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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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Inadvertent globe penetration during retrobulbar anesthesia:A case report

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World Journal of Clinical Cases 2021年第8期9卷 2001-2007页

作者： Ying Dai Tao Sun Jun-Fang Gong Department of Ophthalmology The Fourth Affiliated Hospital of Nantong University/The First People’s Hospital of YanchengYancheng 224000Jiangsu ProvinceChina

BACKGROUND To report the possible reasons for needle perforation and complications related to perforation,as well as the clinical management of subretinal hemorrhage(SRH)during retrobulbar injection.CASE SUMMARY A 65-year-old female was scheduled to undergo pars plana vitrectomy(PPV)in her left eye for rhegmatogenous retinal detachment(RRD).During retrobulbar anesthesia,needle perforation of the globe occurred.Massive SRH in the inferotemporal quadrant together with vitreous hemorrhage were observed.The patient underwent PPV combined with retinotomy for removal of the massive SRH.After earlier surgical intervention,successful reattachment of the retina was achieved.CONCLUSION Inadvertent globe penetration during retrobulbar anesthesia is associated with a poor prognosis and may result in blindness.Timely detection and earlier intervention may be beneficial.

关键词： Needle perforation globe penetration Retrobulbar anesthesia Subretinal hemorrhage Pars plana vitrectomy Retinotomy Case report

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Epidemiologic characteristics and outcomes of open globe injury in Shanghai

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International Journal of Ophthalmology(English edition) 2017年第8期10卷 1295-1300页

作者： Yong-Rong Ji Dong-Qing Zhu Hui-Fang Zhou Xian-Qun Fan Department of Ophthalmology Shanghai Ninth People'sHospital Shanghai Jiao Tong University School of MedicineShanghai 200011 China

AIM： To investigate the epidemiologic characteristics and outcomes of open globe injury in Shanghai. METHODS： A retrospective study was conducted for 148 unilateral open globe injury cases presenting to a tertiary referral hospital of Shanghai. Electronic medical records were reviewed and phone surveys were conducted to collect and analyze 1） background of patient; 2） setting of injury and clinical signs at presentation; 3） treatment procedure and outcome; 4） quality of life after injury. RESULTS： There were more male patients （77.03%） than females （22.97%）, more temporary habitants （79.05%） than residents （20.95%）. The subjects in this study presented a significantly lower constitutional status of education than that of the whole Shanghai population （P〈0.001）. Occupational injury was the first cause of injuries （39.86%）, followed by home accident （20.27%）, road accident （16.80%）, violent behavior （16.89%） and outdoor injury （6,08%）. The 143 subjects （96.62%） were not wearing spectacles at the time of injury. Of all patients, 77 subjects （52.03%） had the outcome of no vision （including enucleation）. The classification and regression tree （CART） prognosis presents 59.58% sensitivity to predict visual survival correctly and 80.19% specificity to predict no vision correctly. The patients whose injured eye had no vision reported more reduction of life quality. CONCLUSION： We found that male subject, temporary habitants, low educational status and no eyewear are risk factors of open globe injury in Shanghai. Occupational injury is the leading cause. CART analysis presents a certain agreement to the actual visual outcome. The injury imposes negative impact on quality of life especially in no vision cases. The education of eye protection may help to avoid the injury.

关键词： ocular injury globe penetration epidemiology risk factors occupational injury

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