Visual loss following intraocular gas injection

The range of indications for vitreoretinal surgery has widened in recent years, and intraocular gas application is frequently performed as part of retinal surgery, with the aim of achieving long-acting tamponade.

Selective literature review.

An intraocular gas bubble containing perfluoropropane (C(3)F(8)) or sulfur hexafluoride (SF(6)) can expand during anesthesia due to nitrous oxide diffusion and cause retinal ischemia and postoperative blindness. A decrease in atmospheric pressure associated with travel to high altitude can have the same effect. Case reports suggest that, considering physical properties of these gases and ocular physiology, patients remain at risk for at least three months after intraocular gas application.

Both doctors and patients need to be well informed about the hazards of intraocular gas application as good communication may prevent complications. If in doubt, the anesthesiologist should avoid nitrous oxide, in particular in the unconscious patient.