Incidence of Brainstem Anesthesia or Retrobulbar Hemorrhage after Retrobulbar Injection
Notice bibliographique
Résumé
TOPIC: To determine the literature-pooled incidence of retrobulbar hemorrhage (RBH) and brainstem anesthesia (BA) after retrobulbar injection (RI). CLINICAL RELEVANCE: RBH and BA are both rare albeit potentially devastating complications of RI. METHODS: Prospectively registered meta-analysis (CRD420251041837). Central, Embase, and Medline were searched from inception to April 16th, 2025, for studies which reported the incidence of RBH or BA after RI. Complication incidence with patient and study characteristics was collected. Risk of bias and certainty of the body of evidence were assessed using Cochrane risk of bias-2 or risk of bias in nonrandomized studies - intervention (ROBINS-I) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool, respectively. Pooled incidence estimates were generated using random-effects meta-analyses of proportions via generalized linear mixed models with logit transformation. Preplanned subgroup analyses were performed, stratified by year (before versus after 2005), concomitant orbital compression maneuver, needle gauge, and number of injections. RESULTS: We included 22 articles (n = 196 113 injections). The pooled incidence of RBH and BA were 0.10% (95% confidence interval [CI]: 0.03%-0.42%) and 0.23% (95% CI: 0.16%-0.34%), respectively. Although direct comparison was not statistically feasible, there was a significant between-subgroup difference of RBH incidence between patients undergoing 0.12% (95% CI: 0.01%-1.01%) or forgoing orbital compression 2.29% (95% CI: 0.74%-6.86%). Further, there was a significant between-subgroup difference of RBH incidence between the singular (0.47% [95% CI: 0.18%-1.24%]), multiple (0.04 [95% CI: 0.04%-0.04%]), or supplemental injection (0.35% [95% CI: 0.02%-7.09%]) subgroups. There was no significant subgroup-level difference in RBH incidence for studies published before versus after 2005. Finally, no significant subgroup-level difference was noted for RBH incidence across 23G (0.17% [95% CI: 0.01%-4.77%]), 25G (0.17% [95% CI: 0.02%-1.21%]), and 27G (0.04% [95% CI: 0.00%-2.67%]) needle gauge subgroups. Subgroup analyses for BA were precluded by insufficient data. CONCLUSIONS: Low-certainty evidence (GRADE) supports that the pooled point estimates of RBH and BA were 0.10% and 0.23%, respectively. The certainty of evidence was downgraded for imprecision and indirectness, reflecting rare events and predominance of observational data. While subgroup analyses suggested significant differences of RBH incidence across strata of orbital compression maneuvers and number of injections, there was insufficient data to perform a comparative meta-analysis. Dedicated comparative studies of these potential factors should be pursued. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».