Motility disorders after cataract surgery in peribulbar anaesthesia
J. Fricke, A. Neugebauer, U. Pink, W. Rüßmann
We report on 14 cases of vertical tropia consecutive to cataract surgery performed in local anaesthesia patients were referred to us with a history of cataract surgery in peribulbar anaesthesia. In the majority of these cases a technique had been applied which comprised an injection of a mixture of 0.5% bupivacaine (3 ml) and 1.0% lidocaine (3-5 ml). 3-5 ml of this mixture were adrninistered via an temporal inferior injection, 2-3 mt were injected in the superior - nasal region. The patients, 10 female and 4 male, were at the time of cataract operation between 68 and 82 years old (mean 73.2, median 73), in 11 cases the left eye was affected. All patients showed limited evaluation of the eye in question both in ad- and in abduction, resulting in a hypotropia of the eye. The main deficiency in elevation was diagnosed in adduction, measured with Maddox dark red glass on the Harms screen. In primary position vertical tropia was 0.5 - 25 (mean 12.2, median 10.0) Measured with the same technique we found an excyclotropia, comprising 1-10º (mean 4.7, median 5) in primary position. We performed corrective strabismus surgery. The squint angles and motility findings had been stable for a period of at least 4 months before squint surgery. In some cases intraoperatively performed forced duction tests hinted to a fibrosis in the inferior rectus muscle. In all cases binocular single vision could be restored in a field within 25 of lateral gaze and within 25 of up- and downgaze. Myotoxic, dose- or concentration-related pharmacologic side effects have to be discussed as causitive factors. Also direct traumata or volume-dependant traumata have to be considered. An additional age-related disposition is possible.
University Eye Clinic, D-50924 Cologne