Ocular perforation by an acupuncture needle

Fielden, Michael; Hall, Riley B.; Kherani, Femida; Crichton, Andrew; Kherani, Amin

doi:10.3129/i10-122

Cited by 15 publications

(8 citation statements)

References 4 publications

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“…Iatrogenic retinal penetration has been reported after retrobulbar or peribulbar block [14], scleral buckle surgery [15], strabismus surgery [16], botulinum toxin injection for strabismus [17], acupuncture [18], and recently by electromyography electrodes placed for neurophysiologic monitoring during intracranial surgery [19]. While some of them can result in VH, subretinal hemorrhage, retinal tear, or RD, many are asymptomatic [16].…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Retinal Penetration from Intravitreal Injections

Kishore

McGowan

Hanebrink

2021

Case Rep Ophthalmol

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We present 2 cases of iatrogenic retinal penetration from intravitreal (IVT) injections in a retrospective noncomparative case series of 2 patients. The first patient, an 81-year-old Caucasian male, developed dense vitreous hemorrhage soon after receiving an IVT bevacizumab injection for macular edema from central retinal vein occlusion. A 25-g vitrectomy 1 week later showed a retinal hole surrounded by fresh hemorrhages in the same quadrant as the IVT injection. The second patient, an 87-years-old male, developed a retinal detachment after 28 injections of anti-VEGF medications for neovascular AMD. A peripheral round hole was observed during vitrectomy without any lattice degeneration in the same quadrant as prior IVT injections. Both eyes were pseudophakic, had normal axial lengths, and received injections without measuring the injection site. Retinal penetration from IVT injections can result in serious sight-threatening complications. Measuring the injection site from the limbus should be part of safe IVT injection technique.

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Section: Discussionmentioning

confidence: 99%

Iatrogenic Retinal Penetration from Intravitreal Injections

Kishore

McGowan

Hanebrink

2021

Case Rep Ophthalmol

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“…2 This report emphasizes that the placement of electrodes in extraocular muscles for IONM carries the risk of globe penetration. Globe penetration with needles has been reported with botulinum toxin injections for strabismus, 4 retrobulbar injections, 5 and acupuncture 6 ; however, there has been little direct attention paid to potential complications with placement of needle electrodes.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Globe Penetration From Electromyography Electrode Placement for Intraoperative Neurophysiologic Monitoring

Bowen

Possin

Altaweel

2019

Journal of VitreoRetinal Diseases

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Purpose: This interventional case report discusses inadvertent bilateral temporal globe penetration during placement of intramuscular wire electrodes to the lateral rectus muscles for intraoperative neurophysiological monitoring (IONM) via electromyography. Methods: An 11-year-old girl underwent surgical resection of massive medulloblastoma within the fourth ventricle, requiring IONM. Placement of an electrode in each lateral rectus muscle resulted in bilateral globe penetration, with choroidal rupture, retinal tears, and hemorrhage. Results: Sterile needle perforation of the globe did not result in endophthalmitis. Encircling laser retinopexy was performed, and no retinal detachments occurred. Conclusions: Insertion of needle electrodes without guidance imaging can potentially lead to globe penetration and incorrect electrode placement. Direct visualization with ultrasound, electromyography, or other advanced image-guided systems may offer a safe solution for electrode placement to avoid injury. Verbal patients should be made aware of postoperative warning signs of globe penetration. For nonverbal patients, a postoperative dilated exam is warranted.

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“…Despite the popularity of acupuncture, there is only one published report of ocular complications arising from facial or periorbital treatment described by Fielden et al 1 This previous case reported a pinpoint retinal injury, which is typical of globe perforations caused by intraocular needle injuries. 2,3 The subretinal track is not mentioned in previous reports.…”

Section: Discussionmentioning

confidence: 99%