Management of iatrogenic globe perforation during peribulbar anesthesia with submacular hemorrhage

Abstract

A patient with an amblyopia and poor vision in the fellow eye experienced iatrogenic globe perforation during peribulbar anesthesia for cataract surgery. The injection and surgery were immediately aborted. Visual acuity was hand motion, and retinal examination revealed retinal detachment, hemorrhagic choroidal detachment, and submacular hemorrhage. These were initially managed medically until the hemorrhagic choroidal detachment resolved and afterward by combined phacoemulsification with pars plana vitrectomy, subretinal recombinant tissue plasminogen activator, and gas tamponade. Two weeks post operative, the patient achieved the best-corrected visual acuity of around 20/200, which after 1 year of follow-up improved to 20/70.

Keywords

• globe perforation
• peribulbar anesthesia
• submacular hemorrhage