Inadvertent globe perforation following peribulbar anesthesia can lead to unpleasant experiences if not identified early and managed appropriately. We present the case of a 75-year-old female who came with decreased vision in the left eye (LE) following cataract surgery under peribulbar block. Her visual acuity in the right eye (RE) was 6/24 and LE was 6/75. Fundus examination of LE showed vitreous hemorrhage with localized subretinal hemorrhage along the inferotemporal arcade suggestive of globe perforation. Optical coherence tomography (OCT, Spectralis. Heidelberg imaging, Germany) scan across the perforation site showed subretinal hemorrhage and full-thickness retinal tear. On follow-up, two more focal points of retinal whitening were noted in the inferotemporal equatorial region. The patient was kept under close monitoring, and 4 weeks later, vision improved to 6/9 and barrage laser was done around the perforation sites. Serial OCT scans and close follow-up in iatrogenic globe perforation can result in good visual outcomes.

Globe perforation following peribulbar anesthetic injection is a rare but dreaded complication that often results in poor visual outcomes. This case report is on a female patient who sustained vitreous hemorrhage, retinal detachment, and macular breaks due to a peribulbar block administered in the setting of cataract extraction. The retina was repaired with pars plana vitrectomy, endolaser of the peripheral retinal break only, and an internal limiting membrane inverted flap for the macular breaks to avoid the endolaser on the macular area, achieving stable visual outcomes. The authors discussed various modes of local anesthesia for vitreoretinal surgery, risks for globe perforations, and how to approach retinal detachment secondary to needle perforations, which are complex cases at high risk for proliferative vitreoretinopathy. Early recognition and intervention in eyes with an inadvertent perforation can lead to a good outcome. Eyes with a longer axial length, superior, and multiple perforations are at higher risk of developing complications such as retinal detachment and vitreous hemorrhage. Complications such as retinal detachment, macular injury, and vascular occlusion are risk factors for poor prognosis.

Proton-pump inhibitors (PPIs) are one of the most prescribed drugs in the world. Although they are remarkably safe, with minimal adverse effects, it has rarely been reported as a cause of anaphylaxis. Hence, we report the case of a 69-year-old patient who experienced intravenous pantoprazole-induced anaphylaxis during peribulbar block anesthesia for mechanical vitrectomy.

UNASSIGNED: We present imaging features of retinal detachment (RD) and secondary epiretinal membrane in a case of an inadvertent globe penetration following preoperative peribulbar anesthesia.
UNASSIGNED: A 60-year-old woman was referred for a localized RD and epiretinal membrane following uneventful cataract surgery. Widefield fundus photography and optical coherence tomography were used to assess and record the pathology. The current literature was reviewed.
UNASSIGNED: Full-thickness breaks were noted in the neurosensory retina extending into the scleral wall. Vertical tracks were noted in the inferotemporal quadrant of the eye. The patient underwent trans pars plana vitrectomy, membrane peel, and gas. Her 1-month postoperative visual acuity was 20/30.
UNASSIGNED: Globe penetration with RD is a rare but potentially sight-threatening complication of peribulbar anesthesia. Diagnosis can be challenging because of the infrequency of occurrence and delays in presentation. A high index of suspicion is key alongside consideration of other likely differentials.

Rhegmatogenous retinal detachment (RRD) following retrobulbar or peribulbar anesthetic injection is a rare but serious complication that often results in poor visual outcomes. Thus, extreme caution should be exercised while administering local ocular anesthesia due to the potential complications arising from local orbital anesthesia. These complications may occur locally or systemically and may arise immediately or be delayed. This case report is on a female patient who sustained optic nerve injury and RRD due to a peribulbar block administered in the setting of cataract extraction and, subsequently, experienced retinal detachment and vitreous hemorrhage at another hospital before being referred to our hospital. The retina was repaired with pars plana vitrectomy, 360 endolaser of the peripheral retina and around tears, and gas injection, achieving stable visual outcomes.

To compare the efficacy of ropivacaine with a mixture of lidocaine and bupivacaine in peribulbar anesthesia for cataract surgery, in terms of post-block intraocular pressure (IOP).
A one-year comparative study was done to compare two anesthetic solutions in peribulbar anesthesia for cataract surgery, from January 2020 to December 2020 at a tertiary health care hospital. Two hundred patients (40-70 years of age) planned for small-incision cataract surgery with posterior chamber intraocular lens (IOL) implantation under peribulbar anesthesia were included in the study. A single-site inferotemporal injection was given till a total eyelid drop was observed. The IOP was measured at four time-points: before block (control), 1-, 5-, and 15-minute post-block with a tonometer.
The 1-minute post-block mean IOP in both the groups was higher than the baseline levels. This reflected raised intraorbital pressure secondary to peribulbar injection of local anesthetic. However, the rise in 1-minute post-block IOP was significantly less in the ropivacaine group. The 5- and 15-min post-block mean IOP values in the ropivacaine group were significantly lower than the corresponding values of the lidocaine-bupivacaine group and baseline (control) ropivacaine values.
The results of this study support that ropivacaine as a local anesthetic drug for peribulbar block for small-incision cataract surgery can be a suitable alternative to the lidocaine-bupivacaine combination. Studies involving a larger sample size are required to consider ropivacaine as a superior drug to the lidocaine-bupivacaine combination.

UNASSIGNED: An ideal anesthetic solution should provide good anesthesia and akinesia with minimal pain on injection.
UNASSIGNED: The aim of this study is to determine the effect on pain perception and efficacy of sodium bicarbonate over hyaluronidase in the local anesthetic mixture during peribulbar anesthesia.
UNASSIGNED: A prospective, randomized, double-blind study.
UNASSIGNED: An independent observer labeled two injections as A (hyaluronidase 1500 IU in 30 mL of lignocaine) and B (7.5% sodium bicarbonate 1 mL in 30 mL of lignocaine). Group 1 was injected with injection A while Group 2 was injected with injection B. The visual analog scale (VAS) was used to determine the intensity of pain. Onset and degree of anesthesia and akinesia were recorded.
UNASSIGNED: Computer software Microsoft Excel SPSS version 26 (Chicago Inc) for windows was used. The qualitative data and quantitative data were reported as proportions and mean ± (standard deviation), respectively. Chi-square test for proportions was used for the comparison of qualitative variables and unpaired Student\'s t-test was used to test the significance between quantitative variables. P < 0.05 was considered statistically significant. All P were two-tailed.
UNASSIGNED: Out of 123 patients, 23 were excluded from the study. Hundred patients were divided into Group 1 and Group 2. The mean age in Group 1 was 64.92 ± 10.77 years while in Group 2 was 62.86 ± 11.17 years. The mean heart rate and mean systolic blood pressure in both groups were statistically insignificant. Group 2 experienced very less pain (mean pain score VAS = 5.12 ± 1.17) as compared to Group 1 (mean pain score was 7.16 ± 1.09) and the difference between both the groups was found to be statistically significant. There was a significant difference in the onset of anesthesia in both groups (P = 0.001). In the sodium bicarbonate group, the onset was faster. The onset of akinesia was better in Group 1 (4.76 ± 2.06 min). Grading of akinesia was better in Group 1.
UNASSIGNED: Sodium bicarbonate reduces pain on injection in peribulbar anesthesia and also results in a quicker onset of anesthesia.

Peribulbar Anesthesia (PBA) is a relatively safe method for cataract surgery. The anesthetic volume should be adjusted according to the axial eyeball length. Thus, using Minimum Effective Volume (MEV) of local anesthetic helps avoiding unnecessary volumes, preventing increases in intra-ocular pressure, and producing satisfactory conditions for cataract surgery. This study aims to determine the MEV90 of local anesthetics in relation to eye globe axial length in peribulbar blocks for cataract surgery.
Patients scheduled for cataract extraction under local anesthesia were divided according to their axial eyeball length; Group 1 included those with axial length from 22 to 24 mm, Group 2 included patients with axial length from 24.1 to 26 mm. The initial volume used was 7 mL of a solution of bupivacaine 0.5% (3 mL) + lidocaine 2% (3 mL) + hyaluronidase 150 IU (1 mL). The subsequent volumes were dependent on the response of the previous patient, by using a Bias Coin Design (BCD) and Up and Down Method (UDM) for MEV-90 determination.
The study was concluded with 119 patients. Sixteen patients needed supplemental volume of local anesthetic in Group 1 and thirteen in Group 2. The MEV90 for Group 1 was approximately 5.82 mL (95% CI 5.6 to 5.87 mL) and 5.45 mL for Group 2 (95% CI 5.38 to 5.91 mL). No major complications were noted. There was a negative correlation between the effective volume of LA and eye globe axial length in both groups (p = 0.001).
The MEV90 of local anesthetics for peribulbar block show a strong and inverse correlation with eye globe axial length. This may help achieving an effective block with minimum complications.

UNASSIGNED: Ocular blindness and ocular morbidities are very much prevalent in pediatric age group in India. Mostly, these are all surgically amenable, provided they have access to safe anesthesia. Suboptimal facilities for conventional general anesthesia (GA) led to a different thought process. The combination of anesthetic and analgesic property of ketamine was utilized in a low-resource setting at a tertiary ophthalmic center for pediatric ophthalmic surgeries.
UNASSIGNED: The aim of this study was to decipher whether this technique is acceptable and feasible.
UNASSIGNED: It was a prospective consecutive series at a rural eye center done over a period of 5 years.
UNASSIGNED: Inclusion criterion was children undergoing eye surgeries between the ages of 7 and 18 years, who could be adequately counseled about the concept of painless intravenous cannulation and subsequent painless block. Intravenous anesthesia comprised of ketamine, in conjunction with peribulbar block. Complications of the technique, time to discharge, mean pain score, and patient and surgeon satisfaction score were documented.
UNASSIGNED: Data were analyzed on Microsoft Excel.
UNASSIGNED: A total of 905 cases were conducted uneventfully without conversion to GA. No emergency resuscitation was required. The surgeon and the patient had a satisfying experience, with the technique being totally acceptable to them.
UNASSIGNED: Intravenous ketamine is an inexpensive and safe anesthetic technique when used in conjunction with regional block and is certainly a boon for minimal resource ophthalmic setup in rural India.

UNASSIGNED: To compare anterior chamber depth and postoperative visual outcome in patients undergoing phacoemulsification under topical vs peribulbar anesthesia.
UNASSIGNED: Prospective, randomized, comparative observational study.Sample size: 110 eyes with 55 eyes each. Group I: Patients undergoing phacoemulsification under topical anesthesia.Group II: Patients undergoing phacoemulsification under peribulbar anesthesia.Once patients were selected, baseline a standard ophthalmic examination was done including best-corrected visual acuity (BCVA), refraction, IOP by NCT, anterior segment evaluation with slit lamp biomicroscopy, keratometry, axial length, and ACD measurement by IOL master. Post-operatively, the patients were reviewed at day 1, week 1, week 6 for the same parameters.Statistics:Quantitative variables: Paired and unpaired t-test.Qualitative variables: Chi square test.A P-value of <0.05 was considered statistically significant.
UNASSIGNED: Inter-group comparisons of post-operative change in ACD at 1-week post-op (P-value<0.001) and 6-week post-op (P-value<0.001) were statistically significant when compared to the pre-op values. The mean spherical equivalent in group I was 0.27±0.26 d and that in group II was 1±0.32 d at 1-week post-op. The mean spherical equivalent in group I was 0.23±0.20 d, while that in group II was 0.85±0.64 d at 6-week post-op. This difference was statistically significant both at 1-week post-op (P-value=0.002) and 6-week post-op (P-value<0.001).
UNASSIGNED: Post-phacoemulsification, the ACD is more after peribulbar anesthesia as compared to topical anesthesia. Post-op refractive outcome is better with the use of topical anesthesia.