A Rare Complication of Intravitreal Injection with Anterior Chamber Paracentesis: Inadvertent Retinal Trauma Induced by the Needle


ABSTRACT

We report four cases of traumatic retinal lesion related to the needle used for anti-VEGF intravitreal injection. An aqueous paracentesis was performed before the injection in all cases. A 30-gauge needle with a ½ inch long tip was always used. In three cases, the distal end of the needle was obviously in contact with the retina and caused a posterior tear in two cases and an equatorial tear diametrically opposed to the site of penetration in on e case. In the last case, a large round posterior retinal hole with detached edge was noted. We assume this lesion was due to a blast of the retina by the stream of the drug that was injected too close. A vitreous hemorrhage occurred in two cases. In our series, the main indication for vitrectomy was the clearing of a dense vitreous hemorrhage due to a retinal tear (2 cases), and the treatment of a retinal detachment due to a posterior tear or hole (2 cases). The patient with the vitreous hemorrhage and the equatorial tear developed a retinal detachment caused by the retraction of scar and was reoperated. These four patients had a worsening of their vision after the causative injection.

Conclusion:

Retinal wound is a rare but potentially devastating complication of intravitreal injections. Anterior chamber paracentesis can favor this complication. This retinal iatrogenic lesion could have been avoided by the use of a needle with a shorter tip.


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Jean-François Le Rouic
Nantes, France
Email : jflerouic@gmail.com
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