Efficacy and safety of trans-fornix conjunctival retrobulbar block in a prospective randomized controlled trial

Retrobulbar block is widely used for vitreoretinal surgery, but the conventional transcutaneous technique advances a sharp needle blindly through the lower eyelid. We evaluated a trans -fornix conjunctival approach in which a curved blunt-tip needle is advanced into the muscle cone under the operating microscope. In a two-center randomized trial, 196 patients were stratified by expected surgical duration and allocated to the transcutaneous or the trans -fornix technique, and pain was graded at predefined procedural stages. The trans -fornix approach reduced pain during anesthetic injection in both cohorts and during scleral indentation in longer procedures, and fewer patients required supplemental anesthesia. Ocular akinesia was better with the trans -fornix technique, and periorbital hemorrhage and ecchymosis occurred only in the transcutaneous group. These findings support the trans -fornix block as a practical and reproducible option for regional anesthesia in vitreoretinal surgery.