Sir,
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I read with concern a case report by Gauba et al1 describing a case of ocular perforation and intra vitreal injection of depomedrone during peribulbar injection.
This is a most unfortunate and frightening complication of a routine injection.2
However, it should be appreciated that such complications will become more common at the hands of ophthalmologists who are rapidly becoming deskilled in the valuable art of making periocular injections.
Until a few years ago the retrobulbar/epibulbar/peribulbar injections to effect akinesia and anaesthesia for ocular surgery were made by the ophthalmologists. This practice has now been passed on to anaesthetists/ nurse practitioners. As a direct consequence of this the ophthalmologists have lost an opportunity to develop expertise in making such injections. The ophthalmologists are now required to make such injections on rare occasions as in the case described by Gauba et al.1
The present training programmes do not give ophthalmologists ample opportunities to practice and develop this most useful skill of making such injections. It should therefore come as no surprise that ophthalmologists have lost the ability to appreciate whether the needle is in the vicinity of the globe or is inside it. Ophthalmologists should make some serious attempt to reclaim the art of retro/peri/epibulbar injections to minimise and eliminate such unfortunate complications.
References
Gauba V, Kelleher S, Raines MF . A case of inadvertent ocular perforation and intravitreal injection of depomedrone during peribulbar injection. Good visual prognosis with delayed vitrectomy. Eye 2003; 17: 1039–1040.
Gillow JT, Aggarwal RK, Kirkby GR . A survey of ocular perforation during ophthalmic local anaesthetic in the United Kingdom. Eye 1996; 10: 537–538.
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Kaushik, N. Ocular perforation during peribular injection. Eye 19, 709 (2005). https://doi.org/10.1038/sj.eye.6701607
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DOI: https://doi.org/10.1038/sj.eye.6701607