gms | German Medical Science

Background: Retinal vascular occlusions have rarely been reported after successful and uncomplicated vitrectomy without elevated intraocular prerssure. Since we observed a series of five cases within few weeks we systematically assessed the underlying reasons.

Patients: During a 3-month period, five patients presented with acute visual disturbance 2-14 days after uneventful vitrectomy with saline, air or gas tamponade in local anaesthesia. On examination, branch retinal arterial occlusion was identified as the underlying reason. After uneventful surgery of 30-60 min duration, patients had presented normal findings without evident retinal perfusion irregularity and an intraocular pressure (IOP) between 6 14 mmHg in the corresponding eyes at the first postoperative visist. The referred back due to a self-assessed change in their visual field under the assumption of a retinal detachment. The findings were photodocumented and all patients followed postoperatively. A systematic review of literature was performed and external expertise attined in order to exclude intraoperative technixcal problems.

Results: On examination, a normal IOP was found in each case. After exclusion of surgical factors namely intraoperative IOP fluctuations, the risk factor assessment revealed a hypertension with peak systolic blood pressur of 180mmHG in 2 instances, an orally controlled diabetes and a polyglobuly in each 1 instance. None of the risk factors per se allowed the association to the vasoocclusive event.

Conclusion: After definitive exclusion of patient-related factors in at least 2 instances and a regular surgical performance the only possible attributable factor was the local anesthetic which had been 3.5 ml of the commercial preparation of Scandicain 1% without additive adrenalin placed retrobulobarly according to the Atkinson technique in all instances. After a change to Mepivacain without conservants, but no other change of technique or equipment, no similar case was observed during more then 300 further vitreoretinal surgeries which indicates that Scandicain with conservant should be used with care as long as it is not excluded that it may cause severe vascular occlusion.