VITREORETINAL SURGERY AFTER INADVERTENT GLOBE PENETRATION DURING LOCAL OCULAR ANESTHESIA

Objective: This study aimed to review visual morbidity resulting from inadvertent globe penetration during administration of local anestheti c and to identify the most appropriate management. Design: The records of 20 consecutive patients referred to a specialist vitreoretinal uni t over a 2-year period were reviewed. Participants: Twenty eyes of 20 consecutive patients were included. Intervention: Observations include d type of local anesthetic administered (e.g,, retrobulbar or peribulb ar), level of training of person administering the block, type of need le used for the block, and findings at presentation to the vitreoretin al unit. The authors also observed results of B-scan ultrasound evalua tion of the retina, interval between the recognition of the complicati on and referral, as well as nature and timing of subsequent surgical i ntervention. Main Outcome Measures: Final visual acuity and retinal st atus (attached versus detached) were measured. Results: The most commo n presentation was vitreous hemorrhage observed from the first postope rative day. Ten eyes were found to have an associated retinal detachme nt on initial assessment in the vitreoretinal unit. These eyes general ly had a poor visual outcome despite vitrectomy with long-acting gas o r silicone oil tamponade. Seven (70%) of the remaining eyes with attac hed retina at the time of presentation achieved good visual recovery a fter vitrectomy. Conclusions: The authors recommend prompt referral fo r consideration of early vitrectomy in eyes with dense vitreous hemorr hage after inadvertent globe penetration. This management may improve the overall visual prognosis by preventing subsequent retinal detachme nt.