Ophthalmology in China ›› 2021, Vol. 30 ›› Issue (4): 278-282.doi: 10.13281/j.cnki.issn.1004-4469.2021.04.006

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Analysis of clinical characteristics of 12 cases of scleral penetration caused by retrobulbar anesthesia

Zeng Rui1, Yang Jiasong2, 3, Li Yunpeng4, Li Honghui5, Li Wensheng2, 3   

  1. 1Shanghai Wellem Medical Group, Shanghai 200050, China; 2Central South University Aier School of Ophthalmology, Changsha 410000, China; 3Shanghai Aier Eye Hospital, Shanghai 200335, China; 4Zhumadian Eye Hospital, Zhumadian 463000, China; 5Chengdu Aier Eye Hospital, Chengdu 610041, China

  • Received:2021-03-16 Online:2021-07-25 Published:2021-07-22
  • Contact: Li Wensheng, Email: drlws@qq.com
  • Supported by:
    Science Research Fundation of Aier Eye Hospital Group (AM1901D3/AR2001D1); Innovation Guidance Project of Science and Technology Department of Hunan Province (2018SK50102)

Abstract: Objective To summarize the clinical characteristics and management of scleral perforation during retrobulbar anesthesia. Design Retrospective case series. Paticipants 12 cases of scleral perforation during retrobulbar anesthesia were enrolled from 2012 to 2019. Methods Patient’s medical records were reviewed. The follow-up period of 12 patients was 9.5±5.4 months. Main Outcome Measures Age, gender, medical history, clinical manifestations, intraoperative conditions, and postoperative follow-up results. Results The average age of 12 patients was (54.9 ±7.8) years, including 8 females. There were 11 patients with high myopia. The operations to be performed under retrobulbar anesthesia were vitrectomy for rhegmatogenous retinal detachment in 8 cases, silicone oil removal in 2 cases, silicone oil removal combined with phacoemulsification in 1 case, and vitrectomy combined with phacoemulsification in 1 case of myopic foveoschisis. Eyeball perforation was found in time during the operation. All patients with rhegmatogenous retinal detachment were tamponaded with silicone oil after scleral perforation was found. In addition, patients with silicone oil removal and myopic foveoschisis were tamponaded with air at the end of the operation. The treatment of scleral penetration was laser photocoagulation of the retina after the removal of hemorrhage beneath or above the retina, silicone oil tamponaded in the case with retinal detachment, and disinfection air tamponaded in the case with no retinal detachment. At the last follow-up, the best corrected visual acuity was from HM to 0.6, and was improved compared with before surgery in 10 cases. Among the 12 patients, 7 of 8 patients with rhegmatogenous retinal detachment underwent vitrectomy combined with silicone oil filling, and no retinal detachment was found after silicone oil removal. In one case of high myopia, the posterior retina was not reattached and the silicone oil could not be removed. Conclusions The complications of eyeball penetration caused by retrobulbar anesthesia can cause serious eye damage, which can be minimized by timely and appropriate treatment. (Ophthalmol CHN, 2021, 30: 278-282)


Key words: retrobulbar anesthesia, scleral perforation, vitrectomy