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R. H. Ghafouri, S. Liang, T. K. Pira; Elevated Intraoperative Intraocular Pressure. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5413.
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To report two cases of intraoperative elevated intraocular pressure (IOP) associated with intracameral injection of either trypan blue or Shugarcaine solution .
Retrospective, observational case series.
Two eyes of two patients ( 65 yo, 1F, 1M) demonstrated elevated intraocular pressures during cataract surgery. Pre-operative axial length, anterior chamber depth and IOP were within normal limits for all three eyes. None of the two patients had previous surgery on the operated eye nor did they have any known ocular disease other than cataract. Both patients underwent uneventful periocular anesthesia with 0.75% bupivacaine and 2% lidocaine mixed with 1 mL dose of hyaluronidase. In both eyes, a supersharp blade was used to create a paracentesis. In both eyes, an intracameral injection of trypan blue followed by shugarcaine solutionin two eyes (combination of preservative free lidocaine, 1:100,00 epinephrnie mixed with balanced salt solution) was immediately followed by a cloudy cornea and significantly elevated IOP measured by palpation and tonopen. Both eyes revealed a normal anterior chamber depth, no iris bowing, and no evidence of globe proptosis or expulsion of intraocular contents. In both eyes, the planned surgical procedure was aborted and efforts to lower the IOP was begun. In one eye, oral hypo-osmotics and topical IOP-lowering eye drops were used to sufficiently lower the IOP, and the IOP returned to normal limits and subsequent examination revealed baseline visual acuity and IOP. In the second patient, a lateral canthomy and inferior cantholysis were performed, and IV Mannitol was administered in addition to topical IOP-lowering drops. An ultrasound B scan was performed and ruled out a choroidal hemorrhage. Additional paracentesis sites were perfomed, followed by a surgical iridectomy. Subsequent examination revealed elevated IOP and no light perception vision.
In our two cases, IOP became significantly elevated immediately following intracameral injection of trypan blue or shugarcaine solution. The mechanism of IOP elevation is unclear, as there were no anatomic abnormalities that could be identified. To our knowledge, this mechanism of intra-operative IOP elevation has not been reported in the ophthalmic literature and should be recognized as a sight-threatening condition.
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