Supplementary Material for: Macula-Involving Serous Choroidal Detachment Following Multiple Short-Interval Trans-Tenon’s Capsule Retrobulbar Anesthesia Injections during Vitreoretinal Surgery: A Case Report

Introduction
Compared with sub-Tenon’s anesthesia (STA), trans-Tenon’s capsule retrobulbar anesthesia (TTRBA) provides rapid and complete akinesia. However, excessive anesthetic volume may cause complications such as choroidal detachment (CD).
Case Presentation
A 59-year-old man who had previously undergone cataract surgery presented with rapidly progressive visual field constriction in the right eye. The best-corrected visual acuity (BCVA) was 20/16; intraocular pressure, 13 mmHg; and axial length, 29.99 mm. Multiple retinal breaks were detected in the superior and nasal retina, with retinal detachment extending from the superior to the inferior retina. Vitrectomy was performed under local anesthesia. STA (2.5 mL lidocaine) was followed by TTRBA (3.0 mL initially, plus an additional total of 4.5 mL administered in two injections) and 7.5 mg intravenous pentazocine. The cumulative TTRBA volume reached 7.5 mL within 50 min. Immediately after the final injection, an orange choroidal elevation developed across the entire retina, including the macula, without vascular whitening. BCVA recovered to 20/20 at 2 weeks postoperatively, with retinal reattachment.
Conclusion
This case suggests that repeated intraconal anesthetic injections totaling >7 mL in a short time may induce macula-involving serous CD via sustained intraorbital pressure elevation. Thus, limiting volume and considering lower-volume alternatives may reduce risk.