Unexpected amaurosis occurring after peribulbar anesthesia: Exploring the causes in two cases

2020 ◽  
pp. 112067212098439
Author(s):  
Amina Rezkallah ◽  
Nezar Gargori ◽  
Philippe Denis ◽  
Véronique Waldmann ◽  
Thibaud Mathis ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Injection Site ◽  
Anterior Segment ◽  
Volume Effect ◽  
Light Perception ◽  
Ophthalmic Examination ◽  
Normal Visual Acuity ◽  
Disposable Needle ◽  
Peribulbar Anesthesia

Peribulbar anesthesia (PB) is known to be safer than retrobulbar (RB) anesthesia. To our knowledge, no amaurosis has been described after PB. We report here the cases of two patients who underwent PB before membrane peeling. The injections were administered with a 25-gauge, 22-mm bevel disposable needle. The anesthetic used was ropivacaine 1% with a volume of 8 ml and 75 µg of clonidine as an adjuvant (7.5 µg/ml). Given that complete akinesia was not achieved, a second injection of 2 ml was administered in the supero-medial injection site. Thirty minutes after the PB, the first patient experienced amaurosis with no light perception (LP). The ophthalmic examination was normal. Visual acuity recovered after 1 day. Regarding the second patient, the loss of VA was observed 20 min after the PB. IOP was 20 mmHg. The anterior segment and fundus exam were normal. Rubin found the PB technique to be as effective and safer than RB injection, as the needles are not supposed to enter the RB space and Davis and Mandel found no amaurosis after PB. PB is administered via the extraconal injection of an anesthetic agent. These amaurosis might be explained by the fact that some anesthetic may have penetrated the RB space. In cases where two PB injections are administered, the anatomy is expected to change due to the volume effect of the first injection. The second injection is higher risk as it is administered closer to the optic nerve.

Bilateral Optic Nerve Hypoplasia with Normal Visual Acuity

1978 ◽  
Vol 86 (4) ◽  
pp. 524-529 ◽  
Author(s):  
Ake Bjork ◽  
C.-G. Laureix ◽  
Ulla Laurell
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Nerve Hypoplasia ◽  
Normal Visual Acuity

Outcomes of Steroid Therapy in Combination with Endoscopic Optic Nerve Decompression Surgery for Direct Traumatic Optic Neuropathy: A Case-Series

2021 ◽  
Vol 104 (7) ◽  
pp. 1166-1171
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Neuropathy ◽  
Poor Prognosis ◽  
Combined Treatment ◽  
Treatment Protocol ◽  
Case Series ◽  
Light Perception ◽  
Traumatic Optic Neuropathy ◽  
Nerve Decompression

Background: Direct traumatic optic neuropathy (TON) carries a poor prognosis. However, the outcome of this injury is diverse and is related to time to treatment and treatment protocol. Objective: To evaluate the outcomes of the combined treatment protocol in patients with direct TON. Materials and Methods: The authors retrospectively reviewed the medical records of patients between January 2015 and August 2019. Main outcome was visual acuity (VA) improvement after the treatment. Results: Thirteen patients (15 eyes) were included. The mean age was 38.61 years with a range of 13 to 65 years. Initial VA varied from no light perception (NPL) in seven eyes of six patients, light perception (PL) in one eye, counting fingers in two eyes, 20/200 in three eyes, and 20/60 in two eyes. Average timing to treatment was 2.8 days (range 0 to 7 days). There were no side effects of high-dose corticosteroids treatment in all patients. During a follow-up period of three months, six of 13 patients (46.1%) had VA improvement. Conclusion: Despite poor prognosis of direct TON, the combined treatment protocol provides a favorable successful rate with most patients on having stable vision, and some having visual improvement from reducing intracanalicular pressure of the optic nerve. Keywords: Endoscopic optic nerve decompression; Traumatic optic neuropathy; Visual acuity; Case series

scholarly journals Ocular imaging findings of bilateral optic disc pit in a child

2013 ◽  
Vol 5 (2) ◽  
pp. 258-261 ◽  
Author(s):  
Abdullah Ozkaya ◽  
Z Alkin ◽  
AT Taylan ◽  
A Demirok
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Nerve Fiber ◽  
Optic Disc ◽  
Anterior Segment ◽  
Rare Condition ◽  
Optic Disc Pit ◽  
Fiber Layer ◽  
Retinal Nerve Fiber

Background: To report a rare condition of bilateral optic disc pit in a child. Case description: A ten-year-old female was admitted with a complaint of headache. Visual acuity was 20/20 in both eyes (OU). Anterior segment examination was normal in OU. Fundus examination revealed optic disc pit (ODP) located temporally with a diameter of 1/5 disc diameter in OU. Intraocular pressure was within normal limits in both eyes. Macular optical coherence tomography (OCT) showed a loss of retinal tissue at the site corresponding to the ODP in both eyes. Retinal nerve fiber OCT revealed decreased RNFL thickness at the temporal side of the optic nerve, corresponding to the ODP in both eyes. The patient and patient’s parents were informed about the disease and called for follow-up examinations every 6 months. In addition, the family was informed about optic pit maculopathy (OPM) and, they were told to return immediately if the patient ever complained of decreased vision in either of her eyes. After a follow-up period of 12 months, visual acuity remained stable, and no complications secondary to ODP were detected. Conclusion: Optic disc pit is diagnosed incidentally unless it is complicated with OPM. The retinal nerve fiber layer thickness is decreased at the side of the optic nerve corresponding to the ODP. Nepal J Ophthalmol 2013; 5(10): 258-261 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8739

scholarly journals Trauma Okular oleh Serangan Kerbau – Laporan Kasus

e-CliniC ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 424
Author(s):  
Wenny Supit
Keyword(s):  
Visual Acuity ◽  
Ocular Trauma ◽  
Recovery Period ◽  
Anterior Segment ◽  
Visual Sensitivity ◽  
Ocular Motility ◽  
Light Perception ◽  
Ocular Trauma Score ◽  
Hand Motion ◽  
Trauma Score

Abstract: Of the many ocular blunt traumas, trauma due to typical buffalo attack thrrough leverage has not been reported. We reported a 65-year-old man attacked by a buffalo on his left eye. The patients complained of pain of his left eye associated with swelling, bleeding, and blurred vision. Eye examination revealed that visual acuity of the left eye was classified as hand motion (HM), limited ocular motility, blepharospasm, and a crescent-shaped anterior lamella laceration with lateral canthal involvement. Anterior segment examination revealed bullous subconjunctival hemorrhage, corneal edema, and rosette-shaped opacification (RSO) of the lens. Head-CT showed traumatic cataract and periorbital haemorrhage; no abnormalities in the right eye. Ovular trauma score (OTS) of the patient was three indicating that the possible visual prognosis was 2% as no light perception (NLP), 11% as light perception (LP) or hand motion (HM), 15% as 1/200-19/200, 31% as 20/200-20/50, and 41% as >20/40. Literature data showed that the visual sensitivity of OTS prediction in NLP, 20/200-20/50, and 20/40 was 100%. The specificity of OTS in predicting vision in LP/HM 1/200-19/200 was 100%. After a recovery period of approximately two months and the sutured wound healed, the patient came to the eye clinic of Prof. Dr. R. D. Kandou Hospital Manado. After a cataract surgery was performed on the left eye of the patient, his visual acuity improved to 20/40.Keywords: ocular trauma, buffalo attack, ocular trauma score (OTS)  Abstrak: Dari sekian banyaknya trauma tumpul, trauma akibat rudapaksa tipikal serangan kerbau yang menggunakan gaya ungkit belum pernah dilaporkan. Kami melaorkan seorang laki-laki berusia 65 tahun yang mendapat serangan kerbau pada mata kiri dengan keluhan nyeri disertai pembengkakan, pendarahan, dan penglihatan kabur. Pemeriksaan mata menunjukkan ketajaman visual mata kiri dengan gerakan tangan, motilitas okular terbatas, blefarospasme, dan laserasi lamela anterior berbentuk bulan sabit dengan keterlibatan kantal lateral. Pemeriksaan segmen anterior menunjukkan perdarahan subkonjungtiva bulosa, edema kornea, dan rosette-shaped opacification (RSO) pada lensa. Hasil CT-kepala menunjukkan katarak traumatik dan perdarahan periorbital, tanpa kelainan pada mata kanan. Skor trauma okular pasien (OTS) ialah tiga yang menandakan kemungkinan prognosis pada visual pasien ialah 2% menjadi no light perception (NLP), 11% menjadi light perception (LP) atau hand motion (HM), 15% menjadi 1/200-19/200, 31% menjadi 20/200-20/50, dan 41% menjadi >20/40. Penggunaan OTS pada kasus ini karena data literatur menunjukkan bahwa sensitivitas penglihatan prediksi OTS di NLP, 20/200-20/50, dan 20/40 ialah 100%. Kekhususan OTS dalam memrediksi visi di LP/HM 1/200-19/200 ialah 100%. Setelah masa pemulihan sekitar dua bulan dan luka penjahitan sembuh, pasien datang kontrol ke poliklinik mata RSUP Prof. Dr. R. D. Kandou Manado. Setelah dilakukan operasi katarak pada mata kiri didapatkan tajam penglihatan mata kiri pasien 20/40.Kata kunci: trauma mata, serangan kerbau, ocular trauma score (OTS)

scholarly journals CMT2A Harboring Mitofusin 2 Mutation with Optic Nerve Atrophy and Normal Visual Acuity

2020 ◽  
Vol Volume 13 ◽  
pp. 41-45
Author(s):  
Silvana Guerriero ◽  
Francesco D'Oria ◽  
Giacomo Rossetti ◽  
Rosa Anna Favale ◽  
Stefano Zoccolella ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Nerve Atrophy ◽  
Mitofusin 2 ◽  
Normal Visual Acuity

scholarly journals A rare case of cytomegalovirus papillitis in patient with immunodeficiency

2016 ◽  
Vol 25 (3) ◽  
pp. 190-4
Author(s):  
Dinda A. Devona ◽  
Made Susiyanti
Keyword(s):  
Visual Acuity ◽  
Serological Test ◽  
Anterior Segment ◽  
Posterior Segment ◽  
Ocular Infection ◽  
Light Perception ◽  
Blurred Vision ◽  
Cmv Retinitis ◽  
Counting Finger ◽  
Test Result

A 26-year-old male diagnosed with AIDS came with sudden blurred vision and central sco-toma in left eye since 2 weeks before admission. His visual acuity was counting finger at 5 meters with normal IOP and anterior segment. The posterior segment revealed edematous optic nerve covered by exudates and hemorrhages. Due to low CD4+ count and serological test result, we considered a HIV-related opportunistic ocular infection, specifically HSV infection. As visual acuity worsened during treatment with acyclovir, we performed PCR ex-amination from aqueous tap which revealed positive CMV DNA. Unfortunately, the visual acuity had worsened to no light perception before he received any specific anti-CMV agent. CMV papillitis is an unusual presentation of CMV retinitis. PCR examination from aqueous or vitreous tap should be performed while waiting for serological test result, especially in doubtful cases. Therefore, appropriate diagnosis and management can be established early to prevent irreversible visual loss.

scholarly journals Optic neuropathy due to allergic fungal rhinosinusitis

2011 ◽  
Vol 02 (02) ◽  
pp. 180-182 ◽  
Author(s):  
Jiji Tresa Cyriac ◽  
Tambi Cherian ◽  
Wasna Ali Hadi ◽  
Joyce Jose
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Anterior Segment ◽  
Sinus Surgery ◽  
Automated Perimetry ◽  
Blurred Vision ◽  
Eye Color ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis ◽  
The Right

ABSTRACTAn uncommon case of allergic fungal rhinosinusitis presented to the ophthalmology outpatient department of our hospital with complaints of blurred vision in the right eye of a few days duration and vague complaints of pain around the eyes. The visual acuity on examination was grossly reduced in the right eye and normal in the left eye. Color vision was normal. Anterior segment examination including pupils was normal. Dilated fundus examination was normal except for temporal pallor in the right optic disc. Automated perimetry and magnetic resonance imaging (MRI) scan of brain and orbit were done. The imaging report showed a bilateral pansinusitis with pressure on the right optic nerve. Perimetry showed a superior field defect on the right side. ENT consultation and computed tomography (CT) with contrast helped to diagnose this as a case of allergic fungal rhinosinusitis. The patient was started on systemic steroids under the care of the ENT surgeon. After a few days, pre-operative assessment showed a gross improvement of visual acuity. Endoscopic sinus surgery was done to remove the polyps and thick mucus material. Histopathologic examination confirmed allergic fungal mucin. Days after surgery, the visual acuity improved further and repeat perimetry showed gross improvement in the visual field. Good history taking and a detailed ophthalmic examination, keeping in mind the probable causes of loss of vision of few days duration with no findings other than a decreased visual acuity and a suspicious disc, were key to the early diagnosis and investigation in this case. This helped in early referral and management of the case before permanent damage and irreversible visual loss occurred. The optic nerve is a cranial nerve which, once damaged permanently, will not regenerate. The amount of sinus involvement was extensive on both sides and invariably the left optic nerve would have been involved in a few days, if intervention was delayed.

Endoscopic Approach to Traumatic Visual Loss

1997 ◽  
Vol 116 (6) ◽  
pp. 652-655 ◽  
Author(s):  
Stilianos E. Kountakis ◽  
Alberto A. J. Maillard ◽  
Richard Urso ◽  
Charles M. Stiernberg
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Visual Loss ◽  
Endoscopic Approach ◽  
Light Perception ◽  
Hand Motion ◽  
Postoperative Visual Acuity ◽  
Level I ◽  
Total Blindness

OBJECTIVE: To review our experience with the use of endoscopic optic nerve decompression in traumatic blindness. METHOD: We did a retrospective analysis of patients with traumatic blindness that underwent endoscopic decompression of the optic canal to determine postoperative visual acuity and correlate if to preoperative visual loss and intraoperative findings. The setting was a Level I university trauma center. We identified 8 patients treated with both surgery and steroids over a 10-month period beginning in 1993 (Seven males, one female). RESULTS: Four of six patients with total blindness (no light perception) had improvements in visual acuity. In three patients, visual acuity returned to preinjury levels. One patients with total blindness was operated on 6 weeks after injury and had a visual acuity of 20/800 at 1-year follow-up. Two patients with hand motion preoperatively had improvement in visual acuity. In one patient, vision returned to normal (20/20), and in the other it improved to 20/200). Five patients were operated on after megadose steroid treatment for at least 48 hours failed; four of five noted dramatic improvements in visual acuity. CONCLUSION: The endoscopic approach may be used to successfully decompress the optic nerve in traumatic blindness.

scholarly journals THE INFLUENCE OF READING AND WRITING ON THE PREVALENCE OF MYOPIA

2016 ◽  
Vol 60 (2) ◽  
Author(s):  
Maciej Czepita ◽  
Krzysztof Safranow ◽  
Damian Czepita
Keyword(s):  
Visual Acuity ◽  
Axial Length ◽  
High Myopia ◽  
Anterior Segment ◽  
Refractive Errors ◽  
Fundus Examination ◽  
P Values ◽  
Reading And Writing ◽  
Ophthalmic Examination ◽  
Excel Spreadsheet

Purpose: In this study we decided to answer the question of whether spending more time on reading and writing leads to higher prevalence of myopia.Material and methods: A total of 70 people (140 eyes) – 17 men and 53 women aged 18–29 years (mean 22.5 ±2.8) were examined. A questionnaire concerning the amount of time spent each day on reading and writing, as well as ophthalmic examination involving: visual acuity, anterior segment and fundus examination, keratometry, auto‍‑refractometry and axial length of the eyeball measurement (using IOL Master) were carried out in all participants. The refractive errors were described as spherical equivalents (SE). Hyperopia was defined to be SE higher than +0.5 Dsph, and emmetropia to be higher than –0.5 and lower than +0.5 Dsph. Myopia was defined to be with a SE lower than –0.5 Dsph. High myopia was defined as SE lower than –8, medium myopia in the range between –8 and –4, and low myopia lower than –0.5 and higher than –4 Dsph. The obtained results were typed into an Excel spreadsheet and analyzed statistically using Statistica 10 software. P values of < 0.05 were considered statistically significant.Results: It was found that people with low myopia spent statistically more time on reading and writing than participants in the emmetropic group (5.8 ±2.4 vs 4.1 ±2.4 h/day, p = 0.003). A relationship between reading and writing and medium and high myopia and hyperopia was not observed (p > 0.05).Conclusion: Near visual work leads to higher prevalence of low myopia.

scholarly journals Correlations of the parameters of cardiopulmonary bypass and hemodynamics during cardiac surgery and the structural and functional state of the retina

2020 ◽  
Vol 35 (2) ◽  
pp. 149-156
Author(s):  
M. L. Diakova ◽  
Yu. K. Podoksenov ◽  
V. M. Shipulin ◽  
E. V. Shishneva ◽  
N. O. Kamenshchikov ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Visual Acuity ◽  
Cardiac Surgery ◽  
Intraocular Pressure ◽  
Cardiopulmonary Bypass ◽  
Optic Nerve ◽  
Anterior Segment ◽  
Absolute Value ◽  
Factors Associated ◽  
Ophthalmologic Examination

Objective. To study the structural and functional retinal changes developed in cardiac surgery patients as a consequence of cardiopulmonary bypass and to identify the factors aff ecting the nature and extent of changes observed.Material and Methods. Ten patients who underwent cardiac surgery under cardiopulmonary bypass (CPB) were studied. The ophthalmologic examination was performed before cardiac surgery and 10–14 days after the surgery.Results. On days 10 to 14, after cardiac surgery, visual acuity was restored to the maximum; the perimetry indicators, the level of intraocular pressure, and the structures of the anterior segment of the eyeballs did not change signifi cantly. The ophthalmoscopy revealed the foci of ischemic edema in the fundus along with the fi rst- and second-order arteries in 30% of cases. The thickness of ganglionic and nerve fi ber layers decreased in one patient (10%), which may be associated with the intraoperative ischemia of orbital artery branches feeding the optic nerve. These changes had direct relationships with the level of maximum mean blood pressure (MBP) during CPB and the fl uctuation of absolute MBP values during CPB: MBP ≥ 90 mmHg during CPB was associated with the occurrence of ischemic foci in the retina in 100% of cases. If the diff erence between the maximum and minimum MBP levels during CPB exceeded 20 mmHg, the changes in the retina occurred more frequently (p = 0.0350) than in the cases where MBP fl uctuations during CPB were less than 20 mmHg.Conclusions. The most signifi cant changes in the vision organs of patients undergoing cardiac surgery under CPB occur in the retina. Factors associated with the occurrence of pathological ischemic changes in the retina were fl uctuations in MBP during CPB (≥20 mmHg) and the absolute value of maximum MBP during CPB (>90 mmHg). 

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