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Published byDulcie Parsons Modified over 9 years ago
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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
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Objectives To report a rare complication of gas bubble migration into the anterior chamber during pneumatic retinopexy
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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
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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
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Next day…
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Next day… Gas bubble filled 75% of AC IOP 38 mmHg
Bubble displaced iris-lens diaphragm posteriorly Corneal edema Poor view of posterior pole
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Management IV acetazolamide Surgical management:
Pars plana vitrectomy Cryotherapy Sub-retinal fluid drainage 20% suphur hexafluride (SF6) Intraoperatively, no gas found in vitreous cavity
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Discussion Pneumatic retinopexy: Generally, a safe procedure
Complications include: Subretinal / subconjunctival gas Vitreous hemorrhage New retinal breaks
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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
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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
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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
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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
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