Abstract：
Two recent cases of central retinal artery occlusion under otherwise uncomplicated sub-Tenon\'s block that resulted in significant visual loss after cataract surgery prompted us to undertake a literature review of such cases. We identified 97 cases of retinal artery occlusion after ophthalmic surgery under regional anaesthesia that had no immediate signs of block-related complications. These occurred after various intraocular (87%) and extraocular (13%) operations, across a wide range of ages (19-89 years) on patients with (59%) or without (39%) known risk factors. The anaesthetic techniques included 40 retrobulbar blocks, 36 peribulbar blocks, 19 sub-Tenon\'s blocks, one topical anaesthetic and one unspecified local anaesthetic. Different strengths of lidocaine, bupivacaine, mepivacaine and ropivacaine, either alone or in various combinations, were used. The details of the anaesthetic techniques were often incomplete in the reports, which made comparison and analysis difficult. Only nine cases had their cause (optic nerve sheath injury) identified, while the mechanism of injury was unclear in the remaining patients. Various mechanisms were postulated; however, the cause was likely to be multifactorial due to patient, surgical and anaesthetic risk factors, especially in those with compromised retinal circulation. As there were no definite risk factors identified, no specific recommendations could be made to avoid this devastating outcome. We have provided rationales for some general considerations, which may reduce this risk, and propose anaesthetic options for ophthalmic surgery on the fellow eye if required, based both on our literature review and our personal experience.
摘要：
最近发生的两例视网膜中央动脉阻塞在原本不复杂的Tenon下阻塞导致白内障手术后视力明显丧失的病例，促使我们对此类病例进行文献综述。我们确定了在区域麻醉下进行眼科手术后的97例视网膜动脉阻塞患者，这些患者没有立即出现与阻塞相关的并发症。这些发生在各种眼内（87％）和眼外（13％）手术后，在广泛的年龄范围内（19-89岁）对有（59％）或没有（39％）已知危险因素的患者。麻醉技术包括40个球后块，36块，19次Tenon\'s块，一种局部麻醉剂和一种未指定的局部麻醉剂。利多卡因的不同强度，布比卡因,甲哌卡因和罗哌卡因,无论是单独还是各种组合，被使用。麻醉技术的细节通常在报告中不完整，这使得比较和分析变得困难。只有9例患者的病因（视神经鞘损伤）被确定，而其余患者的损伤机制尚不清楚。假定了各种机制；然而，由于患者的原因，原因可能是多方面的，手术和麻醉的危险因素，尤其是那些视网膜循环受损的患者。由于没有确定的风险因素，没有具体建议可以避免这一毁灭性的结果。我们提供了一些一般性考虑的理由，这可能会降低这种风险，并在需要时提出眼科手术的麻醉选择，基于我们的文献综述和个人经验。
