We read with interest the case report by Horton et al1 in the March 1996 issue of the Archives and would like to report a similar case with different initial symptoms, management, and outcome.
A 77-year-old white woman with uncontrolled normotensive glaucoma (intraocular pressures ≤20 mm Hg) despite maximum tolerated antiglaucoma therapy and 360° of laser trabeculoplasty underwent a trabeculectomy on her left eye. Preoperatively, her visual acuity was 20/40 OS and the cup-disc ratio was 0.8 OS with an associated 70% pallor. The central 30°-thershold field demonstrated superior papillomacular loss with split fixation and an absolute inferonasal step extending to within 10° of fixation. Surgery was performed with retrobulbar anesthesia using an Atkinson retrobulbar needle penetrating the orbit in the inferotemporal quadrant. No complication was encountered during surgery, but on the first postoperative day, on removal of the eye patch, the patient had no light perception.
Devoto MH, Kersten RC, Zalta AH, Kulwin DR. Optic Nerve Injury After Retrobulbar Anesthesia. Arch Ophthalmol. 1997;115(5):687-688. doi:10.1001/archopht.1997.01100150689035