Weinand F S, Pavlovic S, Dick B
Universitäts-Augenklinik, Giessen.
Klin Monbl Augenheilkd. 1997 Jun;210(6):402-4. doi: 10.1055/s-2008-1035084.
Most penetrating needle puncture injuries occur in retro- or peribulbar anesthesia. Hereby only a small percentage of patients develop endophthalmitis. Ocular penetration after enoral infraorbital nerve block has not yet been reported in literature.
In June 1995 a 74-year-old man presented with a fulminant fibrinous and purulent endophthalmitis. Because he suffers from trigeminal neuralgia his anesthesiologist performed an infraorbital nerve block from enoral two days ago. During this procedure the patient felt a sharp ocular pain.
We suspected an ocular penetration and performed a vitrectomy with intravitreal antibiotic instillation on the admission-day. A needle penetration site near the inferior rectus muscle was detected and after exocryocoagulation a 5 mm wide radial buckle was sutured over penetration site. Three months postoperatively vision recovered from hand moving to 20/50 and all infiltrations had been disappeared. Only preexisting cataract prevented a better vision. 10 months later after successful cataract extraction with intraocular lens implantation patient left hospital with a vision of 20/30.
Careful anamnesis would have prevented this accidental globe penetration. Right upper palate is absent presumably due to congenital cleft malformation or surgery. This allowed needle penetration through smooth tissue into the right globe. Fortunately, endophthalmitis develops only in a small percentage after needle puncture. We recommend immediate pars-plana-vitrectomy and intravitreal antibiotics in case of endophthalmitis after ocular penetration.
大多数穿透性针刺伤发生在球后或球周麻醉时。仅有一小部分患者会发生眼内炎。经口眶下神经阻滞术后发生眼球穿透尚未见文献报道。
1995年6月，一名74岁男性因暴发性纤维素性脓性眼内炎就诊。因其患有三叉神经痛，两天前麻醉医生为其实施了经口眶下神经阻滞。在此过程中患者感到眼部剧痛。
我们怀疑发生了眼球穿透，入院当天即行玻璃体切除术并向玻璃体内注入抗生素。在眼外直肌附近发现了针刺部位，在进行冷冻凝固后，在穿透部位上方缝合了一个5毫米宽的放射状巩膜扣带。术后三个月，视力从手动恢复到20/50，所有炎症浸润均已消失。仅原有的白内障妨碍了视力进一步提高。10个月后，成功进行白内障摘除并植入人工晶状体后，患者出院时视力为20/30。
仔细询问病史本可避免这起意外的眼球穿透。右上腭缺失可能是由于先天性腭裂畸形或手术所致。这使得针头能够穿过光滑组织刺入右侧眼球。幸运的是，针刺后仅有一小部分患者会发生眼内炎。我们建议，眼球穿透后发生眼内炎时应立即行玻璃体切割术并向玻璃体内注入抗生素。
