anterior chamber gas bubble after pneumatic retinopexy in young, phakic patient colin s.h. tan, md...
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Anterior Chamber Gas Bubble After Pneumatic Retinopexy in Young, Phakic Patient
Colin S.H. Tan, MD
The authors have no financial or proprietary interests in the subject of this poster
Objectives
To report a rare complication of gas bubble migration into the anterior chamber during pneumatic retinopexy
Report of a case 45 year old male Retinal tear at 10 o’clock meridian
in RE Superotemporal retinal
detachment Nuclear sclerotic 1+ cataract
Opted for pneumatic retinopexy
Procedure
0.3 cc of 100% perfluropropane (C3F8) injected with 25G needle
Injection 3.5mm behind limbus (superonasal) 27G needle used for routine anterior chamber
paracentesis Gas bubble immediately leaked into AC, filling
40% IOP 14 mmHg Patient postured face down, given 500mg
acetazolamide
Next day…
Gas bubble filled 75% of AC
IOP 38 mmHg
Bubble displaced iris-lens diaphragm posteriorly
Corneal edema
Poor view of posterior pole
Next day…
Management IV acetazolamide Surgical management:
Pars plana vitrectomy Cryotherapy Sub-retinal fluid drainage 20% suphur hexafluride (SF6)
Intraoperatively, no gas found in vitreous cavity
Discussion
Pneumatic retinopexy:
Generally, a safe procedure
Complications include:
Subretinal / subconjunctival gas
Vitreous hemorrhage
New retinal breaks
Gas entrapment in anterior chamber Rare complication of pneumatic
retinopexy May occur with large pressure gradient
associated with: Forceful injection of gas causing zonular
dehiscence Sudden decompression of anterior chamber
during paracentesis May occur if site of injection is too
anterior and peripheral
Unusual features of this case
Younger patient – zonules should be more resistant to dehiscence
No zonulysis or phacodonesis noted during surgery
Small volume of gas injected (0.3 cc)
Superonasal approach may have restricted access, resulting in anterior location of needle relative to vitreous face
Learning points
Essential to ensure correct placement of needle prior to injection of gas
Anterior chamber paracentesis should be performed with caution during pneumatic retinopexy
Acknowlegments
Kent Wee, MD Jong Jian Lee, MD Min-Dinn Zaw, MD Tock Han Lim, MD
The authors have no financial or proprietary interests in the subject of this poster