title: Iatrogenic Central Retinal Artery Occlusion Following Retrobulbar Anesthesia for Intraocular Surgery.
abstract: OBJECTIVE
  To present clinical features of central retinal artery occlusion (CRAO) following retrobulbar anesthesia for intraocular surgery.
  
  
  METHODS
  This observational case series describes 5 consecutive patients with acute CRAO following retrobulbar anesthesia for intraocular surgery. Data collected for this study included subject characteristics, retrobulbar anesthesia technique, treatment type, initial and final best-corrected visual acuity, and other ophthalmologic examinations.
  
  
  RESULTS
  Mean subject age was 67.0 ± 8.2 years (range, 53 to 72 years). All patients had one or more vascular risk factors (e.g., hypertension, cerebral infarction, carotid artery stenosis) and presented with acute vision loss 1 day after uneventful intraocular surgery (cataract surgery in 2 eyes and vitrectomy in 3 eyes). All 5 patients received retrobulbar anesthesia during surgery, 4 of which involved the use of a sharp needle. No immediate complications were noted during intraocular surgery. Final visual prognosis was poor (from finger count to no light perception) although intraocular thrombolysis was attempted in 3 patients.
  
  
  CONCLUSIONS
  Iatrogenic CRAO is a potential complication of retrobulbar anesthesia for intraocular surgery in elderly patients with vascular risk factors. Unfortunately, this complication can lead to severe vision loss. We conclude that retrobulbar anesthesia for intraocular surgery should be performed with great care and special consideration for elderly patients with vascular risk factors.
authors.affiliation: Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Eun Hye
authors.initials: EH
authors.lastname: Jung
authors.affiliation: Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Kyu Hyung
authors.initials: KH
authors.lastname: Park
authors.affiliation: Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Se Joon
authors.initials: SJ
authors.lastname: Woo
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D009915:Orbit; D011183:Postoperative Complications; D015356:Retinal Artery Occlusion / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D014792:Visual Acuity
chemical_list: D000779:Anesthetics, Local
keywords: Cataract; Intraocular surgery; Retinal artery occlusion; Retrobulbar anesthesia; Vitrectomy