球旁注射针头刺破眼球12例临床分析

Accidental perforation of the globe during peribulbar injection

目的 分析球旁注射针头误刺入眼内的症状、临床表现 ,探讨其防治方法。方法 对12例球旁注射针头误刺入眼内的临床表现和疗效进行回顾性分析。其中 1例为普通 5号齿科长针头 ,11例使用一次性注射器针。 2例为手术前球旁注射局部麻醉药物者 ,余均为球旁注射糖皮质激素和 (或 )抗生素治疗的患者。结果 注射后临床表现 :急性视力下降、眼痛 ,玻璃体出血、玻璃体内残存的白色皮质激素、视网膜裂孔及脱离 ,高眼压或低眼压 ,白内障术后伤口裂开。治疗 :主要为玻璃体手术和修补伤口。术后视力≤ 0 0 5者 6例。结论 刺破眼球是球旁注射的严重并发症 ,重在预防。

Objective To evaluate clinical manifestations, management, visual outcome and prevention of accidental penetration of the globe during peribulbar injection. Methods The medical records of 12 cases were retrospectively reviewed. The disposable needle was used in all the cases except one to whom a reusable needle was applied. Lidocaine was injected in 2 cases, steroid or steroid combined with antibiotics was injected in the remaining ones. Results The main symptoms were acute loss of visual acuity (VA) and pain in the involved eye. The signs included vitreous hemorrhage, white steroid material in the vitreous cavity, retinal break and detachment, high intraocular pressure or hypotony and rupture of cataract surgical wound. The treatments consisted of vitrectomy, the repair of retinal detachment or ruptured cataract surgical wound. Six cases ended with VA ≤0 05. Conclusion Inadvertent intraocular perforation during peribulbar injection is a serious complication. The best method to rescue such cases is prevention.