Vitreo-retinal management of inadvertent globe rupture during local ocular anaesthesia

PURPOSE: To review the visual morbidity associated with inadvertent globe rupture, and discern the most appropriate management of such cases. METHOD: A retrospective study over a 2-year period of twenty tertiary referrals; information was gathered principally by reviewing hospital notes, but additional data was gained by questionnaire to the referring hospital. RESULTS: Inadvertent globe rupture is most commonly an unrecognised complication of local anaesthesia but 5 (25%) patients volunteered atypical symptoms during the injection. Presentation is usually as a vitreous haemorrhage noticed on the first post-operative day in 17 (85%) patients, or by reduced vision in 3 (15%) patients within one week. 10 (50%) had an associated retinal detachment on initial assessment in the Vitreo-Retinal Unit, and generally had a limited visual outcome despite vitrectomy with intra-ocular gas or oil tamponade. 8 (40%) of the remaining patients with attached retinas had excellent visual results following surgery. CONCLUSIONS. Globe rupture during local anaesthesia is usually unrecognised at the time of perforation. Complications such as vitreous haemorrhage present early on the first post-operative day but retinal detachments are often not detected for a few weeks. B-scan ultra-sonography is accurate for assessing the retina but is poor at detecting sites of rupture. Eyes with associated retinal detachments often require multiple procedures and have a poor visual prognosis. Conversely, those eyes with attached retinae do very well surgically with good visual rehabilitation. It may be that early vitrectomy in eyes with vitreous haemorrhage prior to the development of retinal detachment would improve the visual prognosis of the former group without any decrimental effect on the latter.