Macular ischaemia after inadvertent perforation of the eyeball and intravitreal injection of anesthetic agents during retrobulbar anaesthesia

Abstract

Perforation of the eyeball during retrobulbar anesthesia is rarely reported. A case of inadvertent ocular perforation during retrobulbar anesthesia in cataract surgery is presented. Retinal complications and follow up after six months are described.

A 58-year-old man presented with vision loss following cataract surgery on his right eye by phacoemulsification and intraocular lens implantation under retrobulbar anaesthesia performed one week earlier. Visual acuity was 0.05. Fundus examination revealed a vitreous haemorrhage in the lower area. A rounded haemorrhage was present next to the lower temporal arcade with a possible entry orifice. Optical coherence tomography, tomographic angiography and fluorescein angiography showed retinal ischaemia in the juxtapapillary macular area.

The patient was followed for 6 months. Visual acuity improved to 0.5. Optical coherence tomography and tomographic angiography showed a reduction of the edema in the retinal layers, with a persistent loss of the inner nuclear and outer plexiform layer.

Accidental intravitreal injection of bupivacaine and lidocaine during retrobulbar anaesthesia can result in permanent visual impairment. Extreme attention should be paid to the injection technique to avoid this complication.