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…

Next day… Gas bubble filled 75% of AC IOP 38 mmHg Bubble displaced iris-lens diaphragm posteriorly Corneal edema Poor view of posterior pole

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