J.ophthalmol.(Ukraine).2022;3:10-17.
http://doi.org/10.31288/oftalmolzh202231017
Received: 11.04.2022; Accepted: 27.04.2022; Published on-line: 15.06.2022
A prospective comparative study of the effect of ocular digital compression and non-compression following peribulbar anaesthesia on visual acuity and pupillary reactions
Ajay Sharma, Head of Department; M. Laalasa, T. Krishna
Sankar Foundation Eye Institute; Department of Vitreoretinal Services; Naiduthota, Visakhapatnam, Andhra Pradesh (India)
TO CITE THIS ARTICLE:Ajay Sharma, Laalasa M., Krishna T. A prospective comparative study of the effect of ocular digital compression and non-compression following peribulbar anaesthesia on visual acuity and pupillary reactions. J.ophthalmol.(Ukraine).2022;3:10-7. http://doi.org/10.31288/oftalmolzh202231017
Background: Peribulbar lignocaine anaesthesia is commonly used in ophthalmic surgeries.
Aim. To identify the effect of ocular digital compression (ODC) following peribulbar anaesthesia (PBA) on the optic nerve.
Setting. A hospital-based prospective non-controlled observational study done at Sankar Foundation Eye Institute, Visakhapatnam, India.
Method. This study conducted on 124 patients aged ≥40 years with non-complicated cataract. All patients were randomly divided into two groups by computer generated database; group 1 for PBA with ocular digital compression and group 2 for PBA without compression. The patient's eye was dilated, administered 2% lignocaine hydrochloride 5 mL, 0.75% bupivacaine 5 mL, and hyaluronidase 75 IU/mL injection for the peribulbar block(PBA). Vision and relative afferent pupil defect (RAPD) reactions were noted at 1 min and 10 mins after anaesthesia in both groups.
Results. Out of 61 (PBA+ODC) cases, vision drop was seen in 33 (54.09%) after 1 min, and 28 (45.91%) patients has no change in the vision after 1 min, and 10 min, and 29 (47.54%) cases had RAPD after 1min, 32 (52.45%) cases had RAPD after 10 min, 32 (52.45%) cases had NSRL after 1min, 29 (47.5%) cases had NSRL after 10 min. This implies during 10 min compression, there is an appearance of RAPD in the previously NSRL eye. Out of 63 patients of PBA without ODC group, vision drop is seen in 48 (76.19%) after 1 min and 10 min. In this group, 57(90.4%) cases had RAPD after 1 min. and 56 (88.8%) cases had RAPD after 10min. 6 (9.5%) cases had NSRL after1 min. 7 (11.1%) cases had NSRL after 10 min. Males had more vision drop in the compression group. 33 (54.09%) cases in group 1 and 48 (76.19%) cases in group 2 had vision drop at 1min and 10 min. In compression group, 29 (47.5%) cases had RAPD 1 min, and 32 (52.45%) cases had RAPD at 10 min. In the non-compression group, 57 (90.47%) cases had RAPD at 1min, and 56 (88.88%) had RAPD at 10 min. The age of >60 yrs patients had more vision drop and RAPD irrespective of compression than the 40-60 yrs of age group, which shows that vascular changes may contribute to decreased optic nerve perfusion.
Conclusion. The non-compression group had more vision drop and RAPD than the compression group. Age of >60 yrs and males had more percentage of vision drop.
Кey words: peribulbar anaesthesia, relative afferent pupil defect, vision drop
References
1.Redman M. Cocaine: What is the crack? A brief history of the use of cocaine as an anesthetic. Anesth Pain Med 2011;1:95-7.
2.Jaichandran V. Ophthalmic regional anaesthesia: A review and update. Indian J Anaesth 2013;57:7-13.
3.Palte HD. Ophthalmic regional blocks: management, challenges, and solutions. Local Reg Anesth 2015; 8: 57-70.
4.Edge KR, Nicoll JM. Retrobulbar hemorrhage after 12,500 retrobulbar blocks. Anesth Analg 1993; 76: 1019-1022.
5.Davis DB 2nd, Mandel MR. Posterior peribulbar anesthesia: an alternative to retrobulbar anesthesia. J Cataract Refract Surg 1986;12:182-4.
6.http://eyewiki.aao.org/Ocular_Anesthesia (accessed on 26th December 2016)
7.Pautler SE, Grizzard WS, Thompson LN, Wing GL. Blindness from retrobulbar injection into the optic nerve. Ophthalmol Surg 1986; 17: 334-7.
8.Ramsey RC, Knobloch WH. Ocular perforation following retrobulbar anaesthesia for retinal detachment surgery. Amj Ophthalmol 1978; 86: 61-4.
9.Ropo A, Ruusuvaara P, Setala K. Visual evoked potentials after retrobulbar or periocular anaesthesia. BrJ Ophthalmol1992; 76: 541-4.
10.Jay WM, Carter H, Williams B, Green K. Effect of applying the Honan intraocular pressure reducer before cataract surgery. AmJr Ophthalmol 1985; 100: 523-7.
11.Palay DA, Stulting RD. The effect of ocular compression on intraocular pressure following retrobulbar anaesthesia. Ophthalmic Surg 1990; 21: 503-7.
12.Ropo A, Ruusuvaara P, Paloheimo M, Mauuksela E-L, Nikki P. Effect of ocular compression. (Autopressor) in intraocular pressure in periocular anaesthesia. Acta Ophthalmol (Copenh) 1990; 68: 227-9.
13.Morgan J E, Chandna A. Intraocular pressure after peribulbar anaesthesia, is the Honan's Balloon necessary? Br J Ophthalmol 1995; 79(1): 46-4.
14.Ubah J, Ajayi BJ, Bekibele CO. Comparison of fixed weight and digital massage techniques for intraocular pressure reduction after peribulbar anaesthesia. Nigerian J Ophthalmol. 2004;12:60-4.
15.Mostafa EM, Mounir A. Effect of the volume of anesthetic solutions and patient's age on the efficacy of retrobulbar anesthesia. Delta Journal of Ophthalmology. 2018 Apr 1;19(2):87.
16.Ropo A, Ruu'suvaara P, et al. Effect of ocular compression on intraocular pressure in periocular anaesthesia. Acta Ophthalmol 1990;68:227-9.
17.O'Donoghue E, Batterbury M, Lavy T. Effect on intraocular pressure of local anaesthesia in eyes undergoing intraocular surgery. Br J Ophthalmol. 1994;78:6057.
18.Meyer P, Flammer J, Lüscher TF. Local anesthetic drugs reduce endothelium-dependent relaxations of porcine ciliary arteries. Investigative ophthalmology & visual science. 1993 Aug 1;34(9):2730-6.
19.Pianka P, Weintraub-Padova H, Lazar M, Geyer O. Effect of sub-Tenon's and peribulbar anesthesia on intraocular pressure and ocular pulse amplitude. Journal of Cataract & Refractive Surgery. 2001 Aug 1;27(8):1221-6.
20.Hessemer V, Heinrich A, Jacobi KW. Ocular circulatory changes caused by retrobulbar anesthesia with and without added adrenaline. Klinische Monatsblatter fur Augenheilkunde. 1990 Dec 1;197(6):470-9.
21.Hulbert MFG, Yang YC, Pennefather PM, et al. Pulsatile ocular blood flow and intraocular pressure during retrobulbar injection of lignocaine: influence of additives. J Glaucoma 1998;7:413–16.
22.Palay DA, Stulting RD. The effect of ocular compression on intraocular pressure following retrobulbar anaesthesia. Ophthalmic Surg 1990; 21: 503-7.
23.Watkins R, Beigi B, Yates M, Chang B, Linardos E. Intraocular pressure and pulsatile ocular blood flow after retrobulbar and peribulbar anaesthesia. Br.J.Ophthalmol. 2001;85(7):796-8.
Information about authors and disclosure of information
Corresponding author: Ajay Sharma1, Sankar Foundation Eye Hospital Institute, Visakhapatnam, Andhra Pradesh, India.
Authors’ contributions: All authors contributed equally to this work
Funding information: This research does not received specific grant from any funding agency in the public, commercial or not-for -profit sector.
Competing interests: The authors have declared that no competing interests exist.
Abbreviations: ODC – ocular digital compression; PBA – peribulbar anaesthesia; RAPD – relative afferent pupil defect.