ABSTRACT
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.
Subject(s)
Amphotericin B/therapeutic use , Drug Resistance, Fungal , Endophthalmitis/microbiology , Eye Infections, Fungal/microbiology , Mycoses/microbiology , Postoperative Complications/microbiology , Trichosporon/isolation & purification , Antifungal Agents/therapeutic use , Cataract Extraction , Endophthalmitis/diagnosis , Endophthalmitis/therapy , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/therapy , Humans , Lens Implantation, Intraocular , Male , Microbial Sensitivity Tests , Middle Aged , Mycoses/diagnosis , Mycoses/therapy , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Trichosporon/drug effects , Vitrectomy , Vitreous Body/microbiologyABSTRACT
PURPOSE: To report a case of retinal and choroidal vascular occlusion occurring as a complication after posterior sub-Tenon triamcinolone injection for treatment of uveitic cystoid macular edema. DESIGN: Interventional case report. METHODS: Retrospective study. A 32-year-old woman with uveitis and cystoid macular edema underwent a right posterior sub-Tenon injection of triamcinolone (40 mg/ml, 1 ml total) through a superotemporal approach after topical anesthesia. After the procedure, the patient experienced severe eye pain, orbital ecchymosis, and globe proptosis consistent with retrobulbar hemorrhage. RESULTS: Dilated fundus examination of the right eye (OD) demonstrated multiple intraretinal hemorrhages with particulate white emboli occluding the retinal and choroidal vessels. Visual acuity was no light perception. Ocular massage and hypotensive therapy was initiated for an intraocular pressure of 50 mm Hg. Canthotomy and cantholysis were performed. A total of 39 months post-incident, her visual acuity improved to 20/100. CONCLUSION: Posterior sub-Tenon triamcinolone injection can rarely result in retinal and choroidal occlusion. Immediate intervention may preserve limited visual acuity.