Mameletzi E, Pournaras J-A C, Ambresin A, Nguyen C
Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland.
Klin Monbl Augenheilkd. 2008 May;225(5):476-8. doi: 10.1055/s-2008-1027268.
The aim of this communication is to describe an unusual and serious complication of retrobulbar anaesthesia for cataract surgery.
A 78-year-old female was referred for visual loss (light perception) 24 hours after apparently uneventful cataract surgery with retrobulbar anaesthesia in her left eye. Fundus examination revealed multiple arterial emboli and a localised retinal detachment. MRI revealed a retrobulbar hypersignal of the optic nerve associated with perineuritis. The cardiovascular examination was normal. We assumed this condition resulted from injection of the anaesthetic mixture into the optic nerve.
In order to improve retinal circulation and oxygenation, the intraocular pressure was maximally lowered and anticalcic therapy administered, expecting optimal arterial dilatation. Methylprednisolone (1 g/day 3 days i. v., then rapidly tapered) was also added. The retina slowly reattached but visual acuity remained unchanged.
Retrobulbar anaesthesia is routinely used for ocular surgery. Serious complications may still happen, however. This case adds to the previously reported spectrum of complications from retrobulbar anaesthesia.
本交流的目的是描述白内障手术球后麻醉一种罕见且严重的并发症。
一名78岁女性在左眼进行表面看似顺利的球后麻醉白内障手术后24小时出现视力丧失（仅存光感）。眼底检查发现多处动脉栓塞及局限性视网膜脱离。磁共振成像显示视神经球后高信号伴神经炎。心血管检查正常。我们认为这种情况是由于麻醉混合剂注入视神经所致。
为改善视网膜循环及氧合，最大程度降低眼压并给予抗钙治疗，期望实现最佳的动脉扩张。还加用了甲泼尼龙（静脉注射1克/天，共3天，然后迅速减量）。视网膜缓慢复位，但视力仍未改变。
球后麻醉常用于眼科手术。然而，严重并发症仍可能发生。该病例增加了先前报道的球后麻醉并发症范围。
