Retinal hemodynamic effects of sub-Tenon anesthesia

Introduction and objectives: Sub-Tenon anesthesia techniques are commonly employed in ophthalmology. However, there is speculation that these techniques may have hemodynamic effects on the eye, potentially affecting patients with impaired ocular perfusion. This study aims to evaluate the impact of sub-Tenon anesthesia during cataract surgery on retinal vessel density (VD) and perfusion density (PD) in eyes affected by diabetic maculopathy (DM) or retinal vein occlusion (RVO), using optical coherence tomography angiography (OCTA). Methods: The study included 20 patients receiving sub-Tenon anesthesia with unpreserved mepivacaine 2% for unilateral cataract surgery: 10 with DM and 10 with RVO, analyzing a total of 40 eyes (20 treated and 20 untreated). Blood pressure, intraocular pressure (IOP), and retinal microvascular changes measured via OCTA (VD, PD) were documented before and shortly after sub-Tenon anesthesia. The contralateral eye, which did not receive anesthesia, served as a control. Results: = 0.38), suggesting a potential hemodynamic effect of sub-Tenon anesthesia. However, the quality of OCTA images strongly influenced these findings. After excluding lower-quality images (signal strength index