Globe penetration during loco-regional anesthesia: prevalence and review of cases

Abstract

AIM: To describe prevalence and different clinical signs and management of cases with penetrating eye injuries during loco-regional anesthesia for ophthalmic surgery. METHODS: A retrospective review of clinical records was carried out, identifying cases of globe penetration secondary to peribulbar anesthesia injection during 5y activity in Centro de Oftalmología Barraquer. RESULTS: A total of 17 460 needle-based ocular anesthesia procedures were performed in our centre and 4 cases of globe penetration were recorded with an estimated prevalence of 0.024%. Globe penetrations were always detected in the first 24h after surgery. Vitreous haemorrhage was found in all the cases. Two eyes presented retinal detachment and two eyes choroidal detachment (CD). The initial surgical approach was performed within the first 48h. Silicone oil was used as tamponade in three eyes and the fourth case remained only with air. Detachments were solved successfully in all the cases. Functional results varied among cases, depending on ocular remarkable antecedent and globe penetration with or without retinal or CD. CONCLUSION: Prevalence of globe penetration during loco-regional anesthesia is low in our centre. Physicians should consider the possibility of globe penetration in eyes with postoperative atypical appearance after loco-regional anesthesia. Immediate B-scan ultrasonography is recommended in suspicious cases with a dense vitreous haemorrhage. An early vitrectomy surgery in conjunction with laser or cryotherapy at the penetration sites is essential for good anatomical and functional results.

Inverted ILM Flap for a Needle Injury to the Macula after Peribulbar Anaesthesia: A Case Report and Literature Review

“…Gopal et al [23] reported five cases of RD after globe perforation for PBA. Differently from our case, which was hyperopic, all the cases reported were highly myopic eyes with a higher risk of globe perforation due to the scleral staphyloma [4][5][6]13] Gomez-Benlloch et al reported a percentage of 0.024% (4 of 17,460 eyes) [9]. Two of the four cases reported were highly myopic, and two cases developed RD complicated by choroidal detachment.…”

“…However, our patient had no high-risk factors, and in this case, one possible explanation was that the surgeon applied an incorrect angle of needle insertion. Some features of the administration technique of the anesthetic drugs, such as the use of sharp long needles and the use of multiple injections, have been described as risk factors for ocular penetration [9]. In our case, peribulbar anesthesia with a 25-gauge 25 mm sharp needle was used.…”

“…Some features of the administration technique of the anesthetic drugs, such as the use of sharp long needles and the use of multiple injections, have been described as risk factors for ocular penetration [ 9 ]. In our case, peribulbar anesthesia with a 25-gauge 25 mm sharp needle was used.…”

“…The worst result was obtained in a patient who developed a PVR and a recurrence of RD. However, they all had good visual recovery due to the early recognition and treatment [ 9 ].…”

“…Described risk factors for globe penetration include posterior staphyloma [4], long axial length [5], inexperienced personnel [6], uncooperative patients [7], the use of sharp long needles, and the use of multiple injections [8]. Regarding the described prognosis factors, outcomes are related to (1) early recognition, (2) absence of retinal detachment (RD), and (3) site of penetration [8,9]. In this work, we reported a case of retinal detachment Life 2023, 13, 1390 2 of 8 with posterior pole laceration after PBA for cataract surgery in a hyperopic patient, who was referred to the Vitreoretinal Surgical Unit of Fatebenefratelli-Gemelli Isola.…”