Globe luxation after peribulbar block – The untold story of an iatrogenic complication

Purpose: To describe our experience in performing biopsy of post-septal orbital masses with core needle under computerized tomography guidance (CT-CNB). Methods: The medical records of all patients who underwent this procedure were reviewed. The procedure was performed under local anesthesia on a day case basis under a peribulbar block. A planning non-contrast computerized tomography (CT) scan of the orbits was performed to localise the mass. A 6-cm 18-G Temno Evolution® semi-automated biopsy needle was inserted through the skin into the orbit. Prior to further advancement of the needle, a low-dose CT limited to the previously determined plane was performed to confirm its position. The needle was then advanced, and the cutting needle was deployed to obtain the biopsy. Results: Five patients who underwent CT-CNB were identified. The CNB was successful in 4 patients and revealed a metastatic prostate adenocarcinoma, diffuse large B-cell lymphoma, a metastatic neuroendocrine tumour, and orbital inflammatory disease. The biopsy failed in the fifth patient when the needle failed to penetrate the tumour despite good localisation on CT. He was eventually diagnosed with fibrous meningioma of the greater wing of sphenoid on open biopsy. None of the patients had any complications other than peri-ocular bruising which was present in all of them. Conclusion: CT-CNB of mass lesions located in the lateral aspect of the orbit can be an alternative to open biopsy in selected cases. It avoids major surgery and allows the use of radiotherapy, if required, without any delay.

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Analysis: Particulate Limits for Intravascular Devices: Considerations for Polymer Coating Embolism

Biomedical Instrumentation & Technology ◽

10.2345/0899-8205-53.6.426 ◽

2019 ◽

Vol 53 (6) ◽

pp. 426-432 ◽

Cited By ~ 1

Author(s):

Amitabh Madhukumar Chopra

Keyword(s):

Polymer Coating ◽

Animal Studies ◽

Polymer Coatings ◽

Medical Instrumentation ◽

New Device ◽

Iatrogenic Complication ◽

Industry Standard ◽

Step Procedure ◽

Release Limits ◽

Intravascular Devices

Abstract Lubricious polymer coatings are increasingly used on intravascular devices to facilitate easier access and navigation through tortuous blood vessels. Recent reports highlight the separation and downstream embolism of polymer particles affecting the vasculature and various organs. The Food and Drug Administration (FDA) acknowledges polymer coating embolism as an iatrogenic complication of intravascular devices and continues to close gaps in standards related to coating integrity. The Association for the Advancement of Medical Instrumentation established particulate testing as an industry standard for evaluating coating integrity of intravascular devices. The FDA recognizes this standard; however, challenges exist in setting particulate limits that may compromise device function without sufficient clinical data. The microscopic nature of polymer emboli not visible with available imaging modalities has impacted reporting. This has also resulted in a reduced number of manufacturer-driven product development projects related to coating integrity. On the other hand, recent procedural trends have supported the innovation of coated devices with expanded indications, requiring particulate evaluations and release limits. This article proposes a methodology to set particulate limits for intravascular devices given existing clinical, regulatory, and manufacturing challenges. The approach with standardization requirements enables characterization, comparison, and evaluation of lubricious coatings from various manufacturers. It incorporates a step-by-step procedure that adds scrutiny to the application of coatings while ensuring device function is not impacted. Together with particulate assessments, clinicopathologic and animal studies permit an understanding of particulate ranges from commercially available devices and setting of particulate limits for new device evaluations.

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Spontaneous globe luxation in iatrogenic Cushing syndrome

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-015-3126-8 ◽

2015 ◽

Vol 253 (10) ◽

pp. 1809-1811 ◽

Cited By ~ 1

Author(s):

Leticia Ortega-Evangelio ◽

Javier Navarrete-Sanchis ◽

Basil K. Williams ◽

Juan Miguel Tomas-Torrent

Keyword(s):

Cushing Syndrome ◽

Globe Luxation

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Efficacy and safety of single injection peribulbar block performed by anesthesiologists prior to cataract surgery

Journal of Clinical Anesthesia ◽

10.1016/s0952-8180(97)00005-6 ◽

1997 ◽

Vol 9 (4) ◽

pp. 285-288 ◽

Cited By ~ 5

Author(s):

Scot W. Hendrick ◽

Michael K. Rosenberg ◽

Miriam H. Lebenbom-Mansour

Keyword(s):

Cataract Surgery ◽

Single Injection ◽

Efficacy And Safety ◽

Peribulbar Block

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Comparing General Anesthesia with Preemptive IV Atropine vs General Anesthesia with Single Injection Peribulbar Block with Levobupivacaine 0.5% or Lidocaine 2% for Prevention of Oculocardiac Reflex in Children Undergoing Strabismus Surgery: Randomized Control Study

QJM ◽

10.1093/qjmed/hcab086.034 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Hani Ali Ezzat ◽

Galal Adel ElKady ◽

Melad Ragaey Zekry ◽

Dalia Ahmed Ibrahim ◽

Abeer Sameer Salem

Keyword(s):

General Anesthesia ◽

General Anaesthesia ◽

Pain Control ◽

Strabismus Surgery ◽

Minor Role ◽

Oculocardiac Reflex ◽

Post Operative Pain ◽

Peribulbar Block ◽

Successful Group ◽

Clinically Significant

Abstract Background Strabismus is one of the common health problems among the children. The incidence of the oculocardiac reflex decreases with age and tends to be more pronounced in young, healthy patients, which is clinically significant for pediatric as it is observed with greatest incidence in young healthy neonates and infants undergoing strabismus surgery. Objective to prevent and attenuate the oculocardiac reflex in children age group from (2yrs to 14 yrs) undergoing surgical correction for strabismus. Patients and Methods Three groups were allocated Group C received general anaesthesia combined with pre emptive atropine, Group L received general anaesthesia combined with Peribulbar block with Lidocaine 2 % and Group LB which received general anaesthesia combined with peribulbar block with Levobupivacaine 0.5%. Results In Our study we found that group L which received peribulbar lidocaine 2 % was the most successful group regarding blocking the occurrence of the OCR and with acceptable post operative pain control results. Conclusion In Our study the use of peribulbar block with lidocaine 2 % in combinations with General anaesthesia is very effective against the incidence of OCR in children undergoing strabismus surgery and superior to the Iv pre emptive Atropine with higher surgeon satisfaction while the use of peribulbar levobupivacaine 0.5% combined with general anaesthesia has a great role in post operative pain control with superior patient satisfaction, on the other hand the atropine is a very important emergency drug but our study found that it has a very minor role in both preventing the OCR and post operative pain control in addition to subjecting the patients to the tachycardia and other complications like dryness of the mouth and blushing so its not recommended by our study.

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Painless Wakeful Peribulbar Block Achieved Safely With a Single Transconjunctival Injection

Ophthalmic Surgery Lasers and Imaging Retina ◽

10.3928/1542-8877-19950501-07 ◽

1995 ◽

Vol 26 (3) ◽

pp. 200-204

Author(s):

C Richard Hulquist

Keyword(s):

Peribulbar Block

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Toxic epidermal necrolysis. Report of 2 cases.

Batna Journal of Medical Sciences (BJMS) ◽

10.48087/bjmscr.2014.1111 ◽

2014 ◽

Vol 1 (1) ◽

pp. 41-43

Author(s):

Abdelhak Ababsa Mouaki ◽

Keyword(s):

Early Diagnosis ◽

Toxic Epidermal Necrolysis ◽

Special Care ◽

Therapeutic Treatment ◽

Early Management ◽

Special Care Units ◽

Iatrogenic Complication ◽

Drug Eruptions ◽

The Way

Toxic Epidermal Necrolysis (TEN) is a real dermatological emergency, requiring early diagnosis and early management, using extensive therapeutic treatment. This iatrogenic complication is fortunately rare, but the prognosis remains severe despite the early management in special care units. We report here two cases of Toxic Epidermal Necrolysis in two men, aged 77 and 46 years old. By the way, we will review clinical and laboratory signs and will emphasize the frequency and the severity of iatrogenic drug eruptions.

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Physical Incompatibility between Vancomycin and Viscoelastic Mimicking Acute Endophthalmitis: The First Report

Case Reports in Ophthalmological Medicine ◽

10.1155/2019/6341694 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Biljana Kuzmanović Elabjer ◽

Dean Šarić ◽

Mladen Bušić ◽

Mirjana Bjeloš ◽

Andrej Pleše

Keyword(s):

Anterior Chamber ◽

Laboratory Tests ◽

Penetrating Keratoplasty ◽

White Male ◽

Vitreous Body ◽

Time Dependent ◽

Corneal Oedema ◽

Iatrogenic Complication ◽

White Material ◽

Specific Management

This is the first documentation of vancomycin precipitation with viscoelastic in the anterior chamber of the eye. A 34-year-old white male underwent uneventful penetrating keratoplasty. Intracameral instillation of 1 mg/0.1 mL of vancomycin followed no attempts of meticulous viscoelastic irrigation. Six hours later thick white material in the anterior chamber was sedimented. The following criteria excluded the diagnosis of endophthalmitis and TASS: clear and transparent anterior chamber and vitreous body, the absence of ciliary injection and corneal oedema, and unremarkable laboratory tests’ results. This iatrogenic complication mimicking endophthalmitis does not require any specific management and should be acknowledged in guidelines for prevention and treatment of endophthalmitis. The objective of this paper is to alert colleagues to this iatrogenic complication of vancomycin mimicking endophthalmitis. Whether this condition should be labelled as positive or negative demands further investigation. As vancomycin is a time-dependent antibiotic, it is possible that this precipitate could serve as a slowly releasing drug depot and viscoelastic as a vehicle for precipitation. This being the case, investigation is needed to analyse its potential to precipitate with another dispersive and cohesive viscoelasticity.

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