Necrosis of the retina and uveal tract secondary to expanding gas tamponade

Document Type

Article

Publication Date

9-1-2021

Publication Title

Retin Cases Brief Rep

Abstract

PURPOSE: To present a case of retinal and uveal necrosis caused by expanding gas tamponade after pars plana vitrectomy.

METHODS: Single case report.

RESULTS: An otherwise healthy 66-year-old woman underwent pars plana vitrectomy with intended 20% sulfur hexafluoride (SF6) tamponade for macular hole repair of her pseudophakic left eye. She developed intractable nausea, emesis and increasing left eye pain in association with gas expanded to totally fill the left eye, just hours after surgery. Extremely elevated intraocular pressure was lowered with a successful paracentesis but recurred within a few hours. She then underwent vitrectomy evacuation of all vitreous cavity gas, reformation of the anterior chamber, and silicone oil placement, normalizing intraocular pressure. Three weeks later, the left eye had no light perception, and devitalization of the retina, choroid, and iris was evident.

CONCLUSION: We present a case of blindness and intraocular tissue dissolution/disorganization after vitrectomy with intended 20% SF6. To our knowledge, this is the most detailed report of the under-recognized complication of expanding gas tamponade. Institutions hosting vitrectomy surgery should consider enacting a formal "Time Out" that requires all team members to witness accurate fractionation of potentially expansile gas. In the event of acute postoperative glaucoma in such eyes, a single small volume paracentesis cannot be relied upon to protect against continued gas expansion.

Volume

15

Issue

5

First Page

523

Last Page

526

DOI

10.1097/ICB.0000000000000841

ISSN

1937-1578

PubMed ID

30601459

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