Evaluation of 19 cases of inadvertent globe perforation due to periocular injections

Abstract

Inadvertent globe perforation due to periocular injection is a serious iatrogenic complication. To study risk factors, management and visual outcome of inadvertent globe perforation during periocular injection, in cases referred to a tertiary eye care center. Retrospective study at a tertiary referral center with a single investigator. Nineteen consecutive cases with a clinical diagnosis of globe perforation were studied (1998-2004). Clinical setting, risk factors, clinical presentation, management and visual outcome were analyzed. Retrobulbar injections 6 (32%), peribulbar injections 10 (53%) and subconjunctival injections 3 (16%) were responsible for inadvertent globe perforation. Anesthetists accounted for 6 (32%) injections and 13 (69%) were referred from high volume community settings. Anesthetists identified the mishap on the table in 17% (1 out of 6) of cases and the ophthalmologists in 69% (9 out of 13) myopia was present in 10 (53%). Breaks were located inferotemporally in nine eyes. Four underwent laser and cryopexy, 14 (74%) underwent vitreous surgery. Visual acuity greater than 20/200 was achieved in 12 patients. Myopia was found to be a significant risk factor. Inferotemporal breaks were common. Anesthetists were more likely to miss this complication when it occurred. In this series, intervention salvaged vision in a significant number of eyes.