Rooney David M, Oltmanns Matthew H, Sapp Mathew R, Morris Robert E
Department of Ophthalmology, William Beaumont Hospital, Royal Oak, Michigan.
Retina Specialists of Alabama, Birmingham, Alabama.
Retin Cases Brief Rep. 2021 Sep 1;15(5):523-526. doi: 10.1097/ICB.0000000000000841.
To present a case of retinal and uveal necrosis caused by expanding gas tamponade after pars plana vitrectomy.
Single case report.
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.
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.
报告一例经扁平部玻璃体切除术后因气体填充膨胀导致视网膜和葡萄膜坏死的病例。
单病例报告。
一名66岁健康女性因左眼人工晶状体眼黄斑裂孔行扁平部玻璃体切除术，术中注入20%的六氟化硫（SF6）气体填充。术后数小时，她出现难以控制的恶心、呕吐，左眼疼痛加剧，同时气体膨胀至完全充满左眼。通过前房穿刺成功降低了极高的眼压，但数小时后眼压再次升高。随后她接受了玻璃体切除术以清除玻璃体腔中的所有气体，重建前房，并植入硅油，眼压恢复正常。三周后，左眼无光感，视网膜、脉络膜和虹膜均出现坏死。
我们报告了一例在预期注入20% SF6的玻璃体切除术后出现失明和眼内组织溶解/紊乱的病例。据我们所知，这是关于气体填充膨胀这一未被充分认识的并发症最详细的报告。开展玻璃体切除术的机构应考虑制定正式的“暂停”程序，要求所有团队成员见证潜在膨胀性气体的准确分装。对于此类术后急性青光眼的情况，不能仅依靠单次少量前房穿刺来防止气体持续膨胀。
