First Author: L.Gutiérrez-Benítez SPAIN
Co Author(s): S. Elnayef
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To show the intraoperative diagnosis and treatment of a globe perforation due to retrobulbar anaesthesia.
The surgery took place at Consorci Sanitari de Terrassa, Barcelona (Spain).
The patient was an 87 year-old man who presented a 2 quadrant superior retinal detachment in his amblyopic right eye. The visual acuity score obtained with Snellen charts before the surgery was light perception in his right eye and 20/50 in his left eye. A 25 gauge 3 port vitrectomy was performed under retrobulbar anaesthesia. We expected to find a 2 quadrant retinal detachment, but we found a 4 quadrant retinal detachment. Moreover, hypotony was observed at the beginning of the surgery, which was partially solved by closing the ports. Perfluorocarbon liquid was injected and an inferotemporal haemorrhage was observed.
Because of the hypotony and the inferotemporal haemorrhage, we suspected an unnoticed globe perforation during retrobulbar anaesthesia. The punction site and the peripheral 360º retina was treated with endophotocoagulation. A fluid-air exchange and an air-silicone oil 2000 cSt exchange was performed. Nine months after the surgery, the right eye visual acuity is hand movement and the retina remains attached.
Hypotony and an unexpected inferotemporal haemorrhage during vitrectomy surgery are very suggestive of an unnoticed globe perforation due to retrobulbar anaesthesia. Once diagnosed, it is recommended to perform endophotocoagulation at the punction site and silicone oil exchange.