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Retinal hemodynamic effects of sub-Tenon anesthesia.

Anthia Papazoglou1,2, Tim J Enz3, Ulrike Steitz1

  • 1Department of Ophthalmology, Cantonal Hospital Aarau, Aarau, Switzerland.

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Summary

Sub-Tenon anesthesia did not cause retinal microvascular changes in patients with diabetic maculopathy or retinal vein occlusion. Initial findings of reduced vessel density were attributed to optical coherence tomography angiography image artifacts, not hemodynamic effects.

Keywords:
cataract surgerydiabetesintraocular pressurelocal anesthesiamepivacaineperfusionretinopathysub-Tenon

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Area of Science:

  • Ophthalmology
  • Anesthesiology
  • Medical Imaging

Background:

  • Sub-Tenon anesthesia is common in ophthalmology but may affect ocular hemodynamics.
  • Patients with diabetic maculopathy (DM) or retinal vein occlusion (RVO) have compromised ocular perfusion.
  • The potential impact of sub-Tenon anesthesia on these vulnerable eyes requires investigation.

Purpose of the Study:

  • To evaluate the effect of sub-Tenon anesthesia on retinal vessel density (VD) and perfusion density (PD).
  • To assess these changes in patients with DM or RVO undergoing cataract surgery.
  • To determine if sub-Tenon anesthesia induces hemodynamic alterations in the retina.

Main Methods:

  • Prospective study of 20 patients (10 DM, 10 RVO) undergoing unilateral cataract surgery with sub-Tenon anesthesia.
  • Optical coherence tomography angiography (OCTA) used to measure VD and PD before and after anesthesia.
  • Contralateral untreated eye served as a control; blood pressure and intraocular pressure monitored.

Main Results:

  • Initial analysis suggested a negative association between sub-Tenon anesthesia and VD/PD.
  • Further analysis excluding low-quality OCTA images revealed no statistically significant differences between treated and control eyes.
  • No significant changes in blood pressure or intraocular pressure were observed post-anesthesia.

Conclusions:

  • Sub-Tenon anesthesia did not induce significant retinal microvascular changes in the studied population.
  • Observed VD and PD reductions were likely due to OCTA image artifacts, not true hemodynamic effects.
  • The safety of sub-Tenon anesthesia regarding retinal hemodynamics in DM/RVO patients is supported by these findings.