Central retinal artery occlusion after peribulbar anesthesia: report of 3 cases

We report 3 cases of central retinal artery occlusion following peribulbar anesthesia. Those patients were scheduled for retinal detachment repair, removal of a pterygium, and cataract surgery, respectively. In patient 1, a peribulbar anesthesia was performed with 17 ml of ropivacaine and a compression with a Honan's balloon was maintained at 30 mmHg for 30 min to reduce intra ocular pressure and facilitate intra ocular surgery. In the second patient, 13 ml of ropivacaine was administered without compression of the ocular globe. Patient 3 received 14 ml of mepivacaine and compression was maintained at 30 mmHg for 10 min. In these 3 cases, the surgeon noticed a whitening of the retina during the postoperative period, corresponding with a typical occlusion of the central artery of the retina. Several mechanisms may be cited in an attempt to explain this retinal ischemia: the high volume injected, the speed of injection, a compression of the ocular globe at high pressures for a prolonged period of time, and/or an intrinsic vasoconstricting effect of local anesthetic agents.