NECROSIS OF THE RETINA AND UVEAL TRACT SECONDARY TO EXPANDING GAS TAMPONADE.

Area of Science:

• Ophthalmology
• Surgical Complications
• Retinal Surgery

Background:

• Pars plana vitrectomy is a common surgical procedure for various retinal conditions.
• Intraocular gas tamponade, such as sulfur hexafluoride (SF6), is frequently used to support retinal reattachment.
• Complications related to intraocular gas, though rare, can be severe.

Observation:

• A case report details a 66-year-old woman who developed severe complications hours after vitrectomy with intended 20% SF6 gas tamponade for macular hole repair.
• The patient experienced intractable nausea, vomiting, and escalating eye pain due to rapid and extreme intraocular gas expansion.
• Despite initial management with paracentesis, the intraocular pressure rapidly increased, necessitating further intervention.

Findings:

• The patient ultimately suffered no light perception with evident retinal, uveal, and iris devitalization.
• This case highlights the potential for significant intraocular tissue damage from uncontrolled expansion of gases like SF6.

Implications:

• Accurate measurement and verification of gas concentration during vitrectomy are critical to prevent vision-threatening complications.
• Relying solely on paracentesis for acute postoperative glaucoma secondary to gas expansion is insufficient.
• Enhanced safety protocols, such as a formal "Time Out" for gas verification, should be considered in surgical settings.