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October 1992

Peribulbar Injection and Direct Infiltration for Vitreoretinal Surgery-Reply

Arch Ophthalmol. 1992;110(10):1358. doi:10.1001/archopht.1992.01080220019004

In Reply.  —We thank Drs Simcock, Raymond, and Lavin for their comments and agree that scleral buckling procedures can sometimes be painful when performed with the local anesthetic technique described in our article. As they correctly pointed out, this seems to be more true of more complex buckling procedures requiring significant manipulation of the recti muscles and much retraction. The addition of peribulbar anesthesia may lessen patient discomfort in these cases.For most patients undergoing vitreoretinal surgery, however, we have not found peribulbar nor retrobulbar anesthesia to be necessary. Administration of peribulbar anesthesia is a relatively safe procedure, but the complications can be severe.1 The anesthetic technique we employ not only minimizes the risks of peribulbar anesthesia, but requires less anesthetic for its effect.In contrast to the approach of Dr Simcock et al, we prefer to initiate surgery with our anesthetic technique and "top it up" with peribulbar