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 Wurzburg, 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.