title: Recognized globe perforation during strabismus surgery: incidence, risk factors, and sequelae.
abstract: BACKGROUND
  Inadvertent perforation of the globe is a well-recognized complication of extraocular muscle surgery. We evaluated the incidence, risk factors, and sequelae of this complication at our institution.
  
  
  METHODS
  Medical records of patients who underwent extraocular muscle surgery at King Khaled Eye Specialist Hospital, Saudi Arabia, between September 1983 and April 1997, were reviewed for the occurrence of globe perforation. We documented preoperative visual acuity and refraction, surgical procedure, how the perforation occurred, and immediate management, as well as the sequelae of the perforation, its management, and final outcome.
  
  
  RESULTS
  Recognized perforations occurred in 15 of 4886 procedures, for an overall incidence rate of 3/1000. Perforations were 3 times more common in myopic eyes (>-6.00 D, P =.05) and 2 times more common in eyes with previous extraocular muscle surgery. Perforations occurred during muscle reattachment (5 cases), placement of traction sutures at the limbus (4 cases with transient hyphema), muscle disinsertion (3 cases), and placement of sutures at the muscle insertion before disinsertion (3 cases). One patient had a large scleral laceration with uveal prolapse, necessitating scleral patch graft at the time of surgery, and later had retinal detachment surgery with loss of 2 lines of visual acuity. Endophthalmitis, cataract, glaucoma, and phthisis bulbi were not encountered in our review.
  
  
  CONCLUSIONS
  The current incidence of globe perforation is low and only rarely associated with serious sequelae.
authors.affiliation: Department of Pediatric Ophthalmology, and the Department of Outpatients, Orthoptic Clinic, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
authors.forename: A H
authors.initials: AH
authors.lastname: Awad
authors.forename: P B
authors.initials: PB
authors.lastname: Mullaney
authors.forename: A
authors.initials: A
authors.lastname: Al-Hazmi
authors.forename: S
authors.initials: S
authors.lastname: Al-Turkmani
authors.forename: D
authors.initials: D
authors.lastname: Wheeler
authors.forename: M
authors.initials: M
authors.lastname: Al-Assaf
authors.forename: M
authors.initials: M
authors.lastname: Awan
authors.forename: J T
authors.initials: JT
authors.lastname: Zwaan
authors.forename: S
authors.initials: S
authors.lastname: Al-Mesfer
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015807:Eye Injuries, Penetrating / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D009915:Orbit / Q000293:injuries*; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D013285:Strabismus / Q000601:surgery*; D014792:Visual Acuity