RESUMEN
A 47-year-old man presented with profound loss of vision in right eye and relative afferent pupillary defect. On fundus examination, posterior pole details were obscured due to dense vitreous haemorrhage. B-scan ultrasonography was performed that revealed a mushroom-shaped hyperechoic lesion with medium internal reflectivity on A-scan ultrasonography. After performing contrast-enhanced MRI of the orbit, a diagnosis of choroidal melanoma was established. Patient was managed using plaque brachytherapy based on multiplanar MRI. This was followed 10 months later by pars plana vitrectomy and cataract extraction. Vision postoperatively improved to 20/60. A systematic clinical assessment along with supportive ancillary investigations augments diagnostic accuracy and reduces delay in definitive management.
Asunto(s)
Braquiterapia , Neoplasias de la Coroides , Melanoma , Neoplasias de la Úvea , Neoplasias de la Coroides/complicaciones , Neoplasias de la Coroides/diagnóstico por imagen , Neoplasias de la Coroides/radioterapia , Humanos , Masculino , Melanoma/complicaciones , Melanoma/radioterapia , Persona de Mediana Edad , Vitrectomía , Hemorragia Vítrea/diagnóstico por imagen , Hemorragia Vítrea/etiología , Hemorragia Vítrea/cirugíaAsunto(s)
Lesiones Oculares Penetrantes/diagnóstico por imagen , Lesiones por Pinchazo de Aguja/diagnóstico por imagen , Bloqueo Nervioso , Retina/lesiones , Tomografía de Coherencia Óptica , Hemorragia Vítrea/diagnóstico por imagen , Adulto , Anestesia Local , Humanos , Masculino , Desprendimiento de Retina/cirugía , Curvatura de la EscleróticaRESUMEN
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.
Asunto(s)
Anestesia Local/efectos adversos , Anestésicos Locales/efectos adversos , Lesiones Oculares Penetrantes/etiología , Inyecciones/efectos adversos , Lesiones por Pinchazo de Aguja/etiología , Esclerótica/lesiones , Cuerpo Vítreo/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Bupivacaína/efectos adversos , Lesiones Oculares Penetrantes/diagnóstico por imagen , Lesiones Oculares Penetrantes/cirugía , Humanos , Masculino , Lesiones por Pinchazo de Aguja/diagnóstico por imagen , Lesiones por Pinchazo de Aguja/cirugía , Facoemulsificación , Desprendimiento de Retina/diagnóstico por imagen , Desprendimiento de Retina/etiología , Desprendimiento de Retina/cirugía , Perforaciones de la Retina/diagnóstico por imagen , Perforaciones de la Retina/etiología , Perforaciones de la Retina/cirugía , Rotura , Ultrasonografía , Agudeza Visual , Hemorragia Vítrea/diagnóstico por imagen , Hemorragia Vítrea/etiología , Hemorragia Vítrea/cirugíaRESUMEN
The authors report a series of 20 eyes from 20 patients in whom inadvertent perforation of the globe occurred during local anesthesia for ocular surgery. Perforation resulted from retrobulbar anesthesia in 18 eyes and from peribulbar anesthesia in 2 eyes. Nine (45%) of 20 eyes had an axial length greater than or equal to 26.00 mm. Combining this figure with axial length data for the general population and estimates for the risk of globe perforation during local anesthesia yields an approximate incidence of perforation in eyes with axial length greater than or equal to 26.00 mm of 1 in 140 injections. Proliferative vitreoretinopathy (PVR) developed in 8 of the 20 eyes (40%) in this series. Overall, 15 (75%) of the 20 eyes were successfully repaired, and, in five eyes (25%), the final visual acuity was 20/70 or better.