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Choi WJ, Song WJ. Transient unilateral exotropia after an infraorbital local anesthetic injection: a case report. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2022. [DOI: 10.14730/aaps.2022.00465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report a case of transient unilateral exotropia, a rare complication that occurred after an infraorbital local anesthetic injection, and present the possible mechanism underlying this adverse effect. A 64-year-old man underwent an excisional biopsy under local anesthesia for bilateral lower eyelid masses. He received a subcutaneous injection of a local anesthetic (a combination of 1:100,000 epinephrine and 2% lidocaine). Intraoperatively, we observed a homogeneous, fat-attenuated mass with thin fibrous septae inside the orbital septum of each eye. Following excision of the masses, the patient developed severe diplopia accompanied by exotropia, impaired adduction, and mydriasis of the right eye. The pupillary light reflex, visual acuity, and visual field test results were within normal ranges. Notably, his symptoms completely resolved 4 hours postoperatively without intervention. To our knowledge, transient unilateral exotropia following infraorbital local anesthetic injection is rare. The exotropia was attributed to diffusion of the epinephrine/lidocaine solution, which may have affected the ciliary ganglion and the medial rectus muscle. Caution is warranted during local anesthetic injections in patients who undergo periorbital surgery.
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Lin T, Feng C, Bi Y, Lu P, Wu M, Qu J, Gong L, Sun X. Lidocaine Hydrochloride Gel for Ocular Surface Anesthesia: Pharmacokinetic Evaluation and Randomized Placebo-Controlled Trial in China. J Ocul Pharmacol Ther 2022; 38:567-575. [DOI: 10.1089/jop.2022.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Tong Lin
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
- Department of Ophthalmology, NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Changming Feng
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
- Department of Ophthalmology, NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Yanlong Bi
- Department of Ophthalmology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peirong Lu
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mingxing Wu
- Department of Ophthalmology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jia Qu
- Department of Ophthalmology, The School of Ophthalmology and Optometry, Affiliated with Wenzhou Medical College, Wenzhou, China
| | - Lan Gong
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
- Department of Ophthalmology, NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
- Department of Ophthalmology, NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Ophthalmology, Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
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Xu Z, Xu L, Li T, Sheng Q, Shi Y, Gao J. Effects of Humanized Nursing on Perioperative Glaucoma Patients under Local Anesthesia and Sleep Quality. Am J Health Behav 2021; 45:971-977. [PMID: 34969409 DOI: 10.5993/ajhb.45.6.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We assessed the effects of humanized nursing on perioperative glaucoma patients under local anesthesia and their sleep quality. METHODS Fifty glaucoma patients who underwent surgery under local anesthesia from January 2018 to January 2020 were enrolled and randomly divided into 2 groups (N=25). The control group received routine nursing care whereas the observation group underwent humanized nursing care. We compared negative emotion scores, treatment compliance, incidence of postoperative complications, comfort score, sleep quality score, and nursing satisfaction. RESULTS After nursing, the observation group had lower SAS and SDS scores than the control group (p < .05). The total treatment compliance rate was higher in the observation group than that in the control group (96.0% vs 72.0%, p < .05). The observation group had a lower incidence rate of postoperative complications than the control group (4.0% vs 24.0%, p < .05). After nursing, the observation group exhibited an increased GCQ score and a decreased PSQI score compared to the control group (p < .05). The total satisfaction rate of nursing was higher in the observation group than that in the control group (96.0% vs 76.0%, p < .05). CONCLUSION Humanized nursing for glaucoma patients during the perioperative period under local anesthesia is able to relieve the negative emotion of patients and enhance their treatment compliance, which is conducive to reducing postoperative complications, increasing physical comfort level, and ameliorating sleep quality, thereby improving nursing satisfaction by patients.
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Affiliation(s)
- Zhiying Xu
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China; , ,
| | - Lina Xu
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Tao Li
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Qunfang Sheng
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yuan Shi
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Jing Gao
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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Fan H, Qian Z, Tzekov R, Lin D, Wang H, Li W. A New Two-Step Anesthesia for 23- or 25-Gauge Vitrectomy Surgery: A Prospective, Randomized Clinical Trial. Ophthalmic Res 2020; 64:34-42. [PMID: 32388512 DOI: 10.1159/000508510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/08/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of topical anesthesia combined with subconjunctival anesthesia (termed two-step anesthesia) for 23- or 25-gauge pars plana vitrectomy or other posterior segment surgery. METHODS Patients (n = 90) requiring 23-/25-gauge vitrectomy or other posterior segment surgery were randomized into 3 groups. Group 1 received peribulbar anesthesia, group 2 received retrobulbar anesthesia and group 3 received two-step anesthesia. A 5-point visual analog pain scale (VAPS) was used to measure self-report of patient pain. Complications were recorded for subsequent analysis. RESULTS VAPS scores for overall intraoperative pain ranged from 0 to 3 (1.07 ± 1.07) in group 1, from 0 to 2 (0.69 ± 0.93) in group 2 and from 0 to 3 (1.06 ± 0.98) in group 3. Assessment of surgeon discomfort score ranged from 0 to 2 (0.31 ± 0.66) in group 1, from 0 to 3 (0.38 ± 0.82) in group 2 and from 0 to 2 (0.47 ± 0.62) in group 3. Both scores reveal no significant difference among the 3 groups. While there were no complications noted in group 1, there was an ocular perforation in group 2. Additionally, there were no complications in group 3 related to the anesthetic technique. CONCLUSIONS Results suggest that two-step anesthesia is a safe and effective anesthetic approach for selected patients undergoing 23- or 25-gauge pars plana vitrectomy or other posterior segment surgeries. It may offer a viable alternative to peribulbar anesthesia and retrobulbar anesthesia for carefully selected 23- or 25-gauge cannular-access ocular surgeries.
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Affiliation(s)
- Hua Fan
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Zhuyun Qian
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Radouil Tzekov
- Department of Ophthalmology, University of South Florida, Tampa, Florida, USA
| | - Dong Lin
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Hongxia Wang
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Wensheng Li
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China, .,Aier School of Ophthalmology, Central South University, Changsha, China,
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Alcubierre R, Sanchez-Dalmau BF, Mousavi K. Compressive optic neuropathy secondary to an allergic reaction to hyaluronidase. ACTA ACUST UNITED AC 2019; 94:441-444. [PMID: 31280939 DOI: 10.1016/j.oftal.2019.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/17/2019] [Accepted: 03/23/2019] [Indexed: 10/26/2022]
Abstract
A 58 year-old woman presented with severe chemosis and ophthalmoparesis on her left eye 8hours after uncomplicated cataract surgery under sub-tenon anaesthesia. Recovery of extrinsic motility was observed after corticosteroid and antihistamine treatment, but a non-haemorrhagic papillary oedema and a concentric defect of visual field were found. It progressed to papillary atrophy with preserved central vision, but with a significant visual field constriction. The aetiological study revealed an allergy to hyaluronidase that was used as adjuvant to the anaesthesia. This complication needs to be promptly diagnosed and treated, as the swelling of the orbital tissues can cause damage to the optic nerve.
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Affiliation(s)
- R Alcubierre
- Centre Ocular Quirúrgic de Sant Boi, Sant Boi de Llobregat, Barcelona, España; Departamento de Oftalmología, Hospital General de l'Hospitalet, Hospitalet de Llobregat, Barcelona, España.
| | - B F Sanchez-Dalmau
- Centre Ocular Quirúrgic de Sant Boi, Sant Boi de Llobregat, Barcelona, España; Departamento de Oftalmología, Hospital Clínic, Barcelona, España
| | - K Mousavi
- Centre Ocular Quirúrgic de Sant Boi, Sant Boi de Llobregat, Barcelona, España
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