Management of Ocular Penetration From Injection of Local Anesthesia Preceding Cataract Surgery

Clinical Presentation and Management of Eyes with Globe Perforation during Peribulbar and Retrobulbar Anesthesia: A Retrospective Case Series

“…23 Wearne et al reported 78% eyes had final BCVA ≤ finger counting. 24 However, the results in our case series were better as nearly 40% of patients achieved a final BCVA≥20/200.…”

“…8,[21][22][23]25 Previous studies have reported that RD may Globe perforation during peribulbar anesthesia recur in 16-43% of cases. 8,14,20,[22][23][24][25] However, in our case series, the retina remained attached in all the eyes even after the tamponade was removed. Table 6 provides a brief comparison of the results of our study vis-a-vis the earlier ones.…”

“…The early indicators of globe perforation include the movement of eyeball along with the movement of the anesthetic syringe needle, unusual difficulty while injecting, severe pain response of the patient, sudden IOP rise or severe hypotony, corneal clouding, change in the ocular red reflex, sudden visual loss, visible enlargement of the eyeball and/ or a popping sound. 4,6,7,20,24 However, it is not always easy to identify the perforation at the time of injection. In our case series, 50% of the "inhouse" perforations were identified at the time of injection, while others were recognized on POD-1.…”

“…There are no reported contraindications for the placement of an intraocular lens in such eyes. 8,9,14,[23][24][25] Most patients in our case series also underwent the planned surgery even after the accidental perforation (recognized or unrecognized) and did not develop any intra-operative complication(s).…”

“…The presence of VH with or without RRD warrants an immediate vitrectomy as PVR changes may develop aggressively. 4,6,8,10,[12][13][14][15]19,20,[23][24][25] One patient in our series presented 3 months after the accidental perforation. The eye had developed advanced PVR and could not undergo vitrectomy.…”

Clinical Presentation and Management of Eyes with Globe Perforation during Peribulbar and Retrobulbar Anesthesia: A Retrospective Case Series

“…23 Wearne et al reported 78% eyes had final BCVA ≤ finger counting. 24 However, the results in our case series were better as nearly 40% of patients achieved a final BCVA≥20/200.…”

“…8,[21][22][23]25 Previous studies have reported that RD may Globe perforation during peribulbar anesthesia recur in 16-43% of cases. 8,14,20,[22][23][24][25] However, in our case series, the retina remained attached in all the eyes even after the tamponade was removed. Table 6 provides a brief comparison of the results of our study vis-a-vis the earlier ones.…”

“…The early indicators of globe perforation include the movement of eyeball along with the movement of the anesthetic syringe needle, unusual difficulty while injecting, severe pain response of the patient, sudden IOP rise or severe hypotony, corneal clouding, change in the ocular red reflex, sudden visual loss, visible enlargement of the eyeball and/ or a popping sound. 4,6,7,20,24 However, it is not always easy to identify the perforation at the time of injection. In our case series, 50% of the "inhouse" perforations were identified at the time of injection, while others were recognized on POD-1.…”

“…There are no reported contraindications for the placement of an intraocular lens in such eyes. 8,9,14,[23][24][25] Most patients in our case series also underwent the planned surgery even after the accidental perforation (recognized or unrecognized) and did not develop any intra-operative complication(s).…”

“…The presence of VH with or without RRD warrants an immediate vitrectomy as PVR changes may develop aggressively. 4,6,8,10,[12][13][14][15]19,20,[23][24][25] One patient in our series presented 3 months after the accidental perforation. The eye had developed advanced PVR and could not undergo vitrectomy.…”

Clinical Presentation and Management of Eyes with Globe Perforation during Peribulbar and Retrobulbar Anesthesia: A Retrospective Case Series

“…23 Wearne et al reported 78% eyes had final BCVA ≤ finger counting. 24 However, the results in our case series were better as nearly 40% of patients achieved a final BCVA≥20/200.…”

“…8,[21][22][23]25 Previous studies have reported that RD may Globe perforation during peribulbar anesthesia recur in 16-43% of cases. 8,14,20,[22][23][24][25] However, in our case series, the retina remained attached in all the eyes even after the tamponade was removed. Table 6 provides a brief comparison of the results of our study vis-a-vis the earlier ones.…”

“…The early indicators of globe perforation include the movement of eyeball along with the movement of the anesthetic syringe needle, unusual difficulty while injecting, severe pain response of the patient, sudden IOP rise or severe hypotony, corneal clouding, change in the ocular red reflex, sudden visual loss, visible enlargement of the eyeball and/ or a popping sound. 4,6,7,20,24 However, it is not always easy to identify the perforation at the time of injection. In our case series, 50% of the "inhouse" perforations were identified at the time of injection, while others were recognized on POD-1.…”

“…There are no reported contraindications for the placement of an intraocular lens in such eyes. 8,9,14,[23][24][25] Most patients in our case series also underwent the planned surgery even after the accidental perforation (recognized or unrecognized) and did not develop any intra-operative complication(s).…”

“…The presence of VH with or without RRD warrants an immediate vitrectomy as PVR changes may develop aggressively. 4,6,8,10,[12][13][14][15]19,20,[23][24][25] One patient in our series presented 3 months after the accidental perforation. The eye had developed advanced PVR and could not undergo vitrectomy.…”

Clinical Presentation and Management of Eyes with Globe Perforation during Peribulbar and Retrobulbar Anesthesia: A Retrospective Case Series

“…23 Wearne et al reported 78% eyes had final BCVA ≤ finger counting. 24 However, the results in our case series were better as nearly 40% of patients achieved a final BCVA≥20/200.…”

“…8,[21][22][23]25 Previous studies have reported that RD may Globe perforation during peribulbar anesthesia recur in 16-43% of cases. 8,14,20,[22][23][24][25] However, in our case series, the retina remained attached in all the eyes even after the tamponade was removed. Table 6 provides a brief comparison of the results of our study vis-a-vis the earlier ones.…”

“…The early indicators of globe perforation include the movement of eyeball along with the movement of the anesthetic syringe needle, unusual difficulty while injecting, severe pain response of the patient, sudden IOP rise or severe hypotony, corneal clouding, change in the ocular red reflex, sudden visual loss, visible enlargement of the eyeball and/ or a popping sound. 4,6,7,20,24 However, it is not always easy to identify the perforation at the time of injection. In our case series, 50% of the "inhouse" perforations were identified at the time of injection, while others were recognized on POD-1.…”

“…There are no reported contraindications for the placement of an intraocular lens in such eyes. 8,9,14,[23][24][25] Most patients in our case series also underwent the planned surgery even after the accidental perforation (recognized or unrecognized) and did not develop any intra-operative complication(s).…”

“…The presence of VH with or without RRD warrants an immediate vitrectomy as PVR changes may develop aggressively. 4,6,8,10,[12][13][14][15]19,20,[23][24][25] One patient in our series presented 3 months after the accidental perforation. The eye had developed advanced PVR and could not undergo vitrectomy.…”