Risk of scleral perforation during peribulbar anesthesia should be disclosed to all patients

Researchers performed this study to assess the risk for and circumstances of serious complications during peribulbar and retrobulbar anesthesia. They retrospectively analyzed data from patients who received secondary care for complications of inadvertent globe perforation during peribulbar or retrobulbar injections over a 17-year period at one of three university-based eye clinics.

The review identified nine cases of globe perforation. Complications ranged from subretinal hemorrhage to globe rupture. The authors calculated the risk of globe perforation during peribulbar or retrobulbar injection at less than 1 in 10,000. This rate is lower than previous studies have reported. However, the risk is greater in eyes that are highly myopic and in eyes with scar formation from previous surgery.

Outcomes were poor. Two cases were minor (subretinal hemorrhage with spontaneous resorption and retinal break requiring photocoagulation). All other cases required one or more vitrectomies to resolve intraocular hemorrhage and retinal detachment. Most cases still had significant functional impairment after treatment. Two of the nine eyes regained reading ability, one eye maintained no light perception acuity and six eyes had ambulatory vision only.

The authors conclude that while perforation is a rare complication of peribulbar anesthesia in normal eyes, its severity highlights the importance of giving all patients detailed information about its risks and complications compared with other methods, such as topical and general anesthesia.