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Published on: January 13, 2017
Fatal air embolism during endoresection of choroidal melanoma
James C Rice1, Linda Liebenberg, Raoul P Scholtz
1Departments of *Ophthalmology, and †Forensic Pathology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Purpose:
To describe a case of intraoperative mortality because of air embolism during resection of a choroidal melanoma by pars plana vitrectomy.
Methods:
Retrospective interventional case report.
Results:
A 69-year-old man died unexpectedly at the time of pars plana vitrectomy. The operative technique involved the use of high-pressure air (60 mmHg) in the presence of traumatically exposed choroidal vasculature. Autopsy revealed a large air embolus in the right ventricle, which resulted in sudden cardiovascular collapse.
Conclusion:
Air embolism is a rare complication of ophthalmic surgery. Infusion of air in the presence of traumatically exposed choroidal vasculature exposes the patient to the risk of air embolism. Ophthalmic surgeons and anesthetists should be aware of the possibility of air embolism during certain ophthalmic procedures, and appropriate intraoperative monitoring should be considered.
Insights
A rare case of intraoperative mortality due to air embolism during pars plana vitrectomy for choroidal melanoma highlights surgical risks. Surgeons must monitor for air embolism, especially with exposed choroidal vasculature.
Area of Science:
- Ophthalmology
- Cardiovascular Surgery
- Pathology
Background:
- Pars plana vitrectomy is a common ophthalmic surgical procedure.
- Choroidal melanoma resection can involve complex techniques.
- Air embolism is a potential, though rare, complication in surgery.
Observation:
- A 69-year-old male patient experienced sudden intraoperative death during pars plana vitrectomy for choroidal melanoma.
- The surgery involved high-pressure air infusion (60 mmHg) with traumatically exposed choroidal vasculature.
- Autopsy confirmed a large air embolus in the right ventricle, leading to cardiovascular collapse.
Findings:
- The case demonstrates a fatal instance of air embolism during ophthalmic surgery.
- High-pressure air infusion into exposed choroidal vasculature presents a significant risk.
- Cardiovascular collapse resulted from the air embolus in the right ventricle.
Implications:
- Ophthalmic surgeons and anesthesiologists must recognize the risk of air embolism in specific procedures.
- Awareness of this complication is crucial for patient safety during pars plana vitrectomy.
- Consideration of enhanced intraoperative monitoring may be warranted in high-risk cases.
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