Variable retinal presentations after retrobulbar needle perforation: a case series

Retrobulbar anesthesia is widely used in ophthalmic surgery due to its rapid onset and effective akinesia. However, although uncommon, globe perforation remains one of its most severe complications and may lead to a wide spectrum of posterior segment damage. While incidence and risk factors have been extensively described, less attention has been given to the management of the resulting retinal and choroidal injuries.

We report a retrospective case series of four patients with retinal or choroidal complications following retrobulbar needle perforation. Clinical presentations were heterogeneous, including proliferative vitreoretinopathy, subretinal hemorrhage, choroidal neovascularization, and submacular hemorrhage. Management was individualized according to the predominant retinal pathology and included pars plana vitrectomy-based approaches, subretinal recombinant tissue plasminogen activator, and intravitreal anti-vascular endothelial growth factor therapy. Anatomical stabilization was achieved in all cases, with visual outcomes appearing to be influenced by macular involvement and timing of intervention.

Retrobulbar needle perforation can result in diverse retinal pathologies despite a common mechanism of injury. This small case series illustrates the importance of early recognition, multimodal imaging, and individualized management in selected complex cases.