This 71YO male presented with decreased vision in his right eye one month following cataract surgery. Vision was hand motion. Slit lamp examination revealed a well-centered posterior chamber IOL.
Optos color RG imaging shows a superotemporal macula-off rhegmatogenous retinal detachment (RRD) caused by a single break. A pneumatic retinopexy using 0.35cc of pure perfluoropropane gas (C3F8) was performed, followed by intravenous mannitol. One day later, vision was hand motion, and a large gas bubble was trapped in the pre-hyaloid space. This configuration reflected gas sequestration within the potential space bordered by the posterior lens capsule, the anterior hyaloid membrane, and the ciliary body. The appearance was unchanged 2 days later.
We attempted to remove the gas in the office, using a plungerless syringe with the needle inserted into the bubble. This maneuver was unsuccessful, necessitating pars plana vitrectomy. The retina remained attached postoperatively with a final vision of 20/100.
Learning Points:
Gas entrapment in the pre-hyaloid space is an exceedingly rare but visually striking complication of pneumatic retinopexy (Chan et al, Surv Ophthalmol 2008;53:443-478), and most likely is caused by a too shallow needle entry into the vitreous. On slit-lamp or fundus examination, the bubble may appear as a donut- shaped or sausage-like lucency located immediately behind the lens.
