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—We did not make the "suggestion that in Abrams' cases N2O anesthesia contributed to the loss of light perception on the first postoperative day." On the contrary, we restated Abrams' postulation that "N2 entry into the SF6 bubble, continuing for 24 hours, increased IOPs [intraocular pressures] and caused central retinal artery occlusion." Apparently, Merhige et al misread N2 for N2O. We did say that "if those patients had received 66% N2O anesthesia, bubble volumes would have tripled and IOPs would have doubled during the operation....such increases might predict first postoperative day central retinal artery occlusion" [italics added], but that speculation does not appear to be contested.This aside, we agree that reoperation with a short N2O induction prior to switching to a halogenated anesthetic in O2, along with central retinal artery monitoring and intraocular gas venting,
Wolf GL, Hartung J. Effect of Nitrous Oxide on Gas Bubble Volume-Reply. Arch Ophthalmol. 1985;103(9):1274. doi:10.1001/archopht.1985.01050090022009
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