J Korean Ophthalmol Soc.  2013 Sep;54(9):1475-1479.

Ocular Perforation and Visual Field Defect Caused by an Acupuncture Needle: a Case Report

• Kang H
• Lee DK
• Lim SJ
• Kim HE
• Kwon OW

Abstract

PURPOSE
To report a case of globe perforation and linear retinal tear after periocular acupuncture therapy which resulted in persistent temporal field defect with normal retinal function evidenced by multifocal electroretinogram (MERG).
CASE SUMMARY
A 42-year-old female presented with decreased visual acuity and pain in her right eye after a periocular acupuncture therapy for blepharospasm. At initial presentation, the best corrected visual acuity (BCVA) was 0.08 in the injured eye and the intraocular pressure was 15 mmHg. Ultrasonography showed minimal vitreous hemorrhage and fundus examination revealed a linear retinal tear in the posterior pole sparing the macula. Consequently, barrier laser photocoagulation was performed around the lesion. The patient suffered from metamorphopsia and persistent decreased visual acuity even after 3 months. On fundus examination, epiretinal membrane with macular pucker was observed on the macula. Spectral domain optical coherence tomography (SD-OCT) revealed retinal nerve fiber layer defect with a full-thickness posterior wall tear. Multifocal electroretinogram showed normal retinal function; however, Humphrey visual field test demonstrated field defect corresponding to the injury. A 25-gauge pars plana vitrectomy was performed with membranectomy and ILM peeling. One month postoperatively, improvement in BCVA and metamorphopsia was achieved; however, the scotomata remained unchanged.
CONCLUSIONS
Ocular perforation or retinal tear caused by an acupuncture needle is a rare condition that has not been reported previously in Korea. Furthermore, no case of traumatic visual field defect with preserved retinal function has been reported elsewhere. Hence, the authors present a case of isolated visual field defect without retinal dysfunction following full-thickness retinal tear caused by an acupuncture needle.

Keyword

Acupuncture; Globe perforation; MERG; Ocular perforation; Visual field defect

MeSH Terms

Acupuncture
Acupuncture Therapy
Adult
Blepharospasm
Disaccharides
Epiretinal Membrane
Eye
Female
Humans
Intraocular Pressure
Korea
Light Coagulation
Needles
Nerve Fibers
Retinal Perforations
Retinaldehyde
Tomography, Optical Coherence
Vision Disorders
Visual Acuity
Visual Field Tests
Visual Fields
Vitrectomy
Vitreous Hemorrhage
Disaccharides
Retinaldehyde

Figure

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  Figure 1. Preoperative examination. (A) At initial presentation, fundus photograph revealed distortion of blood vessels, marked retinal wrinkling and striae with epiretinal membrane. (B) Humphrey automated perimetry demonstrated atypical temporal hemianopsia of the right eye. (C) Spectralis Domain Optical Coherence Tomography (SD-OCT) showed retinal nerve fiber layer defect with a full-thickness posterior wall hole as well as epiretinal membrane and macular pucker.

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  Figure 2. Postoperative examination. (A) Fundus photograph reveals improved distortions after the operation and yet re-mained retinal tear. (B) On visual field test, temporal hemianopsia remains the same. (C) Spectralis Domain Optical Coherence Tomography (SD-OCT) reveals persistent retinal nerve fiber disconnection with the epiretinal membrane removed.

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  Figure 3. Multifocal Electroretinography (Mf-ERG). Neither the trace array nor three-dimensional response density plot demon-strates any retinal dysfunction corresponding to the region of field defect.

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