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T. Josifova, W. Schrader; Inadvertent Perforations in Peribulbar Injections. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4663. doi: https://doi.org/.
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Peribulbar anesthesia has become the method of choice for intraocular surgery und local anesthesia, when topical anesthesia is considered to be not sufficient. It was assumed to be less risky than retrobulbar anesthesia. However, serious complications may occur, when the eye is perforated during the injection. This complication is very critical when it occurs during refractive surgery in a ,,healthy" eye.
Retrospective analysis of patients, who received secondary care for the complications of inadvertent globe perforations during parabulbar injections.
We collected a series of 9 inadvertent globe perforations that led to a variety of complications, from subretinal hemorrhages to an ocular ,,explosion". In one case, only a subretinal hemorrhage occurred that resorbed spontaneously. In one case, a retinal break needed only photocoagulation. In all other cases one or more vitrectomies with endotamponade were necessary to cure intraocular hemorrhage and retinal detachment. One case did not recover from no light perception, only 2 of 9 eyes regained reading vision, the other 6 ambulatory vision only.
According to recently published data, the incidence of an inadvertent perforation is less than 1/1000. Myopic eyes have a higher risk than emmetropic eyes. When the injection is given by the anesthesiologist, the perforation itself is less likely recognized at once than when the injection is done by the ophthalmologist. Considering the severity of the complications, it appears mandatory to inform in detail about the possible risks and complications of peribulbar injections in comparison to topical or general anesthesia.
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