Impact of dexmedetomidine as an adjuvant to peribulbar anesthesia on the retinal vasculature in glaucoma patients: an optical coherence tomography angiography study

IF 0.1 Q4 OPHTHALMOLOGY
Mohamed A. Awwad, M. Elhadad, Mohamed Masoud
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引用次数: 0

Abstract

To assess Dexmedetomidine’s effect as an adjuvant to peribulbar anesthesia on the retinal vasculature in patients with glaucoma undergoing cataract extraction surgery via optical coherence tomography angiography (OCT-A). Thirty-nine glaucoma participants planned for phacoemulsification were allocated into two groups. A 10 ml mixture of peribulbar anesthesia was administered to group I. This anesthetic mixture consisted of 4.5 ml of lidocaine 2% mixed with 4.5 ml of bupivacaine 0.5%,1 ml of dexmedetomidine (50 µg), and 150 IU hyaluronidase. Group II was administered a peribulbar anesthetic mixture consisting of 4.5 ml of lidocaine 2% combined with 4.5 ml of bupivacaine 0.5%,150 IU of hyaluronidase, and 1 ml of normal saline, totaling 10 ml. Optical coherence tomography angiography was used 10 mi before and 10 min after injection to scan optic disc total vessel density, foveal superficial deep capillary plexuses (DCP) density, radial peripapillary capillary network density, and total vessel density plus foveal avascular zone (FAZ) diameter. We also checked the intraocular pressure (IOP) before and 10 min after the anesthetic injection. After the administration of the peribulbar anesthetic, group II demonstrated a notably higher significance in the DCP fovea median percent change (–43.7%) compared with group I (-2%) (P<0.001). Additionally, group II experienced a considerably greater median percent change in DCP total density (–22.4%) postinjection compared to group I (–0.8%) (P value < 0.001). The postinjection median percent changes in foveal total vessel density and superficial vessel density were −16.2% and −56.8% in group II, and −1% and −2.4% in group I, respectively, with a P value less than 0.001. Moreover, following the injection, the median percentage change in the diameter of the foveal avascular zone was significantly higher in group II (–40.6%) than in group I (–2.3%) (P value < 0.001). Additionally, there was a noteworthy increase in the optic disc’s total vessel density and the median percentage shift in radial peripapillary capillary network density in group II (–13.1 and −13.7%, respectively) compared with group I (–1.2 and −1%, respectively, P value < 0.001). IOP before and after injecting the anesthesia was insignificantly different between the studied groups (P =0.198 and 0.069, respectively). The addition of dexmedetomidine to the peribulbar anesthesia demonstrates a protective effect on the retinal microvasculature against the ischemic impact of anesthetic drugs with no significant effect on the IOP. This effect holds significant implications for glaucoma patients.
右美托咪定作为眼周麻醉的辅助药物对青光眼患者视网膜血管的影响:光学相干断层血管成像研究
通过光学相干断层血管造影术(OCT-A)评估右美托咪定作为围术期麻醉的辅助药物对接受白内障摘除手术的青光眼患者视网膜血管的影响。 39名计划接受超声乳化手术的青光眼患者被分为两组。I 组使用 10 毫升的混合麻醉剂,其中包括 4.5 毫升的 2% 利多卡因与 4.5 毫升的 0.5% 布比卡因、1 毫升的右美托咪定(50 微克)和 150 IU 透明质酸酶。第 II 组使用的是布巴周围麻醉混合物,包括 4.5 毫升 2% 利多卡因、4.5 毫升 0.5% 布比卡因、150 IU 透明质酸酶和 1 毫升生理盐水,共计 10 毫升。注射前 10 mi 和注射后 10 min 使用光学相干断层血管造影术扫描视盘总血管密度、眼窝浅层深毛细血管丛(DCP)密度、径向毛细血管周围网络密度和总血管密度加眼窝无血管区(FAZ)直径。我们还检查了注射麻醉剂前和注射后 10 分钟的眼压(IOP)。 注射眼周麻醉剂后,II 组的 DCP 眼窝中位百分比变化(-43.7%)明显高于 I 组(-2%)(P<0.001)。此外,与 I 组(-0.8%)相比,II 组注射后 DCP 总密度的中位百分比变化(-22.4%)要大得多(P 值<0.001)。注射后,II 组眼窝总血管密度和浅层血管密度的中位百分数变化分别为-16.2%和-56.8%,I 组分别为-1%和-2.4%,P 值均小于 0.001。此外,注射后,II 组眼窝无血管区直径变化的中位百分比(-40.6%)明显高于 I 组(-2.3%)(P 值小于 0.001)。此外,与第一组(分别为-1.2%和-1%,P值<0.001)相比,第二组的视盘总血管密度和径向毛细血管周围网络密度变化的中位百分比(分别为-13.1%和-13.7%)也有显著增加。各研究组在注射麻醉剂前后的眼压差异不大(P =0.198 和 0.069)。 在眼周麻醉中加入右美托咪定可保护视网膜微血管免受麻醉药物的缺血影响,而对眼压无明显影响。这种效果对青光眼患者具有重要意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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