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

• 발행기관: 대한안과학회
• 저자명: Naresh Babu Jayant Kumar Piyush Kohli Ashish Ahuja Prerana Shah Kim Ramasamy
• 간행물 정보: 『The Korean Journal of Ophthalmology』Vol.36 No.1, 16~25쪽, 전체 10쪽
• 주제분류: 의약학 > 기타의약학
• 파일형태: PDF
• 발행일자: 2022.02.28

영문 초록

Purpose: To evaluate the clinical presentation, management, and outcome of eyes with an inadvertent globe perforationduring peribulbar or retrobulbar block. Methods: This retrospective study evaluated the eyes which had an accidental globe perforation during local ocular anesthesiafrom 2012 to 2020. The patients were divided into three groups: group 1, Clear media with no rhegmatogenous retinaldetachment (RRD); group 2, significant vitreous hemorrhage (VH) precluding the retinal view without RRD; and group 3, RRDwith/without VH. Results: Twenty-five patients were included in the study. The mean axial length (AL) was 24.7 ± 2.7 mm (range, 20.9–31.2mm). The most common presenting feature was VH (n = 14). The treatment included retinal laser barrage (n = 7) and vitrectomy(n = 17). Retinal breaks were identified in all the eyes (total breaks = 37). The mean presenting best-corrected visual acuityin groups 1, 2, and 3 were logarithm of the minimum angle of resolution 0.79 ± 0.73, 1.82 ± 0.78, and 2.13 ± 0.59 respectively. All the treated patients had an attached retina at the last follow-up. The mean final best-corrected visual acuity for eachgroup was logarithm of the minimum angle of resolution 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 associated withthe superior location of the perforation (p = 0.015), late recognition of the perforation (p = 0.004), and multiple perforations (p= 0.015). Conclusions: Early recognition and intervention in eyes with an inadvertent perforation can lead to a good outcome. Eyeswith a longer AL, superior, and multiple perforations are at higher risk of developing complications like RRD and VH. Complicationslike RRD, macular injury, and vascular occlusion are risk factors for poor prognosis.

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키워드

Local anesthesia Perforation Peribulbar block Retinal detachment Retinal perforations