Primary Retinal Detachment

64
Complications: Prevention and Management
Intraoperative
4 Pneumatic Retinopexy for Primary Retinal Detachment
There are limited complications associated with the use of PR. The
most common set of problems arise from difficulties with the gas
bubble itself, particularly migration into unintended potential
spaces. Subconjunctival gas is the most common location, being reported
in 0–10% of cases (Table 4.5) [3, 9–11]. Gas has also been reported
in the subretinal space (0–4%) [12–15], anterior to the anterior
hyaloid (0–9%) [11, 13, 14], in the suprachoroidal space (0–5%)
[13–15], and exterior to pars plana epithelium (0–1%) [9]. Following
injection, the gas inside the eye may form multiple small “fish egg”
bubbles rather than a single large one. Fish eggs provide inadequate
tamponade, as they do not occlude breaks with the same efficiency
as a large smooth meniscus. This same feature also makes
them more likely to migrate into the subretinal space. Multiple
small bubble formation can usually be avoided through proper injection
technique (see above).When this does occur,the eye may be
forcefully tapped or “thumped” with the surgeon’s finger, which
can lead to coalescence (a technique that has been described,
Table 4.5. Reported intraoperative complications
Subconjunctival hemorrhage [3] Up to 60%
Subconjunctival gas [3, 9–11] 0–10%
Anterior hyaloid gas [11, 13, 14] 0–9.7%
Vitreous hemorrhage [3, 9, 13, 15] 0–5%
Choroidal detachment [13–15] 0–5%
Subretinal gas [12–15] 0–4%
Vitreous incarceration [9, 10, 12, 13] 0–3.6%
Sub pars plana gas [9] 0–1%
Subretinal hemorrhage [13] 0–1%
Hyphema [13, 14] 0–1%
Lens touch [13] 0–1%