1. Anterior Chamber Gas Bubble After Pneumatic Retinopexy in Young, Phakic Patient
Colin S.H. Tan, MD
The authors have no financial or proprietary interests in the subject of this poster

2. Objectives
To report a rare complication of gas bubble migration into the anterior chamber during pneumatic retinopexy

3. Report of a case 45 year old male
Retinal tear at 10 o’clock meridian in RE
Superotemporal retinal detachment
Nuclear sclerotic 1+ cataract
Opted for pneumatic retinopexy

4. Procedure
0.3 cc of 100% perfluropropane (C3F8) injected with 25G needle
Injection 3.5mm behind limbus (superonasal)
27G needle used for routine anterior chamber paracentesis
Gas bubble immediately leaked into AC, filling 40%
IOP 14 mmHg
Patient postured face down, given 500mg acetazolamide

5. Next day…

6. Next day… Gas bubble filled 75% of AC IOP 38 mmHg
Bubble displaced iris-lens diaphragm posteriorly
Corneal edema
Poor view of posterior pole

7. Management IV acetazolamide Surgical management:
Pars plana vitrectomy
Cryotherapy
Sub-retinal fluid drainage
20% suphur hexafluride (SF6)
Intraoperatively, no gas found in vitreous cavity

8. Discussion Pneumatic retinopexy: Generally, a safe procedure
Complications include:
Subretinal / subconjunctival gas
Vitreous hemorrhage
New retinal breaks

9. Gas entrapment in anterior chamber
Rare complication of pneumatic retinopexy
May occur with large pressure gradient associated with:
Forceful injection of gas causing zonular dehiscence
Sudden decompression of anterior chamber during paracentesis
May occur if site of injection is too anterior and peripheral

10. Unusual features of this case
Younger patient – zonules should be more resistant to dehiscence
No zonulysis or phacodonesis noted during surgery
Small volume of gas injected (0.3 cc)
Superonasal approach may have restricted access, resulting in anterior location of needle relative to vitreous face

11. Learning points
Essential to ensure correct placement of needle prior to injection of gas
Anterior chamber paracentesis should be performed with caution during pneumatic retinopexy

12. Acknowlegments Kent Wee, MD Jong Jian Lee, MD Min-Dinn Zaw, MD
Tock Han Lim, MD
The authors have no financial or proprietary interests in the subject of this poster