Possible complications of cataract surgery? 
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 Possible complications of cataract surgery?



Quote:
>The anesthetic is not injected into the optic nerve but rather into the
>subcutaneous regions above and below the eyelids. One is given a
>tranquilizer via an IV in the back of the hand (the most painful part of
>the whole process for me) and when the patient is appropriately mellow,
>these injections are made, and made again at a deeper level after the first
>injections have taken effect. It was close to 36 hours before my scalp felt
>normal again. Once the area is anesthetized the eye is immobile but not
>blind. I "watched" the extraction of my lens (phaecoemulsification process)
>and the insertion of my intraocular lens implant.

My ophthalmologist used a slightly different technique:  First, Xylocaine
was injected around my eyelids (top & bottom) and into a nerve nexus at
the side of my face, near the ear.  Then, more local anesthetic (see below)
is injected through the lower eyelid, beneath the globe, and around to near
the optic nerve at the back of the eye.  This injection is called a Retro-
Bulbar ("RB" among ophthalmologists and anesthesiologists).

Complications due to the RB are rare.  When they happen, though, it's usually
due to incorrect placement of the needle tip:  It penetrates the dura, and
the anesthetic is squirted directly into the sub-arachnoid space, usually
resulting in convulsions and possible death.

[RB mixture: 50/50 Xylocaine/Marcaine, with 10,000 units (10 mg?) of hyalo-
uronidase, to "loosen up" old scar tissue from previous surgery.  My RB had
Carbocaine instead of Xylocaine (due to my ophthalmologist's not wanting
to give my {*filter*} an excuse to clot); ordinarily he would use Xylocaine.]

[All local anesthetics:
 Xylocaine  - lidocaine
 Marcaine   - bupivacaine
 Carbocaine - mepivacaine]

When my right eye was done, I watched hazily as the implant was inserted.
For the procedures on my left eye, however, my eye blacked out.  My
ophthalmologist said this "blacking out" was by far the standard reaction
to the RB; he was surprised that my right eye DIDN'T black out.

Now, phacoemulsification requires a smaller opening in the cornea than
other techniques.  But then, the opening would have had to be big enough
to admit the IOL -- unless, perhaps, the IOL was one of those experimental
"folding" IOLs, which snap open once inside the eye.




Mon, 10 Apr 1995 19:22:45 GMT
 
 [ 1 post ] 

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