Retrobulbar block (numbing the eye with a needle injection)

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I've scheduled cataract surgery in September, but now the surgeon is saying he has called for an anesthesia called retrobulbar block, which is numbing the eye with a needle inserted into the optic nerve. He said it's because my cataract is dense (3) and my eyes don't dilate wide enough (5 1/2). This sounds very scary to me and I don't like the risk factors...damage to the eye muscles, blood clot, retinal detachment, and total blindness! Has anyone had this type of anesthesia for cataract surgery?? Do I really have to have it?

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  • Posted

    No, I haven't needed what the surgeon is suggesting, though I was warned that certain meicine I took for another condition would make the procedure more complicated. Did I still want the surgery?

    Their is always risk, and on time I was told by a chinese registrar, "3% chance you go heaven".

    What I am trying to say is this. Have you got faith in the sugical team, who may well have dealt with similar difficult cases? You have an eye with a bad cataract, so what is the worst that can happen, and how likely? Put that against the more likely benefits, and decide!

    Having had both eyes done, I know my answer>

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  • Posted

    I know nothing about it, but of course you don't have to have any surgery you don't want to have!   You're in charge, not the surgeon, up to you to balance out the risks and advantages
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  • Posted

    A retrobulbar needle is sharp whereas using a subtenons cannula which is blunt offers less risk haemorrhage behind the eye.  Both will effectively numb the eye prior to surgery.  Neither type of injection goes into the optic nerve itself but merely the space behind the eye.  The injection itself is not painful and all you feel is a little pressure.  If you do feel any of the operation you should inform the surgeon because sometimes a few extra anaesthetic drops on the surface are required.

    Cataract surgery is generally 97 per cent successful.  Fortunately the risk of death is extremely remote and much less less than one in 1000 especially when done under local anaesthetic rather than a full general anaesthetic.

    Surgery can never be at 100 per cent successful because of possible complications either during surgery or later in the post operative phase.

    Dense hard catarcacts and small pupils may entail a slightly higher risk but in order to see more clearly you should have the surgery.  Waiting will only result in the cataract becoming more dense.

     

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    • Posted

      Thanks, Robert,

      So do you think the retrobular block is necessary for me because of a dense cataract (3) and smaller pupils (5 1/2). Would I be okay and pain free with topical drops?

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    • Posted

      Hi I have only just read your post so I assume you have had your surgery and are recovering hope it went well.  Just though I would give you the benefit of my experience I had my left cataract removed in 2012 at Moorfields in London my surgeon apparently does the retrobular block for all his patients, (I do have mild glaucoma so don't know if this a factor but don't think so.)  The surgery was great no pain at all I was very relaxed unsual for me as I suffer from anxiety.  The block completley froze the eye.  There may have been a slight problem just after surgery with the muscle at the outer corner of the eye but it did not last long.  Vision was brilliant from day two.  I was very worried at the time because I suffer from blepharitis and dry eye.  I put in all the drops religiously and followed their advice.  Now when I had the right eye done in 2014 things were different was done at local outreach and they only offered numbing drops.  I felt everything and it took ages to place the lens because I was recoiling in pain.  Thank heavens I had a doctor who I knew and trusted.

      Recovery was fine except I did have to go to emergency because of flashing lights which started around 4 weeks after surgery.  They did think it might be retina detaching but turned out to be the gel coming away from back of the eye which is common as you get older and more likely after cataract surgery.  Although things are ok now I would have gone back up to London and had a block again given the chance.  That said Moorfields are great and have a good reputation and I attend the clinic for glaucoma so any problems with the eyes are picked up.  Hope this helps.

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    • Posted

      " I did have to go to emergency because of flashing lights which started around 4 weeks after surgery."

      Hello libralady smile

      I read your story and I have a question - did the flashing go away?

      I had my eye done 8 weeks ago and since day one I have a blinking, pulsating light in the right corner of my eye.

      I also became very nearsighted but I wanted a my vision set for distance. I see objects larger than natural. Like seeing them with a magnifying glass. I see double past the reading distance.

      My doctor claims that "all is fine" but she prescribed bunch of different glasses for me to use - strange solution for someone who was promised to be able to drive and do some basic sports without any glasses except "maybe for reading fine prints".

      This Friday evening, two days ago, all of the sudden, I got some very bright flashing lights. I call my doctor and see said to wait until Monday unless it gets worst. Two hours later, i notice tons of large floaters making impossible to for me to walk around without feeling dizzy and confused as they appeared to be dancing like shadows everywhere I looked.

      Needless to say, I am miserable and depressed and very scared of losing my sight! Please pray for me!!!

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    • Posted

      Hello   Yes I still get the odd flash and of course floaters which I had from when the flashing started.  As I explained the surgery was more difficult in that eye so more trauma I suppose.  I was told they can last up to a year gradually reducing but I did read somewhere on line that some people have the odd flash longterm.  Being under the clinic for glaucoma I have been many times and mentioned the odd flash they say everything is fine and the pvd (the gel coming away which pulls on the retina and causes the flashes) is now complete.  The did mention it could happen with the other eye but that surgery was 2012 and uncomplicated so hope it will be ok.  I was told to go to the emergency Moorfields clinic in London if I started to get lots of flashes and showers of floaters.  From what you say I wouldf advise you to have it checked go back to the hospital where the surgery was done or at least see an optician. I would go today if possible. Do let us know how you get on and try not worry. It may be like me the gel coming away but best to get it checked.  I think also some people get shimmering in the corner (I have) caused by the light bouncing off the artifical lens.
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  • Posted

    Eye Surgeons, can do cataract surgery with either method. However, they do develop their prefered choice early on, and continue to only use one method or the other. So if you have a reason to choose, do that, and ask for a surgeon who does your preferred choice. With the injection, they do put drops into your eye first to numb it, so you do not feel the injection at all.

    I had mine done with the drops, and they have to keep putting them in because they dont last long, and my surgeon kept calling for more, which seemed urgent each time, this meant the aneathasist had to keep coming in to do the drops. Like 'libralady', i did keep feeling it, and for that reason I would choose the injection another time.

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  • Posted

    There are two types of blocks. The retrobulbar block is not very safe! I supposedly had the peribulbar block - without my consent, and I am suspicious that something went wrong as I still observe too many "side effects" eight weeks after the surgery! Doctors use the block for their comfort, not that it is needed!! Please search the Internet - there are many legitimate answers. If you feel uncertain, change the doctor - I wish that I have listened to my inner voice that said NO GO!!!

    here is one link

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377384/

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    • Posted

      I was not aware that there are 2 types of blocks.  Which one I had I don't know without asking which I might do when next at the clinic in November.  As I have said it was the choice of the consultant.  I can only say that with the block the surgery was quick I felt nothing at all and could see well the next day.  The only possible side effect I can think and it may be nothing to do with the block was some slight muscle odd feeling on the outer lower side of eye but this quickly disappeared.  The 2nd surgery with with just numbing eye crops was not nice as I explained in my earlier post. I was ok until the doctor removed the old lens and then when he tried to place the new one in I felt everything he had to give me maximum local anaesthetic and it took a while to place the lens.  I also had to have a stitch put in although I did with the first surgery as well. Everybody is different but I preferred the block.  What are the side effects you say you have eight weeks after the surgery.
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    • Posted

      Thank you, Katherine! That's what my "gut" was telling me when my HMO doctor said he used the block (didn't say which one) on uncooperative patients. (Me? I'm the most cooperative person in the world.) He also said he used it on half of his patients. I immediately searched the internet, cancelled my surgery, and found another doctor. But I have to change my insurance to go to her...so I can't have the surgery until January 2016 when my new ins. takes effect.

      I pray you will make a full recovery!!!  

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