Venous-air embolism during vitrectomy for endoresection of choroidal melanoma: Case report

2021 ◽  
pp. 112067212199510
Author(s):  
Miroslava Paolah Meraz Gutiérrez ◽  
Efrain Jose Camara Rodriguez ◽  
Alejandra Pando Cifuentes ◽  
Grecia Yael Ortiz-Ramirez ◽  
Vidal Soberón Ventura
Keyword(s):  
Vision Loss ◽  
Choroidal Melanoma ◽  
Air Embolism ◽  
Orotracheal Intubation ◽  
Venous Air Embolism ◽  
Vascular Arcade ◽  
Pars Plana ◽  
The Right ◽  
Melanoma Case

Introduction: The purpose of this study is to report a case of venous-air embolism during a vitrectomy for endoresection of choroidal melanoma. Case description: A 31-year-old man went to the clinic because of photopsias and vision loss in his right eye. On fundoscopy of the right eye, a choroidal mass with an associated retinal detachment was found near the inferotemporal vascular arcade. Multimodal imaging was performed and diagnosis of choroidal melanoma was made. Metastatic workup ruled out systemic extension. The patient underwent pars plana vitrectomy for endoresection of the lesion. During the application of laser under air, he started complaining of chest pain and dyspnea. He presented signs of supraventricular tachycardia, tachypnea, hypotension and oxygen desaturation. He was managed with orotracheal intubation, bronchodilators and vasopressor support, and stabilization was achieved. He was discharged 2 days after with no sequalae. After 1-year of follow-up, the patient has a visual acuity of counting fingers and no signs of tumor recurrence or systemic extension. Conclusions: Although rare, vitreoretinal surgeons should be aware of this potentially fatal complication and take steps to prevent it.

scholarly journals Recurrent Intraocular Lens Dislocation in a Patient with Familial Ectopia Lentis

2021 ◽  
Vol 18 (9) ◽  
pp. 4545
Author(s):  
Tomasz K. Wilczyński ◽  
Alfred Niewiem ◽  
Rafał Leszczyński ◽  
Katarzyna Michalska-Małecka
Keyword(s):  
Intraocular Lens ◽  
Pars Plana Vitrectomy ◽  
Vision Loss ◽  
Silicone Oil ◽  
Single Case ◽  
Recurrent Dislocation ◽  
Ectopia Lentis ◽  
Pars Plana ◽  
The Right

A 36-year-old patient presented to the hospital with recurrent dislocation of the intraocular lens (IOL). The patient with the diagnosis of familial ectopia lentis was first operated on for crystalline lens subluxation in the left eye in 2007 and in the right eye in 2009. In both eyes, lens extraction with anterior vitrectomy and transscleral fixation of a rigid IOL was performed. In 2011, the IOL in the right eye luxated into the vitreous cavity due to ocular trauma. The patient underwent a pars plana vitrectomy with the IOL resuturation to the sclera. Seven years later, a spontaneous vision loss in the right eye was caused by a retinal detachment. The pars plana vitrectomy with silicone oil tamponade and a consequential oil removal three months later were performed in 2018. The follow-up examination revealed recurrent IOL dislocation in the same eye. Due to a history of previous suture-related complications a decision was made to remove the subluxated rigid polymethyl-methacrylate (PMMA) IOL and fixate to sclera a sutureless SOLEKO FIL SSF Carlevale lens. The purpose of this report is to present a single case of a 36-year-old patient who was presented to the hospital with recurrent dislocation of the intraocular lens. In a three-month follow-up period, a good anatomical and functional outcome was finally obtained with transscleral sutureless intraocular lens. This lens is an option worth considering especially in a young patient with a long life expectancy and physically active.

scholarly journals Cerebral Venous Air Embolism due to a Hidden Skull Fracture Secondary to Head Trauma

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Ai Hosaka ◽  
Tetsuto Yamaguchi ◽  
Fumiko Yamamoto ◽  
Yasuro Shibagaki
Keyword(s):  
Head Trauma ◽  
Superior Sagittal Sinus ◽  
Skull Fracture ◽  
Air Embolism ◽  
Skull Fractures ◽  
Venous Air Embolism ◽  
Sagittal Sinus ◽  
The Right ◽  
Head Computed Tomography

Cerebral venous air embolism is sometimes caused by head trauma. One of the paths of air entry is considered a skull fracture. We report a case of cerebral venous air embolism following head trauma. The patient was a 55-year-old man who fell and hit his head. A head computed tomography (CT) scan showed the air in the superior sagittal sinus; however, no skull fractures were detected. Follow-up CT revealed a fracture line in the right temporal bone. Cerebral venous air embolism following head trauma might have occult skull fractures even if CT could not show the skull fractures.

scholarly journals Ten-Year Follow-Up after Bilateral Submacular Neovascular Membrane Removal in a Case of Autosomal Recessive Bestrophinopathy

2017 ◽  
Vol 8 (1) ◽  
pp. 265-270 ◽  
Author(s):  
Carlos A. Moreira Jr. ◽  
Carlos A. Moreira-Neto ◽  
Mario Junqueira Nobrega ◽  
Eduardo Cunha de Souza
Keyword(s):  
Vision Loss ◽  
Internal Limiting Membrane ◽  
Eye Drops ◽  
Fluid Exchange ◽  
Internal Limiting Membrane Peeling ◽  
Pars Plana ◽  
One Year ◽  
The Right ◽  
Best Disease

Herein, we report the case of an 8-year-old girl who presented in December 2000 with a submacular neovascular membrane in the right eye, with a clinical diagnosis of Best disease. At that time, she underwent pars plana vitrectomy (PPV) with removal of the subretinal choroidal neovascularization (CNV). Her vision improved from 20/200 to 20/25. Four years later, a new CNV developed in the other eye. Initially, she underwent unsuccessful photodynamic therapy. As her vision worsened, she underwent a second, this time successful, PPV with membrane removal in the left eye, with vision improving to 20/30. Ten years later, she returned complaining of vision loss over the last year. Her vision was 20/200 OU, and optical coherence tomography demonstrated very large intraretinal cystoid spaces resembling bilateral macular schisis. Four ranibizumab injections as well as dorzolamide eye drops were tried, both without success. Finally, she underwent PPV with internal limiting membrane peeling and gas-fluid exchange in the left eye. One month later, the macula appeared flat and vision had improved to 20/60. The same procedure was performed 1 year later for the right eye, with vision improving to 20/80. One year later, mild cystic spaces developed again in both eyes, although much smaller than previously observed. Her vision remained stable.

scholarly journals Valsalva Retinopathy Associated with Sexual Activity

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Khalid Al Rubaie ◽  
J. Fernando Arevalo
Keyword(s):  
Visual Acuity ◽  
Sexual Activity ◽  
Vision Loss ◽  
Internal Limiting Membrane ◽  
Internal Limiting Membrane Peeling ◽  
Sudden Loss ◽  
Initial Visual Acuity ◽  
Pars Plana ◽  
23 Gauge ◽  
The Right

A 54-year-old healthy male presented complaining of sudden loss of vision in the right eye. Initial visual acuity was counting fingers. The patient’s acute vision loss developed after sexual activity. Color fundus photos and fluorescein angiography were performed showing a large subinternal limiting membrane hemorrhage in the macular area. A 23-gauge sutureless pars plana vitrectomy with brilliant blue assisted internal limiting membrane peeling was performed with best-corrected visual acuity recovery to 20/50 at 6 months of followup.

scholarly journals Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Salvatore Di Lauro ◽  
Melissa Castrejón ◽  
Itziar Fernández ◽  
Jimena Rojas ◽  
Rosa M. Coco ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Visual Loss ◽  
Vision Loss ◽  
Multicentric Study ◽  
Prospective Multicentre Study ◽  
Snellen Chart ◽  
Pars Plana ◽  
Phakic Eyes

Purpose. To quantify the frequency of visual loss after successful retinal detachment (RD) surgery in macula-on patients in a multicentric, prospective series of RD.Methods. Clinical variables from consecutive macula-on RD patients were collected in a prospective multicentric study. Visual loss was defined as at least a reduction in one line in best corrected visual acuity (VA) with Snellen chart. The series were divided into 4 subgroups: (1) all macula-on eyes (n=357); (2) macula-on patients with visual loss at the third month of follow-up (n=53) which were further subdivided in (3) phakic eyes (n=39); and (4) pseudophakic eyes (n=14).Results. Fifty-three eyes (14.9%) had visual loss three months after surgery (n=39phakic eyes;n=14pseudophakic eyes). There were no statistically significant differences between them regarding their clinical characteristics. Pars plana vitrectomy (PPV) was used in 67.2% of cases, scleral buckle in 57.7%, and scleral explant in 11.9% (36.1% were combined procedures).Conclusions. Around 15% of macula-on RD eyes lose VA after successful surgery. Development of cataracts may be one cause in phakic eyes, but vision loss in pseudophakic eyes could have other explanations such as the effect of released factors produced by retinal ischemia on the macula area. Further investigations are necessary to elucidate this hypothesis.

scholarly journals Surgical Management of a Patient with Anterior Megalophthalmos, Lens Subluxation, and a High Risk of Retinal Detachment

2017 ◽  
Vol 8 (1) ◽  
pp. 61-66 ◽  
Author(s):  
María Carmen Guixeres Esteve ◽  
Augusto Octavio Pardo Saiz ◽  
Lucía Martínez-Costa ◽  
Samuel González-Ocampo Dorta ◽  
Pedro Sanz Solana
Keyword(s):  
Retinal Detachment ◽  
Vision Loss ◽  
Lens Subluxation ◽  
Intraocular Lens Dislocation ◽  
Common Causes ◽  
History Of ◽  
Anterior Megalophthalmos ◽  
The Right ◽  
Iris Claw

The early development of lens opacities and lens subluxation are the most common causes of vision loss in patients with anterior megalophthalmos (AM). Cataract surgery in such patients is challenging, however, because of anatomical abnormalities. Intraocular lens dislocation is the most common postoperative complication. Patients with AM also seem to be affected by a type of vitreoretinopathy that predisposes them to retinal detachment. We here present the case of a 36-year-old man with bilateral AM misdiagnosed as simple megalocornea. He had a history of amaurosis in the right eye due to retinal detachment. He presented with vision loss in the left eye due to lens subluxation. Following the removal of the subluxated lens, it was deemed necessary to perform a vitrectomy in order to prevent retinal detachment. Seven months after surgery, an Artisan® Aphakia iris-claw lens was implanted in the anterior chamber. Fifteen months of follow-up data are provided.

scholarly journals Spontaneous Necrosis of a Large Choroidal Melanoma: Unusual Presentation in a 49-Year-Old Male

2019 ◽  
Vol 6 (3) ◽  
pp. 174-179
Author(s):  
Carmen Baumann ◽  
Danilo Iannetta ◽  
Sarah E. Coupland ◽  
Carl Groenewald ◽  
Mandagere Vishwanath ◽  
...  
Keyword(s):  
Choroidal Melanoma ◽  
Vitreous Haemorrhage ◽  
Tumour Mass ◽  
Mixed Cell ◽  
Ocular Tissues ◽  
Complete Lysis ◽  
Pars Plana ◽  
The Right ◽  
Good Vision ◽  
Viable Tumour

Purpose: To demonstrate a case of massive vitreous haemorrhage obscuring the underlying diagnosis of a large mixed-cell choroidal melanoma which had undergone spontaneous necrosis. Case Report: A 49-year-old man in good general health suddenly lost vision in his right eye due to an extensive vitreous haemorrhage 1 day after a workout at the gym. He reported good vision prior to that without any symptoms of flashes, floaters, or shadows. He was referred to the vitreoretinal department of a tertiary eye hospital, where he presented with a drop in vision to light perception only in the right phakic eye. Pars plana vitrectomy was performed in the right eye, which revealed intraoperatively massive retinal ischemia and choroidal haemorrhage, but no obvious tumour mass that could have been biopsied. The vitrectomy cassette specimen was sent for histopathology, where “ghost-like” melanoma cells were identified. The eye was subsequently enucleated, revealing an extensively necrotic and haemorrhagic choroidal melanoma of mixed cell type with only small viable tumour foci at the base and almost complete lysis of the detached retina. Conclusion: Some uveal melanomas (UMs) undergo spontaneous necrosis due to rapid growth, with the centre of the tumour outstripping its established blood supply in the “watershed area” of the eye, and becoming hypoxic with associated necrosis of intraocular structures. Such UMs are often associated with haemorrhage and/or inflammation and usually cause significant destruction of ocular tissues, resulting in enucleation as the only treatment option.

scholarly journals The Use of Intravitreal Ranibizumab for Choroidal Neovascularization Associated with Vogt-Koyanagi-Harada Syndrome

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
A. M. Kolomeyer ◽  
M. S. Roy ◽  
D. S. Chu
Keyword(s):  
Vision Loss ◽  
Corticosteroid Treatment ◽  
Exudative Retinal Detachment ◽  
Intravitreal Ranibizumab ◽  
Loss To Follow Up ◽  
Finger Counting ◽  
Combinational Treatment ◽  
Vkh Syndrome ◽  
The Right

Purpose. To describe the use of intravitreal ranibizumab for choroidal neovascular membrane (CNVM) secondary to Vogt-Koyanagi-Harada (VKH) syndrome.Methods. Interventional case report.Results. A 50-year-old woman presented with conjunctival injection and bilateral eye pain. Vision was 20/400 and 20/80 in the right and left eyes, respectively. Bilateral iritis, vitritis, and choroidal thickening were evident. Exudative retinal detachment was present in the left eye. Corticosteroid treatment improved vision to 20/40 bilaterally. Methotrexate (MTX) was initiated and vision remained stable for 3 months. After a 5-month loss to follow-up, vision in the left eye decreased to finger counting (CF) and a parafoveal CNVM was identified. After 3 intravitreal ranibizumab injections, vision improved to 20/40. Twelve months later, despite inflammation control, vision decrease to CF due to recurrent CNVM. A fourth ranibizumab injection was given. Twenty months later, best-corrected vision was 20/400, and an inactive CNVM was present in the left eye.Conclusion. After initial CNVM regression and visual acuity improvement due to ranibizumab, the CNVM recurred and became refractory to treatment. Despite control of inflammation and neovascularization, VKH chronicity lead to permanent vision loss in our patient. A combinational treatment approach may be required in such patients.

Venous air embolism in swine: transport of gas bubbles through the pulmonary circulation

1990 ◽  
Vol 69 (1) ◽  
pp. 237-244 ◽  
Author(s):  
A. Vik ◽  
A. O. Brubakk ◽  
T. R. Hennessy ◽  
B. M. Jenssen ◽  
M. Ekker ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Gas Bubbles ◽  
Air Embolism ◽  
Threshold Value ◽  
Maximum Increase ◽  
Venous Air Embolism ◽  
Mean Pulmonary Arterial Pressure ◽  
Significant Difference ◽  
Group 2 ◽  
The Right

The assumption that the lung is an effective filter for gas bubbles is of importance for certain occupations (e.g., divers, astronauts) as well as in the accomplishment of several medical procedures. The filtering capacity was tested in pigs by use of continuous air infusion into the right ventricle and a transesophageal echocardiographic transducer for detection of air in the left atrium. Twenty pigs, anesthetized with pentobarbital sodium and mechanically ventilated, were divided into groups that received air at infusion rates of 0.05 (group 1a, n = 7), 0.10 (group 2, n = 6), and 0.20 (group 3, n = 5) ml.kg-1.min-1. Two pigs served as controls. The breakthrough incidence was 0, 67, and 100%, respectively. Group 1a received a second infusion of 0.10 ml.kg-1.min-1 (group 1b, n = 7), and spillover of bubbles occurred in only 14% of these pigs. Infusion of gas caused a maximum increase in mean pulmonary arterial pressure (PAP) of 129 +/- 9% to 39.2 +/- 1.3 (SE) mmHg, with no significant difference between the groups. Breakthrough was observed only in animals with a dramatic reduction in mean arterial pressure and a PAP that returned to almost-normal values at spillover time. Our results suggest that the threshold value for breakthrough of air bubbles in pigs is reduced compared with that in dogs. The hemodynamic consequences at a given infusion rate are, however, greatly enhanced.

Venous Air Embolism During Pars Plana Vitrectomy: A Case Report and Review of the Literature

2017 ◽  
Vol 1 (5) ◽  
pp. 334-337 ◽  
Author(s):  
Sundeep K. Kasi ◽  
Scott Grant ◽  
Harry W. Flynn ◽  
Thomas A. Albini ◽  
Nidhi Relhan ◽  
...  
Keyword(s):  
Case Report ◽  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Air Embolism ◽  
Choroidal Detachment ◽  
Fatal Complication ◽  
Ocular Surgery ◽  
Venous Air Embolism ◽  
Pars Plana ◽  
Air Exchange

Purpose: Presumed venous air embolism (PVAE) is a rare and potentially fatal complication of pars plana vitrectomy that is poorly described and understood but requires improved awareness among ophthalmologists and vitreoretinal surgeons. Methods: A case report is presented along with a systematic review of published reports of PVAE during ocular surgery. Results: An otherwise healthy adult male undergoing retinal detachment repair under local anesthesia with monitored anesthesia care died from a PVAE. Literature search yielded 2 experimental models, 6 individual case reports, and several editorials. Review of existing reports reveals that PVAE can affect patients of any age or gender with no medical predilection and occurs in cases of trauma, endoresection, or retinal detachment repair. It is typically associated with a drop in end-tidal carbon dioxide during fluid–air exchange and can present similar to a hemorrhagic choroidal detachment. Analysis suggests that venous air embolism can be prevented by ensuring full engagement of the infusion cannula into the vitreous cavity prior to fluid–air exchange. Conclusion: Presumed venous air embolism is a potentially fatal complication of ocular surgery and in some cases may be recognized by ophthalmologists as a choroidal detachment during fluid–air exchange in pars plana vitrectomy. It is imperative to immediately stop the air infusion line if venous air embolism is suspected.

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