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

International Journal of Ophthalmology(English edition) 2022年第10期15卷 1683-1690页

作者： Alba Gómez-Benlloch Maximiliano Olivera Jeroni Nadal gemma julio Javier Elizalde Centro de Oftalmología Barraquer Barcelona 08021Spain Institut Universitari Barraquer Universitat Autònoma de BarcelonaBarcelona 08021Spain School of Medicine Universitat Internacional de CatalunyaBarcelona 08017Spain

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 5 y 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 24 h 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 48 h. 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 locoregional 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.

关键词： loco-regional anesthesia peribulbar retrobulbar globe penetration retina

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