Surgical outcomes of macular hole and epimacular membrane treatment in patients with intraoperative amaurosis under sub-Tenon's anesthesia

Abstract

Objective: Some patients have been found to develop intraoperative amaurosis under sub-Tenon's anesthesia. We explored whether these patients have poor surgical outcomes during mid- to long-term postoperative follow-up.

Methods: In this case series, 74 of 85 patients with macular diseases who underwent phacoemulsification combined with vitrectomy under sub-Tenon's anesthesia developed intraoperative amaurosis. The surgical outcomes at the 2- and 4-month follow-ups in these patients were investigated and compared with the outcomes in patients without amaurosis using best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and pattern visual evoked potential (PVEP).

Results: Both BCVA and the OCT-based macular structure in patients with intraoperative amaurosis showed significant postoperative improvement comparable with that of patients without amaurosis. The presence of intraoperative amaurosis was not associated with either macular hole closure or macular edema regression. PVEP revealed no significant changes in the wave latency or amplitude before and after surgery.

Conclusion: Intraoperative amaurosis following sub-Tenon's block is commonly seen but does not predict a poor surgical prognosis. When a patient develops amaurosis during surgery, the surgeon should increase patient comfort through verbal communication rather than perform an additional intervention to help relieve the patient's anxiety.

Keywords: Intraoperative amaurosis; case series; intraocular surgery; macular diseases; sub-Tenon’s anesthesia; surgical outcome.

Figure 1.

Visual outcomes in patients with IMH and EMM before and after surgery. (a) Best-corrected visual acuity (BCVA) showed significant improvement in patients with IMH at both the 2- and 4-month follow-up compared with preoperatively. (b) BCVA showed significant improvement in patients with EMM at both the 2- and 4-month follow-up. (c) The macular foveal thickness in patients with EMM showed a significant decrease at the 4-month follow-up compared with preoperatively. *Paired-samples t test, P < 0.0001. IMH, idiopathic macular hole; EMM, epimacular membrane.

Figure 2.

Representative optical coherence tomography (OCT) images in patients with IMH and EMM who developed intraoperative amaurosis. (a) Preoperative OCT imaging showing full-thickness IMH in a patient with intraoperative amaurosis. IMH closure in (b) U-type, (c) V-type, and (d) W-type configuration after surgery in patients with IMH who developed intraoperative amaurosis. (e) Preoperative OCT image in a patient with EMM. (f) OCT demonstrated removal of the EMM and improvement of the macular fovea structure in the same patient after surgery. IMH, idiopathic macular hole; EMM, epimacular membrane.