title: Dual platelet inhibition in cases of severe retrobulbar hemorrhage following retrobulbar and peribulbar anesthesia.
abstract: OBJECTIVE
  To evaluate the prevalence of dual platelet inhibition in cases of severe retrobulbar hemorrhage following retrobulbar and peribulbar anesthesia.
  
  
  METHODS
  Department of Ophthalmology, Ludwig-Maximilans Universität, München, Germany.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Two groups of patients were screened retrospectively over a 5-year period for the inclusion criterion of severe retrobulbar hematoma after retrobulbar or parabulbar injection. The first group consisted of emergency cases referred to the clinic. A second group of patients had received retrobulbar block at the hospital. All cases were collected and screened for the presence of antiplatelet therapy.
  
  
  RESULTS
  Among roughly 160 000 patient records screened, 3 patients with grade IV retrobulbar hematoma were identified. Two of these patients were taking dual antiplatelet medications and 2 were on anticoagulation therapy during the time of retrobulbar or peribulbar anesthesia. None of the cases showed single medication platelet inhibition. The visual acuity of all patients stayed low at the 6-month follow-up (1.2 logMAR in 1 patient and no light perception in 2 patients).
  
  
  CONCLUSIONS
  Retrobulbar hematoma is a rare but severe complication of retrobulbar anesthesia. With the high prevalence of dual platelet inhibition found in these cases, a prospective controlled trial seems unethical. In these high-risk patients, surgery should be performed under topical anesthesia if possible or general anesthesia if necessary.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Departments of Ophthalmology (Huebert, Kook, Miller, Mayer, Haritoglou, Kampik, Gandorfer, Hintschich, Wolf) and Anesthesiology (Boost), Ludwig-Maximilans Universität, München, and the Department of Cardiology (Heinicke), Asklepios Klinik Burglengenfeld, Burglengenfeld, Germany.
authors.forename: Irene
authors.initials: I
authors.lastname: Huebert
authors.affiliation: From the Departments of Ophthalmology (Huebert, Kook, Miller, Mayer, Haritoglou, Kampik, Gandorfer, Hintschich, Wolf) and Anesthesiology (Boost), Ludwig-Maximilans Universität, München, and the Department of Cardiology (Heinicke), Asklepios Klinik Burglengenfeld, Burglengenfeld, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Heinicke
authors.affiliation: From the Departments of Ophthalmology (Huebert, Kook, Miller, Mayer, Haritoglou, Kampik, Gandorfer, Hintschich, Wolf) and Anesthesiology (Boost), Ludwig-Maximilans Universität, München, and the Department of Cardiology (Heinicke), Asklepios Klinik Burglengenfeld, Burglengenfeld, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kook
authors.affiliation: From the Departments of Ophthalmology (Huebert, Kook, Miller, Mayer, Haritoglou, Kampik, Gandorfer, Hintschich, Wolf) and Anesthesiology (Boost), Ludwig-Maximilans Universität, München, and the Department of Cardiology (Heinicke), Asklepios Klinik Burglengenfeld, Burglengenfeld, Germany.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Boost
authors.affiliation: From the Departments of Ophthalmology (Huebert, Kook, Miller, Mayer, Haritoglou, Kampik, Gandorfer, Hintschich, Wolf) and Anesthesiology (Boost), Ludwig-Maximilans Universität, München, and the Department of Cardiology (Heinicke), Asklepios Klinik Burglengenfeld, Burglengenfeld, Germany.
authors.forename: Christina V
authors.initials: CV
authors.lastname: Miller
authors.affiliation: From the Departments of Ophthalmology (Huebert, Kook, Miller, Mayer, Haritoglou, Kampik, Gandorfer, Hintschich, Wolf) and Anesthesiology (Boost), Ludwig-Maximilans Universität, München, and the Department of Cardiology (Heinicke), Asklepios Klinik Burglengenfeld, Burglengenfeld, Germany.
authors.forename: Wolfgang J
authors.initials: WJ
authors.lastname: Mayer
authors.affiliation: From the Departments of Ophthalmology (Huebert, Kook, Miller, Mayer, Haritoglou, Kampik, Gandorfer, Hintschich, Wolf) and Anesthesiology (Boost), Ludwig-Maximilans Universität, München, and the Department of Cardiology (Heinicke), Asklepios Klinik Burglengenfeld, Burglengenfeld, Germany.
authors.forename: Christos
authors.initials: C
authors.lastname: Haritoglou
authors.affiliation: From the Departments of Ophthalmology (Huebert, Kook, Miller, Mayer, Haritoglou, Kampik, Gandorfer, Hintschich, Wolf) and Anesthesiology (Boost), Ludwig-Maximilans Universität, München, and the Department of Cardiology (Heinicke), Asklepios Klinik Burglengenfeld, Burglengenfeld, Germany.
authors.forename: Anselm
authors.initials: A
authors.lastname: Kampik
authors.affiliation: From the Departments of Ophthalmology (Huebert, Kook, Miller, Mayer, Haritoglou, Kampik, Gandorfer, Hintschich, Wolf) and Anesthesiology (Boost), Ludwig-Maximilans Universität, München, and the Department of Cardiology (Heinicke), Asklepios Klinik Burglengenfeld, Burglengenfeld, Germany.
authors.forename: Arnd
authors.initials: A
authors.lastname: Gandorfer
authors.affiliation: From the Departments of Ophthalmology (Huebert, Kook, Miller, Mayer, Haritoglou, Kampik, Gandorfer, Hintschich, Wolf) and Anesthesiology (Boost), Ludwig-Maximilans Universität, München, and the Department of Cardiology (Heinicke), Asklepios Klinik Burglengenfeld, Burglengenfeld, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hintschich
authors.affiliation: From the Departments of Ophthalmology (Huebert, Kook, Miller, Mayer, Haritoglou, Kampik, Gandorfer, Hintschich, Wolf) and Anesthesiology (Boost), Ludwig-Maximilans Universität, München, and the Department of Cardiology (Heinicke), Asklepios Klinik Burglengenfeld, Burglengenfeld, Germany. Electronic address: armin.wolf@med.uni-muenchen.de.
authors.forename: Armin
authors.initials: A
authors.lastname: Wolf
mesh_terms: D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000188:drug therapy; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures; D002318:Cardiovascular Diseases / Q000188:drug therapy; D000077144:Clopidogrel; D004338:Drug Combinations; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D018918:Phacoemulsification; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D019315:Retrobulbar Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D004338:Drug Combinations; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin