Profound postoperative hypotony with globe collapse after 25-gauge pars plana vitrectomy.

Abstract

To report a series of cases of profound hypotony with globe collapse on postoperative day 1 after sutureless 25-gauge pars plana vitrectomy and to identify common risk factors for this complication. Retrospective chart review of three patients. Ocular history and surgeries, preoperative diagnosis, operative technique, postoperative and final visual acuities, reformation intervention, and need for additional surgery were reviewed. Three cases were reviewed. Patient ages were 22, 53, and 53 years. All patients had a history of a rhegmatogenous retinal detachment repaired by surgery and all had at least one vitrectomy. Two had a prior scleral buckle and two had pathologic myopia. All patients underwent sutureless 25-gauge pars plana vitrectomy. No patient had intraocular air, gas, or silicone oil tamponade. All patients presented on postoperative day 1 with globe collapse, hand motion vision, and scleral infolding. All patients underwent office-based injection of sterile balanced salt solution or air. One patient required an additional procedure-operative closure of sclerotomies and intraocular gas tamponade. All three patients attained a final Snellen visual acuity of 20/50 or 20/60. These cases represent a small fraction (0.12%) of patients who underwent 25-gauge pars plana vitrectomy by one surgeon. Patients had several risk factors, including severe eye disease, prior retinal detachment repair, prior vitrectomy, pathologic myopia, and lack of intraocular tamponade. In patients with several risk factors, consideration should be given for intraocular gas or air injection or sclerotomy closure.