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