BACKGROUND A subtype of the Omicron variant of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is suggested to be responsible for the outbreak in Northern China since the quarantine was lifted in December 2...BACKGROUND A subtype of the Omicron variant of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is suggested to be responsible for the outbreak in Northern China since the quarantine was lifted in December 2022.The coronavirus disease 2019 virus is primarily responsible for the development of respiratory illnesses,however,it can present a plethora of symptoms affecting a myriad of body organs.This virus has been theorized to be linked to demyelinating lesions of the peripheral and central nervous system including transverse myelitis and acute retrobulbar optic neuritis(ARON).For example,magnetic resonance imaging(MRI)of the orbit and brain showed enlargement of the retrobulbar intraorbital segments of the optic nerve with high T2 signal,and no abnormalities were seen in the brain tissue.In this case series,we analyzed the connection between SARSCoV-2 infection and the onset of ARON.CASE SUMMARY Fifteen patients,and a teenage boy who did not have any pre-existing ocular or demyelinating diseases suddenly experienced a loss of vision after SARS-CoV-2 infection.The patients expressed a central scotoma and a fever as the primary concern.The results of the fundus photography were found to be normal.However,the automated perimetry and MRI scans showed evidence of some typical signs.Out of the 15 patients diagnosed with ARON after SARS-CoV-2 infection,only one individual tested positive for the aquaporin-4 antibody.CONCLUSION Direct viral invasion of the central nervous system and an immune-related process are the two primary causes of SARS-CoV-2-related ARON.展开更多
Background Managements of optic neuritis （ON） included high-dose corticosteroids or combined with systemic immunomodulatory agents. It was important to make a correct diagnosis of ON before initiation of treatment. ...Background Managements of optic neuritis （ON） included high-dose corticosteroids or combined with systemic immunomodulatory agents. It was important to make a correct diagnosis of ON before initiation of treatment. The purpose of the study was to report and analyze the clinical features of retinal diseases in patients who were misdiagnosed as having retrobulbar ON. Methods Retrospective review of 26 patients （38 eyes） initially diagnosed with retrobulbar ON but were ultimately diagnosed with retinal or macular diseases. Data obtained from fundus examination, fluorescence fundus angiography （FFA）, automated static perimetry, full-field electroretinogram （ffERG）, multifocal electroretinogram （mfERG）, and optical coherence tomography （OCT） were evaluated. Results Thirty-eight eyes of 26 patients were found to have misdiagnosis of retrobulbar ON, based on normal or slight abnormal fundus findings and abnormal visual evoked potentials （VEP）. The mean age of the patients was 34 years and the correct diagnosis of the patients included acute zonal occult outer retinopathy （AZOOR, 15 eyes, 14 patients）, occult macular dystrophy （OMD, 8 eyes, 4 patients）, cone or cone-rod dystrophy （10 eyes, 5 patients）, acute macular neuroretinopathy （AMNR, 3 eyes, 2 patients）, and cancer-associated retinopathy （CAR, 2 eyes, 1 patient）. Conclusion When attempting to diagnose retrobulbar ON in clinical practice, it is crucial to carry out necessary examinations of the retinal function and morphology to decrease misdiagnosis.展开更多
Retrobulbar anesthesia (block) is used for many ocular surgeries, whereas it is well known that this procedure has complications such as for retrobulbar hemorrhage, globe perforation, optic nerve injury and brain stem...Retrobulbar anesthesia (block) is used for many ocular surgeries, whereas it is well known that this procedure has complications such as for retrobulbar hemorrhage, globe perforation, optic nerve injury and brain stem anesthesia. In this report, we present a unique case in the literature of isolated exudative retinal detachment (RD) secondary to iatrogenic retrobulbar hemorrhage. A 73-year-old woman underwent retrobulbar block for combined phaco-vitrectomy. Immediately after the injection, progressive proptosis was recognized. The globe was decompressed and she underwent combined phaco-vitrectomy after stabilization of the eye on the same day. At the be-ginning of the vitrectomy, a dome shaped serous RD was observed in the infero-temporal quadrant. Peripheral exploration was performed, whereas there was no retinal tear or hole. On the first day postoperatively, serous RD was disappeared. In conclusion, this report suggests that increased intraorbital pressure secondary to iatrogenic retrobulbar hemorrhage might lead exudative RD.展开更多
Objective: To evaluate the clinical effect of integrated Chinese and Western medicine in treating acute retrobulbar optic neuritis. Methods: Combined Therapy of modified prescription of Danzhi Xiaoyao San and Taohong ...Objective: To evaluate the clinical effect of integrated Chinese and Western medicine in treating acute retrobulbar optic neuritis. Methods: Combined Therapy of modified prescription of Danzhi Xiaoyao San and Taohong Siwu Decoction and Mailuoning was applied to 12 patients (13 diseased eyes) and changes of such criteria as visual acuity, optic fundus, visual field, fundus fluorescein angiogram, pattern visual evoked potential and contrast sensitivity were observed. Results: 5 eyes (38. 46 % ) were cured, 5 (38. 46% ) markedly effective, 2 (15. 38% ) effective and 1 ineffective, the total effective rate being 92. 31 %. After treatment, visual acuity of 10 eyes was elevated to over 1. 0, and the other criteria were also improved in various degrees. Conclusion: The program of integrated therapy was effective in treating acute retrobulbar optic neuritis.展开更多
AIM: To describe prevalence and different clinical signs and management of cases with penetrating eye injuries during loco-regional anesthesia for ophthalmic surgery. METHODS: A retrospective review of clinical record...AIM: To describe prevalence and different clinical signs and management of cases with penetrating eye injuries during loco-regional anesthesia for ophthalmic surgery. METHODS: A retrospective review of clinical records was carried out, identifying cases of globe penetration secondary to peribulbar anesthesia injection during 5 y activity in Centro de Oftalmología Barraquer. RESULTS: A total of 17 460 needle-based ocular anesthesia procedures were performed in our centre and 4 cases of globe penetration were recorded with an estimated prevalence of 0.024%. Globe penetrations were always detected in the first 24 h after surgery. Vitreous haemorrhage was found in all the cases. Two eyes presented retinal detachment and two eyes choroidal detachment(CD). The initial surgical approach was performed within the first 48 h. Silicone oil was used as tamponade in three eyes and the fourth case remained only with air. Detachments were solved successfully in all the cases. Functional results varied among cases, depending on ocular remarkable antecedent and globe penetration with or without retinal or CD.CONCLUSION: Prevalence of globe penetration during loco-regional anesthesia is low in our centre. Physicians should consider the possibility of globe penetration in eyes with postoperative atypical appearance after locoregional anesthesia. Immediate B-scan ultrasonography is recommended in suspicious cases with a dense vitreous haemorrhage. An early vitrectomy surgery in conjunction with laser or cryotherapy at the penetration sites is essential for good anatomical and functional results.展开更多
BACKGROUND Orbital hemorrhage can be classified as traumatic or spontaneous depending on its cause.Spontaneous orbital hemorrhage refers to an internal orbital hemorrhage without apparent cause.Therefore,we aimed to d...BACKGROUND Orbital hemorrhage can be classified as traumatic or spontaneous depending on its cause.Spontaneous orbital hemorrhage refers to an internal orbital hemorrhage without apparent cause.Therefore,we aimed to describe a case of an orbital hematoma after a severe cough the night before due to inhalation of cooking oil fumes.CASE SUMMARY A 46-year-old woman was referred to our hospital with a complaint of exophthalmos accompanied with blurred vision,pain,binocular diplopia,and dizziness lasting for 5 h noted on waking in the morning.She also experienced nausea and vomiting due to high pressure of orbit and dizziness.Based on the auxiliary examination and her medical history,the patient was finally diagnosed with bulbar conjunctival vascular lesion combined with spontaneous retrobulbar hematoma.The patient was administered tobramycin and dexamethasone eye ointment,and applied pressure dressing on the left eye to stop the bleeding.Simultaneously,we administered intravenous etamsylate,oral Yunnan Baiyao capsule,intravenous mannitol to reduce orbital pressure,and intravenous dexamethasone injection at 10 mg/dL combined with neurotrophic therapy to reduce tissue edema.Among them,the Yunnan Baiyao capsule is a traditional Chinese herbal medicine to remove stasis and stop bleeding;thus,it promotes blood circulation and relieves pain resulting in reduced edema of the lesion site.The symptoms did not improve significantly during the first 2 d of treatment.We speculate that high orbital pressure and binocular diplopia induced frequent nausea and vomiting in the patient,causing increased pressure on the superior vena cava and leading to repeated orbital bleeding.After the second day,the symptoms started gradually improving.CONCLUSION This case further emphasizes the importance of comprehensive,detailed medical history and careful ophthalmic examination of the patient.展开更多
BACKGROUND Apnea caused by retrobulbar anesthesia is a very rare but severe complication during ophthalmic surgery.CASE SUMMARY We report a rare case of apnea caused by retrobulbar anesthesia,and emergency resuscitati...BACKGROUND Apnea caused by retrobulbar anesthesia is a very rare but severe complication during ophthalmic surgery.CASE SUMMARY We report a rare case of apnea caused by retrobulbar anesthesia,and emergency resuscitation was used.A 74-year-old female patient was diagnosed with rhegmatogenous retinal detachment in the right eye and planned to undergo vitrectomy under retrobulbar anesthesia.After the retrobulbar anesthesia in her right eye,she became unconscious and apneic.It was suggested that she had developed brainstem anesthesia.Assisted ventilation was initiated.Atropine 0.5 mg,epinephrine 1 mg,ephedrine 30 mg,and lipid emulsion were given.Five minutes later,her consciousness and breathing gradually returned,but with uncertain light perception in her right eye.Alprostadil 20μg was given,and after 2 h her visual acuity resumed to the preoperative level.CONCLUSION Brainstem anesthesia is a serious complication secondary to retrobulbar anesthesia.Medical staff should pay attention to the identification of brainstem anesthesia and be familiar with the emergency treatment for this complication.展开更多
Blindness is a serious complication that can occur after facial trauma and may represent the loss of one of the most useful senses in the human relationship with the world—the sight. This study aims to review the pat...Blindness is a serious complication that can occur after facial trauma and may represent the loss of one of the most useful senses in the human relationship with the world—the sight. This study aims to review the pathophysiology of blindness related to facial trauma in order to identify the mechanisms by which it develops and to recognize the signs and symptoms required to establish proper diagnosis and treatment. Blindness following facial trauma may occur due to mechanisms that involve injury to the eyeball, optic nerve and eyelids. The leading causes of blindness resulting from facial trauma, and which may be altered by medical interference, are related to retrobulbar hemorrhage and traumatic optic neuropathy, which require extremely rapid diagnosis and can be accomplished with the resources available in most trauma-based emergency services. The authors conclude that loss of vision tends to be irreversible in direct eyeball and optic nerve lesions, but can be prevented in retrobulbar hemorrhage and traumatic optic neuropathy. Eyeball and, especially, sight accuracy evaluation should be included in the initial care of trauma patients, so that the lesions that might lead to loss of vision are diagnosed and treated early.展开更多
BACKGROUND To report the possible reasons for needle perforation and complications related to perforation,as well as the clinical management of subretinal hemorrhage(SRH)during retrobulbar injection.CASE SUMMARY A 65-...BACKGROUND To report the possible reasons for needle perforation and complications related to perforation,as well as the clinical management of subretinal hemorrhage(SRH)during retrobulbar injection.CASE SUMMARY A 65-year-old female was scheduled to undergo pars plana vitrectomy(PPV)in her left eye for rhegmatogenous retinal detachment(RRD).During retrobulbar anesthesia,needle perforation of the globe occurred.Massive SRH in the inferotemporal quadrant together with vitreous hemorrhage were observed.The patient underwent PPV combined with retinotomy for removal of the massive SRH.After earlier surgical intervention,successful reattachment of the retina was achieved.CONCLUSION Inadvertent globe penetration during retrobulbar anesthesia is associated with a poor prognosis and may result in blindness.Timely detection and earlier intervention may be beneficial.展开更多
基金Municipal Science and Technology Plan Project of Xingtai City,Hebei Province,No.2022ZC232 and No.2022ZC129.
文摘BACKGROUND A subtype of the Omicron variant of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is suggested to be responsible for the outbreak in Northern China since the quarantine was lifted in December 2022.The coronavirus disease 2019 virus is primarily responsible for the development of respiratory illnesses,however,it can present a plethora of symptoms affecting a myriad of body organs.This virus has been theorized to be linked to demyelinating lesions of the peripheral and central nervous system including transverse myelitis and acute retrobulbar optic neuritis(ARON).For example,magnetic resonance imaging(MRI)of the orbit and brain showed enlargement of the retrobulbar intraorbital segments of the optic nerve with high T2 signal,and no abnormalities were seen in the brain tissue.In this case series,we analyzed the connection between SARSCoV-2 infection and the onset of ARON.CASE SUMMARY Fifteen patients,and a teenage boy who did not have any pre-existing ocular or demyelinating diseases suddenly experienced a loss of vision after SARS-CoV-2 infection.The patients expressed a central scotoma and a fever as the primary concern.The results of the fundus photography were found to be normal.However,the automated perimetry and MRI scans showed evidence of some typical signs.Out of the 15 patients diagnosed with ARON after SARS-CoV-2 infection,only one individual tested positive for the aquaporin-4 antibody.CONCLUSION Direct viral invasion of the central nervous system and an immune-related process are the two primary causes of SARS-CoV-2-related ARON.
文摘Background Managements of optic neuritis （ON） included high-dose corticosteroids or combined with systemic immunomodulatory agents. It was important to make a correct diagnosis of ON before initiation of treatment. The purpose of the study was to report and analyze the clinical features of retinal diseases in patients who were misdiagnosed as having retrobulbar ON. Methods Retrospective review of 26 patients （38 eyes） initially diagnosed with retrobulbar ON but were ultimately diagnosed with retinal or macular diseases. Data obtained from fundus examination, fluorescence fundus angiography （FFA）, automated static perimetry, full-field electroretinogram （ffERG）, multifocal electroretinogram （mfERG）, and optical coherence tomography （OCT） were evaluated. Results Thirty-eight eyes of 26 patients were found to have misdiagnosis of retrobulbar ON, based on normal or slight abnormal fundus findings and abnormal visual evoked potentials （VEP）. The mean age of the patients was 34 years and the correct diagnosis of the patients included acute zonal occult outer retinopathy （AZOOR, 15 eyes, 14 patients）, occult macular dystrophy （OMD, 8 eyes, 4 patients）, cone or cone-rod dystrophy （10 eyes, 5 patients）, acute macular neuroretinopathy （AMNR, 3 eyes, 2 patients）, and cancer-associated retinopathy （CAR, 2 eyes, 1 patient）. Conclusion When attempting to diagnose retrobulbar ON in clinical practice, it is crucial to carry out necessary examinations of the retinal function and morphology to decrease misdiagnosis.
文摘Retrobulbar anesthesia (block) is used for many ocular surgeries, whereas it is well known that this procedure has complications such as for retrobulbar hemorrhage, globe perforation, optic nerve injury and brain stem anesthesia. In this report, we present a unique case in the literature of isolated exudative retinal detachment (RD) secondary to iatrogenic retrobulbar hemorrhage. A 73-year-old woman underwent retrobulbar block for combined phaco-vitrectomy. Immediately after the injection, progressive proptosis was recognized. The globe was decompressed and she underwent combined phaco-vitrectomy after stabilization of the eye on the same day. At the be-ginning of the vitrectomy, a dome shaped serous RD was observed in the infero-temporal quadrant. Peripheral exploration was performed, whereas there was no retinal tear or hole. On the first day postoperatively, serous RD was disappeared. In conclusion, this report suggests that increased intraorbital pressure secondary to iatrogenic retrobulbar hemorrhage might lead exudative RD.
文摘Objective: To evaluate the clinical effect of integrated Chinese and Western medicine in treating acute retrobulbar optic neuritis. Methods: Combined Therapy of modified prescription of Danzhi Xiaoyao San and Taohong Siwu Decoction and Mailuoning was applied to 12 patients (13 diseased eyes) and changes of such criteria as visual acuity, optic fundus, visual field, fundus fluorescein angiogram, pattern visual evoked potential and contrast sensitivity were observed. Results: 5 eyes (38. 46 % ) were cured, 5 (38. 46% ) markedly effective, 2 (15. 38% ) effective and 1 ineffective, the total effective rate being 92. 31 %. After treatment, visual acuity of 10 eyes was elevated to over 1. 0, and the other criteria were also improved in various degrees. Conclusion: The program of integrated therapy was effective in treating acute retrobulbar optic neuritis.
文摘AIM: To describe prevalence and different clinical signs and management of cases with penetrating eye injuries during loco-regional anesthesia for ophthalmic surgery. METHODS: A retrospective review of clinical records was carried out, identifying cases of globe penetration secondary to peribulbar anesthesia injection during 5 y activity in Centro de Oftalmología Barraquer. RESULTS: A total of 17 460 needle-based ocular anesthesia procedures were performed in our centre and 4 cases of globe penetration were recorded with an estimated prevalence of 0.024%. Globe penetrations were always detected in the first 24 h after surgery. Vitreous haemorrhage was found in all the cases. Two eyes presented retinal detachment and two eyes choroidal detachment(CD). The initial surgical approach was performed within the first 48 h. Silicone oil was used as tamponade in three eyes and the fourth case remained only with air. Detachments were solved successfully in all the cases. Functional results varied among cases, depending on ocular remarkable antecedent and globe penetration with or without retinal or CD.CONCLUSION: Prevalence of globe penetration during loco-regional anesthesia is low in our centre. Physicians should consider the possibility of globe penetration in eyes with postoperative atypical appearance after locoregional anesthesia. Immediate B-scan ultrasonography is recommended in suspicious cases with a dense vitreous haemorrhage. An early vitrectomy surgery in conjunction with laser or cryotherapy at the penetration sites is essential for good anatomical and functional results.
文摘BACKGROUND Orbital hemorrhage can be classified as traumatic or spontaneous depending on its cause.Spontaneous orbital hemorrhage refers to an internal orbital hemorrhage without apparent cause.Therefore,we aimed to describe a case of an orbital hematoma after a severe cough the night before due to inhalation of cooking oil fumes.CASE SUMMARY A 46-year-old woman was referred to our hospital with a complaint of exophthalmos accompanied with blurred vision,pain,binocular diplopia,and dizziness lasting for 5 h noted on waking in the morning.She also experienced nausea and vomiting due to high pressure of orbit and dizziness.Based on the auxiliary examination and her medical history,the patient was finally diagnosed with bulbar conjunctival vascular lesion combined with spontaneous retrobulbar hematoma.The patient was administered tobramycin and dexamethasone eye ointment,and applied pressure dressing on the left eye to stop the bleeding.Simultaneously,we administered intravenous etamsylate,oral Yunnan Baiyao capsule,intravenous mannitol to reduce orbital pressure,and intravenous dexamethasone injection at 10 mg/dL combined with neurotrophic therapy to reduce tissue edema.Among them,the Yunnan Baiyao capsule is a traditional Chinese herbal medicine to remove stasis and stop bleeding;thus,it promotes blood circulation and relieves pain resulting in reduced edema of the lesion site.The symptoms did not improve significantly during the first 2 d of treatment.We speculate that high orbital pressure and binocular diplopia induced frequent nausea and vomiting in the patient,causing increased pressure on the superior vena cava and leading to repeated orbital bleeding.After the second day,the symptoms started gradually improving.CONCLUSION This case further emphasizes the importance of comprehensive,detailed medical history and careful ophthalmic examination of the patient.
文摘BACKGROUND Apnea caused by retrobulbar anesthesia is a very rare but severe complication during ophthalmic surgery.CASE SUMMARY We report a rare case of apnea caused by retrobulbar anesthesia,and emergency resuscitation was used.A 74-year-old female patient was diagnosed with rhegmatogenous retinal detachment in the right eye and planned to undergo vitrectomy under retrobulbar anesthesia.After the retrobulbar anesthesia in her right eye,she became unconscious and apneic.It was suggested that she had developed brainstem anesthesia.Assisted ventilation was initiated.Atropine 0.5 mg,epinephrine 1 mg,ephedrine 30 mg,and lipid emulsion were given.Five minutes later,her consciousness and breathing gradually returned,but with uncertain light perception in her right eye.Alprostadil 20μg was given,and after 2 h her visual acuity resumed to the preoperative level.CONCLUSION Brainstem anesthesia is a serious complication secondary to retrobulbar anesthesia.Medical staff should pay attention to the identification of brainstem anesthesia and be familiar with the emergency treatment for this complication.
文摘Blindness is a serious complication that can occur after facial trauma and may represent the loss of one of the most useful senses in the human relationship with the world—the sight. This study aims to review the pathophysiology of blindness related to facial trauma in order to identify the mechanisms by which it develops and to recognize the signs and symptoms required to establish proper diagnosis and treatment. Blindness following facial trauma may occur due to mechanisms that involve injury to the eyeball, optic nerve and eyelids. The leading causes of blindness resulting from facial trauma, and which may be altered by medical interference, are related to retrobulbar hemorrhage and traumatic optic neuropathy, which require extremely rapid diagnosis and can be accomplished with the resources available in most trauma-based emergency services. The authors conclude that loss of vision tends to be irreversible in direct eyeball and optic nerve lesions, but can be prevented in retrobulbar hemorrhage and traumatic optic neuropathy. Eyeball and, especially, sight accuracy evaluation should be included in the initial care of trauma patients, so that the lesions that might lead to loss of vision are diagnosed and treated early.
文摘BACKGROUND To report the possible reasons for needle perforation and complications related to perforation,as well as the clinical management of subretinal hemorrhage(SRH)during retrobulbar injection.CASE SUMMARY A 65-year-old female was scheduled to undergo pars plana vitrectomy(PPV)in her left eye for rhegmatogenous retinal detachment(RRD).During retrobulbar anesthesia,needle perforation of the globe occurred.Massive SRH in the inferotemporal quadrant together with vitreous hemorrhage were observed.The patient underwent PPV combined with retinotomy for removal of the massive SRH.After earlier surgical intervention,successful reattachment of the retina was achieved.CONCLUSION Inadvertent globe penetration during retrobulbar anesthesia is associated with a poor prognosis and may result in blindness.Timely detection and earlier intervention may be beneficial.
