Babu N, Kumar J, Kohli P, Ahuja A, Shah P, Ramasamy K. Clinical presentation and management of eyes with globe perforation during peribulbar and retrobulbar anesthesia: A retrospective case series.
KOREAN JOURNAL OF OPHTHALMOLOGY 2021;
36:16-25. [PMID:
34743491 PMCID:
PMC8849991 DOI:
10.3341/kjo.2021.0090]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/24/2021] [Indexed: 11/23/2022] Open
Abstract
Aim
To evaluate the clinical presentation, management, and outcome of eyes with an inadvertent globe perforation during peribulbar or retrobulbar block.
Methods
This retrospective study evaluated the eyes which had an accidental globe perforation during local ocular anesthesia from 2012 to 2020. The patients were divided into three groups; Group 1: Clear media with no rhegmatogenous retinal detachment (RRD); Group 2: significant vitreous hemorrhage (VH) precluding the retinal view without RRD; and Group 3: RRD with/without VH.
Results
Twenty-five patients (25 eyes) were included in the study. The mean axial length (AL) was 24.7±2.7mm (Range, 20.9-31.2mm). Eleven eyes (45.8%) had an AL≥24mm. The most common presenting features were VH (n=14), hypotony (n=7), and RRD (n=7). The treatment included retinal laser barrage (n=7) and vitrectomy (n=17). Retinal breaks were identified in all the eyes (total breaks=37). Other complications included full-thickness macular hole (n=5), subretinal hemorrhage (n=4), and retinal vascular occlusion (n=4). The mean presenting best-corrected visual acuity (BCVA) in groups 1,2 and 3 were logMAR 0.79±0.73, 1.82±0.78, and 2.13±0.59 respectively. All the patients, except the one who did not undergo surgery, had an attached retina at the time of the last follow-up. The mean final BCVA for each group was logMAR 0.59±0.79, 0.48±0.26, and 1.25±0.64 respectively (p=0.006). The development of RRD was associated with a larger AL (p=0.015); while the development of significant VH precluding the retinal view was associated with the superior location of the perforation (p=0.015), late recognition of the perforation (p=0.004), and multiple perforations (p=0.015).
Conclusion
Early recognition and intervention in eyes with an inadvertent perforation can lead to a good outcome. Eyes with a longer AL, superior, and multiple perforations are at higher risk of developing complications like RRD and VH. Complications like RRD, macular injury, and vascular occlusion are risk factors for poor prognosis.
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