Bilateral periorbital and cervicofacial emphysema following retinal surgery and fluid gas exchange in a case of inadvertent globe perforation.

Surgical emphysema is defined as gas or air trapped in the subcutaneous tissue plane. Here, we report a rare case of bilateral periorbital and cervicofacial subcutaneous emphysema following a vitreoretinal surgery for inadvertent globe perforation during the administration of peribulbar anesthesia. This condition, although self‑resolving when restricted to the subcutaneous plane has the potential to spread into deeper tissue planes such as the retropharyngeal space. The presence of crepitus helps to distinguish it from angioneurotic edema. Ophthalmologists must be sensitive to the fact that surgical emphysema can be a very rare, but possible complication of an intraocular surgery following globe perforation.

Comparison of Surgical Results for Idiopathic Macular Hole: Fluid-Gas Exchange vs. Fluid-Air Exchange

PURPOSE: In pars plana vitrectomy for macular hole, internal limiting membrane (ILM) peeling, fluid-gas exchange, prone position for more than one week are generally needed. However, the authors modified these surgical procedures. After vitrectomy, we performed ILM peeling with Indocyanine green (ICG) dye and fluid air exchange and kept the patient prone position for one day. We then compare the clinical results and analyze possible factors affecting surgical outcomes. METHODS: Data were reviewed from a retrospective study on Group I, form whom vitrectomy, fluid gas exchange, and ILM peeling without ICG were completed, and on Group II, for whom vitrectomy, fluid air exchange, and ILM peeling with ICG were completed. We evaluated the anatomical and functional success statistically. RESULTS: The anatomical success rate was 79% and 94% and the functional success rate was 42% and 88% in groups I and II respectively. Furthermore, preoperative visual acuity significantly affected the visual outcome. CONCLUSIONS: Without having to maintainl face-down position for a long time, successful anatomical and functional outcomes were obtained through fluid air exchange and prone position for one day. This result suggests that complete ILM peeling with ICG shortens the required duration of tamponade and allows for less stringent maintenance of face-down position.