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July 1985

Vitreous Hemorrhage Following Paracentesis in a Diabetic With Epipapillary Neovascularization

Arch Ophthalmol. 1985;103(7):891-894. doi:10.1001/archopht.1985.01050070017011

To the Editor.  —We saw a 53-year-old, insulin-dependent diabetic woman with bilateral disc neovascularization (NVD) but no preretinal or vitreous hemorrhage at the time of her initial evaluation at the Retinal Vascular Center at the Wilmer Ophthalmological Institute, Baltimore (Fig 1). In preparation for full-scatter retinal photocoagulation, the patient was given a retrobulbar injection of 3 mL of a mixture of equal parts 2% lidocaine and 0.75% bupivacaine hydrochloride using a sharp, 25-gauge, 35-mm-long needle inserted through the skin at the inferotemporal orbital rim directed toward the orbital apex of the right eye. Immediately following the injection, orbital fullness suggesting a retrobulbar hemorrhage was appreciated.Indirect ophthalmoscopy revealed complete closure of the central retinal artery. It was our clinical impression that a lateral canthotomy might not have been sufficient to reestablish retinal circulation, and therefore, 0.1 mL of aqueous was aspirated from the anterior chamber at the temporal limbus.The

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