perform. Objectives: This study compares the efficacy of levobupivacaine over lignocaine for peribulbar anesthesia in cataract surgery. Methods: A prospective, randomized double-blinded study comparing levobupivacaine for peribulbar anesthesia in cataract surgery was done with 30 patients in each group. Included patients were randomly categorized into Group 1 and Group 2. Group 1 received lignocaine with adrenaline and Group 2 received 0.5% levobupivacaine with main outcome variables of the study intraoperative and postoperative pain, motor sensory onset, akinesia score, and analgesia duration. Results: In both the groups, there was no significant difference in terms of age and gender. There was statistical significance between the two groups in terms of motor blockade. There is a significant mean difference between Group 1 and Group 2 when compared with akinesia score with P &lt; 0.05. The pain was less in Group 2 than Group 1. There is no significant difference in both when compared with verbal pain score. Heart rate and blood pressure showed a difference. Conclusion: Topical anesthesia with levobupivacaine was more effective than lignocaine surgeries with better analgesia and lesser complication.

A novel enucleation- exenteration approach of the equine eye via the supraorbital fossa: an experimental and clinical study in donkeys (Equus asinus).

This study investigated the description and feasibility of a surgical procedure for enucleation-exenteration of the equine eye via the supraorbital fossa. A preliminary study was performed on both eyes of four cadaveric heads of native breed donkeys (Equus asinus) to describe the surgical anatomy and demonstrate a new supraorbital enucleation surgical approach. For the clinical study, eight donkeys were admitted for unilateral enucleation. All procedures were performed in a lateral recumbent position under the influence of inhalation anesthesia in combination with a retrobulbar nerve block. A semi-circular incision was made in the skin and fascia of the supraorbital fossa to gain access into the orbital cavity, after which the periorbital fat was dissected and removed. Bleeding was controlled by electrocautery and large blood vessels were ligated, then the eyeball was dissected sharply and freed from its bony attachment. The procedure was successfully accomplished in all clinical cases, and no significant complications occurred during or throughout the postoperative follow-up period. The initial results suggest the feasibility and safety of the supraorbital enucleation technique described in this study for equine eye enucleation. This new technique seems promising due to its feasibility, safety, and positive outcomes observed in both cadaveric and clinical studies.

Pain Management Strategies before Pan-Retinal Photocoagulation for Diabetic Retinopathy: A Systematic Review.

This systematic review aims to consolidate key findings regarding the efficacy of pain relief medications administered prior to pan-retinal photocoagulation (PRP) for diabetic retinopathy (DR). A comprehensive search of major databases from 1993 to 2023 was conducted. Clinical trials comparing pain relief drugs before PRP in patients diagnosed with DR requiring PRP treatment were eligible for inclusion. The assessment of pain scores involved the use of various scales, such as the visual analog scale (VAS), numerical rating scale (NRS), verbal rating scale (VRS), and other ordinal pain scales. In addition, laser parameters were taken into consideration during the analysis. Twenty-two clinical trials from initial 150 studies were included in the review. Nine studies evaluated the pain relief effects of nonsteroidal anti-inflammatories NSAIDs (selective NSAID and nonselective NSAID), two studies compared the effects of opioids (conventional opioids and atypical opioids), and eleven studies investigated the effects of benzodiazepines, lidocaine, and other sedatives. This review synthesizes findings from multiple studies reporting pain as an adverse outcome of PRP in patients with advanced DR. Based on the evidence from reviewed clinical trials, the administration of lidocaine 2% via transconjunctival, retrobulbar, or peribulbar block along with specific NSAIDs, such as topical ketorolac administrated 24 hours before treatment or oral diclofenac potassium (50 mg) prior to PRP, demonstrated beneficial effects among patients with DR.

Incident glaucoma and ocular hypertension after periocular and intravitreal steroid injections: a claims-based analysis

Background/aimsThis study aims to determine the incidence and risk of open-angle glaucoma or ocular hypertension (OHT) following ocular steroid injections using healthcare claims data.MethodsWe retrospectively reviewed deidentified insurance claims data...

Efficacité et intérêt des injections rétrobulbaires de hyaluronidase dans le traitement des cécités compliquant une injection faciale d’acide hyaluronique : revue de la littérature

Hyaluronic acid injections are becoming increasingly common among both the general public and the medical community, but they are not without risks. The occurrence of blindness, although rare, is a tragic event for both the patient and the practitioner. One of the treatments proposed in the literature is to inject hyaluronidase as close as possible to the site of ischemia, retrobulbarly. The aim of our study is to evaluate the effectiveness and potential benefits of retrobulbar hyaluronidase injections. A literature review was conducted using the PubMed database. Only articles addressing retrobulbar hyaluronidase injections for the treatment of blindness following hyaluronic acid injections were included. We identified 12 case reports or series, comprising a total of 16 patients. Among these 16 patients, 3 regained their vision. Hyaluronidase was injected between 20minutes and 7days after the onset of the complication, with injected doses ranging from 3×150IU to 3×1500IU. Literature reveals only 3 cases of successful treatment out of the 16 reported injections. The time interval before retrobulbar injection, as well as the dose and the experience of the injecting practitioner, may influence the success rate of this treatment. Other treatments, such as intravascular hyaluronidase injections, remain to be explored.