Scleral perforation during retrobulbar and peribulbar anesthesia: risk factors and outcome in 50,000 consecutive injections.
OBJECTIVE
To measure the frequency of scleral perforation and identify related risk factors during local anesthetic injection for intraocular surgery.


METHODS
Multispecialty eye hospital.


METHODS
All patients (n = 50,000) having retrobulbar (26,857) or peribulbar (23,143) injections at the King Khaled Eye Specialist Hospital were reviewed. Cases of scleral perforation were analyzed for potential technical and ophthalmic risk factors, management of injuries, and visual and anatomic outcomes. Mean follow-up was 14.4 months (range 8 to 24 months).


RESULTS
Seven (0.014%) needlestick injuries were identified, all of which had posterior staphyloma as the only identifiable risk factor. Applying a previously measured prevalence of 10.7% for posterior staphyloma in our surgery patients gave a scleral perforation rate of 0.13% (7 of 5350) for staphylomatous eyes. All perforated globes had originally planned cataract extraction within 8 weeks of injury. Additional management consisted of observation (2 cases), cryotherapy (2 cases), and vitreoretinal procedures for retinal detachment (3 cases) and subretinal hemorrhage (1 case). At last follow-up, all retinas were attached and 3 cases (42.8%) had a visual acuity of worse than 20/160. Both cases requiring multiple retinal detachment surgeries developed proliferative vitreoretinopathy and poor visual acuity.


CONCLUSIONS
Eyes with posterior staphyloma sustained needlestick injuries at a rate of 1 in 760 compared with 0 injection perforations in more than 44,000 nonstaphylomatous eyes.
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King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
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D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage; D003452:Cryosurgery; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016602:Needlestick Injuries / Q000209:etiology* / Q000601:surgery; D009915:Orbit; D012160:Retina / Q000293:injuries; D012163:Retinal Detachment / Q000209:etiology / Q000601:surgery; D012166:Retinal Hemorrhage / Q000209:etiology / Q000601:surgery; D012167:Retinal Perforations / Q000209:etiology / Q000601:surgery; D012307:Risk Factors; D012590:Sclera / Q000293:injuries*; D014792:Visual Acuity; D014821:Vitrectomy
D000779:Anesthetics, Local