Dynamic angle closure following pars plana vitrectomy with perfluoropropane gas

Area of Science:

• Ophthalmology
• Surgical Complications

Background:

• Aphakia, a condition of lacking a lens, presents unique challenges in ophthalmic surgery.
• Pars plana vitrectomy (PPV) with perfluoropropane (C3F8) gas tamponade is a common procedure for retinal detachment repair.

Observation:

• A 23-year-old male with aphakia experienced vision loss and underwent PPV with C3F8 gas.
• Postoperatively, the patient developed elevated intraocular pressure (IOP) and corneal edema.
• Supine positioning caused a large C3F8 gas bubble to obstruct the anterior chamber, leading to acute angle closure and a sharp IOP spike.

Findings:

• The study captured real-time visualization of C3F8 gas migration causing intermittent acute angle closure in an aphakic patient.
• Positional changes significantly influenced intraocular pressure by altering gas bubble dynamics within the anterior chamber.
• Pars plana aspiration of C3F8 gas effectively normalized IOP, resolving the acute angle closure episode.

Implications:

• Positional secondary angle closure glaucoma is a potential complication following PPV with C3F8 gas in aphakic eyes.
• The intermittent nature of this condition may delay diagnosis, necessitating heightened clinical suspicion.
• Ophthalmologists should carefully discuss and monitor for this complication, especially regarding post-operative positioning advice for aphakic patients.