Esswein M B, von Noorden G K
Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.
Am J Ophthalmol. 1993 Oct 15;116(4):424-30. doi: 10.1016/s0002-9394(14)71399-6.
Nine patients had a permanent paresis of a vertical rectus muscle after cataract extraction. We sought to determine the common factors associated with and their contribution to vertical muscle paresis after cataract extraction. The study design included a survey that was conducted among the referring cataract surgeons and anesthesiologists with particular attention to surgical technique and anesthetic administered, as well as a medical history and examination and appropriate laboratory tests. Patients had a complete ophthalmic examination including prism cover testing in all nine diagnostic positions, forced-duction testing, and saccadic velocity and generated muscle force estimation. The results of the study demonstrate no correlation between the pareses and the use of a bridle suture, antibiotic or corticosteroid injection, systemic disease, or surgical technique. Peribulbar anesthesia was the most consistent feature in seven of the nine cases. In the other two, an atypical retrobulbar injection had been given. On the basis of the location of the injections, the needle type, and the concentration and quantity of the anesthetic injected, we conclude that permanent pareses of a vertical rectus muscle may be caused by a myotoxic effect of the local anesthetic.
9例患者在白内障摘除术后出现垂直直肌永久性麻痹。我们试图确定与白内障摘除术后垂直肌麻痹相关的常见因素及其作用。研究设计包括对转诊的白内障外科医生和麻醉医生进行调查，特别关注手术技术和所用麻醉剂，以及病史、检查和适当的实验室检查。患者接受了全面的眼科检查，包括在所有九个诊断位置进行棱镜遮盖试验、被动牵拉试验、扫视速度和产生肌力评估。研究结果表明，麻痹与使用缝线固定、抗生素或皮质类固醇注射、全身性疾病或手术技术之间无相关性。球周麻醉是9例中的7例最一致的特征。另外2例给予了非典型的球后注射。根据注射部位、针头类型以及注射麻醉剂的浓度和剂量，我们得出结论，垂直直肌的永久性麻痹可能是由局部麻醉剂的肌毒性作用引起的。
