ORIGINAL RESEARCH article
Front. Neurosci.
Sec. Visual Neuroscience
This article is part of the Research TopicInnovations in Ophthalmic Imaging - Novel Techniques and ApplicationsView all articles
Retinal Hemodynamic Effects of Sub-Tenon Anesthesia
Provisionally accepted
- 1Ophthalmology, UniversitatsSpital Zurich, Zürich, Switzerland
- 2Universitat Basel, Basel, Switzerland
- 3Ophthalmology, Kantonsspital Aarau AG, Aarau, Switzerland
- 4Ophthalmology, Inselspital Universitatsspital Bern, Bern, Switzerland
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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 A negative association between sub-Tenon anesthesia to VD and PD was observed, with a VD-change of -1.5 ± 2.8 mm/mm2 (p=0.02) in the treated eye compared to 0.7 ± 3.4 mm/mm2 in the untreated eye (p=0.36) and a PD-change of -3.7 ± 7.0 % (p=0.029) in the treated eye compared to 1.6 ± 8.2 % in the untreated eye (p=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 <6), no statistically significant difference was observed between the intervention and control eyes, indicating a false positive correlation due to image artifacts. In the overall population, no significant changes in blood pressure and intraocular pressure were observed before and after the injection. Conclusions This study did not prove retinal microvascular changes associated with sub-Tenon anesthesia. The observed VD and PD reductions were likely caused by OCTA image artifacts rather than true hemodynamic changes.
Keywords: Cataract surgery, diabetes, Intraocular Pressure, Local anesthesia, Mepivacaine, Perfusion, retinopathy, Sub-tenon
Received: 03 Dec 2025; Accepted: 28 Jan 2026.
Copyright: © 2026 Papazoglou, Enz, Steitz, Dysli and Tschopp. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Anthia Papazoglou
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