Traumatic Branch Retinal Vein Occlusion With Retinal Neovascularization Following Inadvertent Retrobulbar Needle Perforation.

Retrobulbar injection of anesthesia is one of the most common procedures performed for ophthalmic surgery. Complications are rare but can be potentially serious, including retrobulbar hemorrhage, brainstem anesthesia, and inadvertent globe perforation. This is the preliminary report describing branch retinal vein occlusion (BRVO) secondary to accidental retrobulbar needle laceration with subsequent preretinal neovascularization.

Risks and sequelae of scleral perforation during peribulbar or retrobulbar anesthesia.

PURPOSE: To assess the risk for and circumstances of serious complications during peribulbar and retrobulbar anesthesia. SETTING: University eye departments, Freiburg and Würzburg, Germany, and Skopje, Macedonia. METHODS: This retrospective analysis comprised patients who received secondary care for complications of inadvertent globe perforation during peribulbar or retrobulbar injections over a 17-year period. RESULTS: The review identified 9 inadvertent globe perforations that led to a variety of complications, ranging from subretinal hemorrhage to a globe rupture. Two cases were minor (subretinal hemorrhage with spontaneous resorption and retinal break requiring photocoagulation). All other cases required 1 or more vitrectomies to resolve intraocular hemorrhage and retinal detachment. Most cases still had significant functional impairment after treatment. Two of the 9 eyes regained reading ability, 1 eye maintained no light perception acuity, and 6 eyes had ambulatory vision only. CONCLUSIONS: Although perforation is a rare complication of peribulbar anesthesia in normal eyes, the severity of complications in this study point to the importance of giving all patients, not only those with risk factors (eg, myopia, scar formation), detailed information about the possible risks and complications of peribulbar injections compared with those of other methods such as topical anesthesia and general anesthesia.

Broken needle in the cervical spine: a previously unreported complication of Xiaozendao acupuncture therapy.

Xiaozendao (meaning "small-needle-knife," in Chinese) is a form of alternative medical instrument shaped like an acupuncture needle with a flat edge on the needle tip. It is widely used for the treatment of many different disorders in Asian countries, especially in the People's Republic of China. Its use has gained increasing popularity. To our knowledge, there are no reports of practitioners' experiences or adverse events related to "small-needle-knifed" therapy until now. We reported the first case of spinal-cord injury with delayed onset of neurologic symptoms from a broken small-needle-knife insertion into the spinal cord.

Ocular explosion after peribulbar anesthesia.

We report 3 cases of globe rupture after peribulbar anesthesia. We discuss the predisposing factors, presenting features, and visual outcome after this complication. Globe explosion is a severe complication of inadvertent intraocular injection during peribulbar anesthesia. Visual outcome after vitrectomy is generally poor; however, cases that do not develop a retinal detachment may achieve good results.

Inadvertent ocular perforation and intravitreal injection of an anesthetic agent during retrobulbar injection.

We report the clinical management of a patient who sustained scleral perforation and intraocular injection of local anesthetic agent during retrobulbar block. We discuss the management options for this rare complication of local anesthesia in cataract surgery.

Traumatic intramuscular orbital haemorrhage.

Retrobulbar haemorrhage is an uncommon but well-documented complication of retrobulbar anaesthetic blocks in ocular surgery. Peribulbar anaesthesia has been advocated to be equally effective but safer. The incidence of retrobulbar haemorrhage with peribulbar blocks is very low. We report a case in which a peribulbar anaesthetic for cataract surgery resulted in sight-threatening retrobulbar haemorrhage within the medial rectus muscle and required an anterior orbitotomy and direct decompression of the muscle. The surgery was successful. This case illustrates a potentially serious complication of peribulbar anaesthesia, with the successful outcome achieved by rapid definitive diagnosis and intervention.

Scleral perforation during retrobulbar and peribulbar anesthesia: risk factors and outcome in 50,000 consecutive injections.

PURPOSE: To measure the frequency of scleral perforation and identify related risk factors during local anesthetic injection for intraocular surgery. SETTING: 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.

Management of ocular perforations resulting from peribulbar anaesthesia.

PURPOSE: To analyze the clinical presentation and outcome of treatment for globe perforation secondary to peri-bulbar anaesthesia. METHODS: Eight patients (3 females and 5 males) aged 66-84 years were included in the study. Ocular perforations were suspected in 3 cases before or during surgery, in 4 cases diagnosis was established within one week and in one case at 3 weeks. Three patients underwent indirect argon laser photocoagulation to seal the retinal break, one patient had cryotherapy, 3 patients underwent a pars plana vitrectomy with fluid gas exchange and endo-laser; and one patient refused any further treatment. RESULTS: The final visual acuity after a mean follow up of 14 months was better than 6/9 in 2 patients, between 6/9-6/12 in 4 patients, and perception of light in 2 patients. CONCLUSION: If diagnosed early and treated adequately, a majority of patients with globe perforation during periocular anaesthetic could be saved.

Vitreoretinal surgery after inadvertent globe penetration during local ocular anesthesia.

OBJECTIVE: This study aimed to review visual morbidity resulting from inadvertent globe penetration during administration of local anesthetic and to identify the most appropriate management. DESIGN: The records of 20 consecutive patients referred to a specialist vitreoretinal unit over a 2-year period were reviewed. PARTICIPANTS: Twenty eyes of 20 consecutive patients were included. INTERVENTION: Observations included type of local anesthetic administered (e.g., retrobulbar or peribulbar), level of training of person administering the block, type of needle used for the block, and findings at presentation to the vitreoretinal unit. The authors also observed results of B-scan ultrasound evaluation of the retina, interval between the recognition of the complication and referral, as well as nature and timing of subsequent surgical intervention. MAIN OUTCOME MEASURES: Final visual acuity and retinal status (attached versus detached) were measured. RESULTS: The most common presentation was vitreous hemorrhage observed from the first postoperative day. Ten eyes were found to have an associated retinal detachment on initial assessment in the vitreoretinal unit. These eyes generally had a poor visual outcome despite vitrectomy with long-acting gas or silicone oil tamponade. Seven (70%) of the remaining eyes with attached retina at the time of presentation achieved good visual recovery after vitrectomy. CONCLUSIONS: The authors recommend prompt referral for consideration of early vitrectomy in eyes with dense vitreous hemorrhage after inadvertent globe penetration. This management may improve the overall visual prognosis by preventing subsequent retinal detachment.

Inadvertent globe perforation during retrobulbar injection in high myopes.

PURPOSE: To report ocular perforation that occurred during retrobulbar injection in 7 highly myopic eyes. METHODS: Seven patients with a diagnosis of globe injury during retrobulbar injection for ocular anesthesia before cataract surgery were managed by vitreoretinal surgery. All injections were performed by ophthalmologists. The surgeon recognized the perforation in 4 cases at the time of injection. The preoperative vision was hand motion perception in 4 eyes and light perception in 3 eyes. All patients underwent vitreoretinal surgery because of the presence of vitreous hemorrhage and/or retinal detachment diagnosed by funduscopy or ultrasonography. At the time of surgery, all eyes had vitreous hemorrhage and 4 eyes had rhegmatogenous retinal detachment. The number of vitreoretinal procedures performed was: 1 procedure in 4 patients, 2 procedures in 2 patients, and 3 procedures in 1 patient. The period of follow-up ranged from 4 months to 4 years, averaging 20 months. RESULTS: At the end of the follow-up period, the retina was attached in 6 patients. The postoperative vision was 20/400 in 3 eyes, finger counting in 3 eyes, and light perception in 1 eye. CONCLUSION: Special care should be taken in retrobulbar injection of highly myopic globes, which have an increased risk of perforation. The functional outcome of surgical repair of these eyes was poor.

Retinal detachment secondary to ocular perforation during retrobulbar anaesthesia.

The clinical characteristics and the retinal breaks associated with rhegmatogenous retinal detachments secondary to accidental globe perforation during local infiltration anaesthesia in five highly myopic eyes are presented. Retinal detachment was total with variable proliferative vitreoretinopathy. The pattern of retinal breaks was rather typical and predictable. Management involved vitreous surgery with internal tamponade by silicone oil in four eyes and perfluoropropane gas in one eye. At the last follow-up, all eyes had attached retina. One eye did not recover useful vision due to possible concurrent optic nerve damage.

[Spinal cord stab injury by acupuncture needle: a case report].

It is very rare for neurosurgeons to encounter cases of spinal cord injury caused by a broken acupuncture needle. A 45-year-old man was referred to our clinic because of urinary retention about two weeks after acupuncture therapy (a needle was broken during treatment). The patient showed no motor weakness, or sensory disturbance. The needle was seen transversely stabbing the spinal cord at C1/2 on CT imaging and X-ray film. In all of the reported seven cases of longitudinal stab injuries (posterior puncture), sensorimotor disturbances were present. In transverse stab injuries (lateral puncture), however, two cases did not show motor weakness but sensory disturbance. The centrifugal pathway for micturition in the spinal cord lies in the middle one third of the lateral columns and in the width of the central canal. The patient complained of urinary retention because the bilateral descending fibers might have been stabbed by the needle. Surgical treatment relieved the patient from his complaint.

[Cervical spinal cord injury caused by a broken acupuncture needle: a case report].

Spinal cord injury is a rare but considerable complication of acupuncture. A case with cervical spinal cord injury caused by a broken acupuncture needle was reported and sixteen previously reported cases including our case were reviewed. A 49-year-old woman was treated by herself with acupuncture on the nuchal region for occipitalgia, and the needle was accidentally broken during the treatment. Six hours later she noticed pain and numbness in the right upper and lower extremities. Neurological examination revealed slight impairment of temperature, pain and touch sensation on the right extremities. Plain X-ray film and CT scan showed a broken needle in the interspinous ligament between C1/C2 vertebrae, the tip of the needle appearing to be in the spinal canal. The needle was removed surgically nineteen days after the accident. Intraoperative fluoroscopic monitoring with injection of dye enabled the needle to be found without difficulty. Postoperative course was uneventful, and her pain and sensory impairment gradually disappeared. Once the diagnosis for cervical spinal cord injury by an acupuncture needle is made, the needle should be removed surgically as soon as possible, especially prior to the development of motor symptoms. This is because movement of the needle in the spinal cord is considered to be a main possible cause of the development and progression of symptoms.