March 2012
Volume 53, Issue 14
Free
ARVO Annual Meeting Abstract  |   March 2012
High-resolution Surface Coil Magnetic Resonance Imaging After Peribulbar And Retrobulbar Injections
Author Affiliations & Notes
  • David R. Almeida
    Ophthalmology,
    Queen's University, Kingston, Ontario, Canada
  • Michel J. Belliveau
    Ophthalmology,
    Queen's University, Kingston, Ontario, Canada
  • Thomas Enright
    Radiology,
    Queen's University, Kingston, Ontario, Canada
  • Omar Islam
    Radiology,
    Queen's University, Kingston, Ontario, Canada
  • Sherif R. El-Defrawy
    Ophthalmology,
    Queen's University, Kingston, Ontario, Canada
  • Jeffrey Gale
    Ophthalmology,
    Queen's University, Kingston, Ontario, Canada
  • Footnotes
    Commercial Relationships  David R. Almeida, None; Michel J. Belliveau, None; Thomas Enright, None; Omar Islam, None; Sherif R. El-Defrawy, None; Jeffrey Gale, None
  • Footnotes
    Support  Queen's University
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 2186. doi:https://doi.org/
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    • Get Citation

      David R. Almeida, Michel J. Belliveau, Thomas Enright, Omar Islam, Sherif R. El-Defrawy, Jeffrey Gale; High-resolution Surface Coil Magnetic Resonance Imaging After Peribulbar And Retrobulbar Injections. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2186. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : Retrobulbar and peribulbar blocks are commonly used forms of anesthesia for ophthalmic surgical procedures; however, the precise anatomic localization of injected solution is unknown for each technique. We set out to examine the anatomic distribution of gadolinium contrast by high-resolution surface coil magnetic resonance imaging (MRI) after peribulbar and retrobulbar injection.

Methods: : Comparative case series. Four eyes were randomized to either peribulbar (n=2) or retrobulbar (n=2) injection of gadolinium and lidocaine 2% without epinephrine. Serial MRI imaging with surface coil was performed to determine anatomic distribution.

Results: : Retrobulbar injection technique localizes to the intraconal space with central nervous system (CNS) access via the optic canal, superior orbital fissure, and cavernous sinus. Contrastingly, peribulbar administration produces a mostly extraconal distribution; however, a small amount of intraconal solution may communicate with the CNS via the inferior orbital fissure and pterygopalatine fossa.

Conclusions: : We show the full extent of spread of anesthetic blocks and demonstrate the novel finding of pterygopalatine fossa extension, which provides a readily accessible route for CNS toxicity after peribulbar injection. Additionally, we highlight cavernous sinus involvement with the retrobulbar technique. MRI with gadolinium contrast administration provides an important methodological advantage over previous reports and is a safe, reproducible, and superior method of orbital imaging.

Keywords: anatomy • orbit • imaging/image analysis: clinical 
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