Globe Perforation During Peribulbar Anesthesia: Experience of Half a Million Consecutive Injections

Aim: To evaluate the risk factors, clinical presentation, management and outcome of inadvertent globe perforation during peribulbar anaesthesia.Methods: This retrospective study evaluated the medical records of all the patients treated for globe perforation secondary to peribulbar block preceding ocular surgery from 2012 to 2020. The patients were divided into three groups; Group 1 - clear media with no retinal detachment (RD); group 2 - vitreous hemorrhage (VH) without RD; and group 3 - RD with/without VH.Results: Twenty-five patients (25 eyes) were identified. The incidence of globe perforation was 0.002 %. The mean axial length (AL) was 24.7±2.7mm (Range, 20.9-31.2mm). Eleven eyes (45.8%) had AL≥24mm. The most common presenting features were VH (n=14), ocular hypotony (n=7) and RD (n=7). The treatment included laser photocoagulation for the retinal break(s) (n=7) and vitrectomy (n=17). Retinal breaks were identified in all the patients (total breaks, 37). Other complications included full-thickness macular hole (n=5), subretinal haemorrhage (n=4) and retinal vascular occlusions (n=4). Mean presenting best-corrected visual acuity (BCVA) in group 1,2 and 3 were logMAR 0.79±0.73, 1.82±0.78 and 2.13±0.59 respectively. All the patients, except one who did not undergo surgery due to advanced proliferative vitreoretinopathy, had an attached retina at the time of last follow-up. The mean final BCVA was logMAR 0.59±0.79, 0.48±0.26 and 1.25±0.64 respectively. Conclusion: Early intervention can help manage the eyes with inadvertent perforation successfully. The presence of retinal detachment, as well as macular and vascular complications are risk factors for poor prognosis.