Primary Use of Pneumatic Retinopexy in Managing of Retinal Detachment Caused by Ocular Perforation after Retrobulbar Anesthesia-Case Report

以氣體注射復位術治療因球後麻醉穿刺眼球造成之網膜剝離－病例報告

林純如(Chun-Ju Lin) ； 蔡忠斌(Chong-Bin Tsai) ； 黃峻峰(Jiunn-Feng Hwang) ； 陳珊霓(San-Ni Chen)

《中華民國眼科醫學會雜誌》 48卷4期 (2009/12) Pp. 579-583

https://doi.org/10.30048/ACTASOS.200912.0040

摘要

目的：報告一個以氣體注射復位術治療因球後麻醉穿刺眼球造成之網膜剝離的病例。
方法：病例報告。
結果：一位八十二歲女性，無特殊過去眼科或內科病史，約兩個月前在眼科診所接受右眼球後麻醉與白內障摘除手術。術後右眼持續視力模糊，所以醫院求診。右眼最佳矯正視力為三十公分辨指數，眼底照片顯示針頭穿刺傷口及視網膜剝離，黃斑部下血塊延伸至中心小窩處。經玻璃體內注射零點二毫升SF6及病人遵從俯臥姿勢後，視網膜復位良好：再以局部網膜雷射術封閉針頭穿刺傷口。術後六個月，視網膜維持復位，且不需進一步手術，視力恢復至0.02。
結論：以針頭注射局部麻醉藥物的方式中，眼球穿刺傷為少見但嚴重的併發症。留意高度近視與後葡萄腫等危險因子，早期發現並迅速轉介治療可改善視力預後。複雜病例的處理十分棘手，除鞏膜扣壓、冷凍治療外，有時尚須進行玻璃體切除術與矽油灌注。在此病例，只以氣體注射及局部網膜雷射術治療，即讓視網膜維持復位，且不需再次手術。若採用此較簡單治療方式得以成功使視網膜復位，可以節省醫療費用。若無法奏效，仍可選擇進一步手術。但最後視力與黃斑部狀況相關。以氣體注射復位術治療因球後麻醉穿刺眼球造成之網膜剝離，仍需較多病例與較長追蹤時間來釐清其效果。

並列摘要

Purpose: We report the clinical management of a patient who sustained scleral perforation and retinal detachment after retrobulbar block for cataract surgery.
Method: Interventional case report.
Case Report: This 82-year-old female patient had no significant past ocular or medical history. She had a planned cataract surgery after a single retrobulbar injection in the right eye at a local clinic 2 months ago. Blurred vision of the right eye was noted postoperatively. The best-corrected visual acuity of the right eye was counting finger at 30 cm. Fundus photography showed the site of the exit wound and retinal detachment. The submacular blood clot extended to cover the fovea. After intravitreal sulfur hexafluoride injection and remaining in the prone position, the retina was reattached. Focal laser was used around the retinal exit wound. At 6 months postoperatively, the retina remained flat and did not require further surgery. The best-corrected visual acuity was 0.02.
Conclusion: Globe perforation is a rare but potentially significant complication associated with injection of local anesthetic agents using needles. Careful attention to risk factors, early recognition, and prompt referral for management are recommended to improve visual prognosis. Sometimes managing complicated retinal detachment is difficult. In our case, only intravitreal gas injection and focal laser reattached the retina without incident. This simple approach is easier and more economical for older patients. If it doesn't work, further sophisticated surgeries can still be performed. However, final visual acuities depend on the severity of the intraocular injury and the macular status.

並列關鍵字

Ocular Perforation ； pneumatic retinopexy ； retinal detachment ； retrobulbar anesthesia