Bilateral subcutaneous emphysema from pressurized infusion during pars plana vitrectomy: a case report

To report a case of extensive subcutaneous emphysema introduced during vitrectomy while using an advanced feedback-controlled pressurized infusion system.

Clinical case report of a 56-year-old woman undergoing pars plana vitrectomy for rhegmatogenous retinal detachment of the left eye. The clinical and radiologic findings of the patient's eyes were documented. The mechanisms of feedback-controlled pressurized infusion devices were reviewed to explain the adverse events. A search of PubMed was conducted to look for any similar cases and/or discussion.

In this surgical case, vitrectomy was completed with air-fluid exchange and a formed anterior chamber was observed with an estimated pressure of high teens to low 20s by the surgeon. After the undraping, the patient was noted to have severe facial crepitus extending to the clavicles. Immediate chest X-ray was done, followed by computed tomography, confirming orbital and subcutaneous emphysema, as well as the presence of perfluoro-N-octane in the left orbit.

Integrated pressurized infusion devices using feedback sensors allow for a sophisticated method of maintaining intraocular pressure and globe formation. However, inadvertent or occult globe rupture may lead to disruption of feedback control and subsequent high rates of infusion. As the infused substances exit the site of rupture, they can lead to extensive extraocular gas or fluid accumulation, and we report a case of severe bilateral subcutaneous emphysema as a result.