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Retrobulbar gas after macular hole surgery: a case report
Daniel B Roth1, Sheila D Ballintine
1Retina-Vitreous Center, Department of Ophthalmology, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey.
Purpose:
To present a case of a patient who underwent vitreoretinal surgery for repair of a full-thickness macular hole and received an inappropriate concentration of C3F8 gas.
Methods:
Interventional case report.
Results:
A 63-year-old man with a Stage IV full-thickness macular hole underwent uneventful macular hole surgery. The vitreous cavity was filled with presumed 16% perfluoropropane (C3F8) gas and none of the sclerotomies were sutured closed. Postoperatively, the patient presented with severe pain and proptosis and a visual acuity of count fingers. His condition was managed initially with a vitreous gas tap after which an emergency computed tomography was performed revealing retrobulbar air. The patient returned to the operating room and underwent surgical decompression of the retrobulbar gas. Despite medical management to manage his intraocular pressure, the patient required a second vitreous tap. By Postoperative Day 10 after his original macular hole surgery, the gas fill of the posterior segment started to decrease, his proptosis had resolved, and his pain had diminished. By Postoperative Day 60, the macular hole closed and the optic nerve exhibited no pallor or cupping.
Conclusion:
Despite an inappropriate concentration of gas being used, the unsutured sclerotomies allowed escape of the gas from the vitreous space, buffering the rise in intraocular pressure and preventing complete vascular occlusion.
