Central Venous Occlusion Research Articles

Percutaneous transluminal angioplasty procedure for central venous stenosis inpatient undergoing hemodialysis in Pelni Hospital: case series

Introduction: Many causes leads to kidney impairment. This does not rule out the increasing number of patients undergoing hemodialysis. The common vascular access used during hemodialysis is an arteriovenous fistula (AVF). The arteriovenous fistula was preferred because it lasts longer and has a lower risk of infection for vascular access, meanwhile central venous stenosis or occlusion in the vein that carries the blood from the extremities to the heart often occur. If vascular access is still used during hemodialysis in which central venous stenosis is formed, it needs to make a new vascular access option. Percutaneous transluminal angiography (PTA) main objectives are to dilate the venous lesion that has occlusion more than 50% and extending the lifespan of arteriovenous fistula. In this case, we report six patients hemodialysis with central venous stenosis treated with percutaneous transluminal angiography. This procedure has benefits that are arteriovenous fistula can be used again to reach hemodialysis adequacy optimally and reduce pain and swelling in the arms. Case description: There six cases who were 45,48,57.58,63 and 66 years old who underwent percutaneous transluminal angioplasty procedures for central venous stenosis. Several past illnesses of the patients underlying the kidney impairment such chronic hypertension, chronic coronary heart complications, and/or diabetes. Several patients felt AVF swollen and/or painful. Minimal residual stenosis after balloon angioplasty was performed. Conclusion: According to our cases, patients that underwent the hemodialysis felt swollen or/and pain due to stenosis ballooning angioplasty help minimize the residual stenosis.

Primary Patency Rates of Endovascular Interventions in Hemodialysis Patients with Central Venous Stenosis and Occlusions

Background: The purpose of this study was to determine the primary patency rate of endovascular interventions in hemodialysis patients who had central venous stenosis or occlusion. Material and Methods: Twenty-seven hemodialysis patients, who underwent endovascular intervention between January 2013 and January 2018 for central venous stenosis or total obstruction, were included in the study. Endovascular interventions consisted of percutaneous transluminal angioplasty (PTA) or stent implantation. Primary patency rate of endovascular intervention at the sixth and twelfth months were evaluated. Results: Stent implantation and PTA were used in 5 patients and 22 patients, respectively. 14 patients had stenosis and 13 patients had occlusion. The total procedural success rate was 81%, 86% in stenosis and 77% in occlusion. There was no procedure-related complication. The primary patency for PTA at 6 and 12 months were 40% and 10%, respectively. For stent implantation, primary patency rate at 6 and 12 months was 70% and 30%, respectively. Conclusion: Endovascular interventions for central venous stenosis and occlusion are safe, with low rates of technical failure and they can be first-line treatment for central venous stenosis or occlusion in hemodialysis patients.

Initial and long-term outcomes of Percutaneous Transluminal Angioplasty for central venous stenosis or occlusion in chronic hemodialysis patients: Analysis of 363 lesions in single center

The purpose of this study was to evaluate the initial and long-term outcomes of Percutaneous Transluminal Angioplasty (PTA) for central venous stenosis or occlusion in chronic hemodialysis patients. A total of 363 central venous lesions (277 stenosis and 86 occluded lesions) of 146 patients were enrolled and analyzed retrospectively; these included 130 de novo lesions and 233 restenosis lesions. The procedural success rate in our cohort was 97.0% (352/363 lesions); success rate for stenosis was significantly higher than that for occluded lesions (99.3% vs. 89.5%, P < 0.001). Complications during PTA procedures occurred in nine lesions (2.5%); however, there were no serious complications. A total of 120 stents were implanted for 111 lesions; the rate of stent placement for occluded lesions was significantly higher than that for stenosis lesions (68.8% vs. 18.4%, P < 0.001). The primary patency of de novo lesions was significantly higher than that of restenosis lesions (P = 0.0004); the assisted patency of de novo lesions at 12 and 36 months were 94.4% and 89.0%, respectively. There was no significant difference of primary patency between balloon angioplasty and stent placement for de novo lesions, however, primary patency after stent placement for restenosis lesions was significantly higher than that after balloon angioplasty (P = 0.001). In conclusion, PTA for central venous stenosis or occlusion was safe procedure with low rate of technical failure. The patency of vascular access in long-term was maintained by the repeated intervention. Stent placement could help prolong the patency period for restenosis lesions.

Brachial Arterial Transposition: Another Option for Vascular Access?

Brachial Arterial Transposition: Another Option for Vascular Access?

Conversion of Arterio-Venous Access of Hemodialysis to Arterio-Arterial Access for Treatment of Venous hypertension with Central Venous Occlusion

This report describes conversion of arterio-venous graft or fistula to arterio-arterial vascular access as a new surgical treatment option for central venous occlusion. It starts with control of the axillary vein and the synthetic graft or superficialized vein proximally, the suture line of venous anastomosis is closed and end-to-side anastomosis of the synthetic graft or vein to the brachial artery (BA) is done, then ligation of the BA distal to the anastomosis is done. Now the blood flow is directed through synthetic graft or vein from proximal to distal BA that can be used as arterio-arterial vascular access for hemodialysis.

Invited Commentary Open Venous Bypass in the Era of Endovascular Therapy

Central venous disease and obstruction in dialysis patients is a common problem and a cause of upper extremity access failure. Endovascular therapy, angioplasty and stenting, is the first line of therapy nowadays in treating central venous disease. However high failure rates and need for re-intervention due to external compression at the thoracic outlet led many to perform other salvage procedures like clavicle or rib resection 1. Glass C. Maevsky V. Massey T. et al. Subclavian vein to right atrial appendage bypass without sternotomy to maintain arteriovenous access in patients with complete central vein occlusion, a new approach. Ann Vasc Surg. 2009; 23: 465-468 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar and even more creative ideas like percutaneous bypass. 2. Chiung-Yu Chen M. Weng M.J. Percutaneous extraanatomic bypass for treatment of central venous occlusions in patients undergoing hemodialysis. AJR Am J Roentgenol. 2020; 214: 477-481 Crossref PubMed Scopus (2) Google Scholar Open central venous bypass should be considered in patients, particularly younger patients, as their life depends on a functioning upper extremity bypass. In addition, most of them have symptoms related to superior vena cava syndrome. The big questions are who should get it? What algorithm should we follow? What is the long-term patency? In the current paper, 3. Uceda P.V. Feldtman R.W. Ahn S.S. Long term results of bypass graft to the right atrium in the management superior vena cava syndrome in fialysis patients. Ann Vasc Surg. 2021; (accepted for publication) Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar the authors provide the readers with some answers to all these questions based on their experience. The authors present a mix of 5 patients (3 with fistulas, 1 with dialysis graft and 1 with dialysis catheter) treated with atrial bypass with no mortality. From the authors’ affiliation, two are vascular surgeons and one is a cardiac surgeon. Having a multidisciplinary approach, vascular and cardiac surgeons along with other interventionlists, would identify and increase the enthusiasm for this open and durable procedure and help some of the dialysis patients who need it the most.

Analysis of the vascular access service for patients on haemodialysis in Livingstone Hospital.

Reliable vascular access is key to sustainable haemodialysis treatment. Guidelines recommend an arteriovenous fistula (AVF) as the preferred modality in preference to arteriovenous grafts (AVGs) or central venous catheters (CVCs). There are limited data on vascular access in sub-Saharan Africa. This study aimed to evaluate the vascular access used in a South African tertiary hospital and identify problems with achieving the recommended access goals. A cross-sectional analysis was performed of the haemodialysis programme at Livingstone Tertiary Hospital. Current and initial vascular access used, timing until the creation of permanent access, and any complications experienced were recorded. CVCs were used in 56% of subjects, 38% were using an AVF and 5% were using an AVG. Only 12% of the group had no AVF attempt. The overwhelming majority (95%) had dialysis initiated with a CVC. The rate of pre-emptive AVF creation was low and a delay in AVF creation was seen in 63% of patients. Central venous stenosis or occlusion was present in 26% of patients and likely due to prior or current CVC use. The prevalence of CVC use was high and there were significant delays to AVF creation. High rates of central venous stenosis compromise future AVF use and are likely due to prolonged CVC use. Changes needed to improve the vascular access service include a multidisciplinary access clinic, dedicated theatre list, vascular access co-ordinator and further data collection to continually evaluate the vascular access service.

An Underconsidered Cause of Central Venous Occlusion

Classic iliocaval venous compression also known as May Thurner or Cockett’s syndrome is defined as extrinsic arterial compression of the left iliac vein. We present a retrospective case review. A 68-year-old man who was treated for 6 months with rivaroxaban for an unprovoked left lower extremity deep vein thrombosis (DVT) developed recurrent DVT 2 weeks after cessation. He was evaluated at an outside hospital and anticoagulation was restarted. Thrombophilic workup was negative with the exception of a mildly elevated homocysteine. Adjuncts including prostate-specific antigen, chest radiograph, and colonoscopy were all unremarkable. His symptoms progressed to severe swelling, pain, limited ambulation, and numbness. He presented to another institution where a computed tomography venography revealed a thrombosed iliac artery aneurysm causing extrinsic venous compression. He had a prior aortobifemoral bypass for occlusive disease. He underwent mechanical thrombolysis with the reconstitution of collateral blood flow. Two days after his procedure, his venous claudication resolved. Central venous occlusions can present with a multitude of symptoms including edema, pain, claudication, thrombosis, and chronic venous insufficiency. Central venous occlusion needs to be included in the differential diagnosis of all patients who present with these symptoms. Arterial aneurysm development is just one etiology of extrinsic compression. Treatment can usually be achieved through endovascular approaches.

Long-term Durability of Superficial Femoral Vein AV Fistula for Dialysis Access

Over the last half century, the numbers of patients on dialysis continue to increase. Central venous stenosis or occlusion, inadequate arm veins, and ultimate failure of repeated interventions are not uncommon. Many patients, especially the young, face exhaustion of traditional dialysis access options and abandonment of the upper extremities. Superficial femoral vein (SFV) arterial venous fistula of the lower extremity has been previously described as a final salvage effort, but there is little data on long-term patency. This study looks at the long-term durability of SFV av fistulae.

Blunt Transmediastinal Dissection with Radiofrequency Wire Reentry for Extravascular Bypass of Thoracic Central Venous Occlusions Refractory to Recanalization

Extravascular perforation is a risk of recanalizing chronic central venous occlusions. The authors describe an endovascular technique to bypass venous occlusions using a combination of a hydrophilic guide wire and radiofrequency wire in 7 patients to achieve central venous access to the right atrium without major complications.

Gianturco Z-stent placement for the treatment of chronic central venous occlusive disease: implantation of 208 stents in 137 symptomatic patients.

To report the technical successes, adverse events, and long-term stent patency rates of Gianturco Z-stents for management of chronic central venous occlusive disease. Overall, 137 patients, with mean age 48.6±16.1 years (range, 16-89 years), underwent placement of Gianturco Z-stents for chronic central venous occlusions. Presenting symptoms included lower extremity edema (n=66, 48.2%), superior vena cava syndrome (n=30, 21.9%), unilateral upper extremity swelling (n=20, 14.6%), hemodialysis fistula or catheter dysfunction (n=11, 8.0%), ascites (n=8, 5.8%), and both ascites and lower extremity edema (n=2, 1.5%). Most common etiologies of central venous occlusion were prior central venous access placement (n=58, 42.3%), extrinsic compression (n=29, 21.2%), and post-surgical anastomotic stenosis (n=27, 19.7%). Number of stents placed, stent implantation location, stent sizes, technical successes, adverse events, need for re-intervention, follow-up evaluation, stent patencies, and mortality were recorded. Technical success was defined as recanalization and stent reconstruction with restoration of in-line venous flow. Adverse events were defined by the Society of Interventional Radiology Adverse Event Classification criteria. Primary and primary-assisted stent patencies were analyzed using Kaplan-Meier analysis. In total, 208 Z-stents were placed. The three most common placement sites were the inferior vena cava (n=124, 59.6%), superior vena cava (n=44, 21.2%), and brachiocephalic veins (n=27, 13.0%). Technical success was achieved in 133 patients (97.1%). There were two (1.5%) severe adverse events (two cases of stent migration to the right atrium), one (0.7%) moderate adverse event, and one (0.7%) mild adverse event. Mean follow-up was 43.6±52.7 months. Estimated 1-, 3-, and 5-year primary stent patency was 84.2%, 84.2%, and 82.1%, respectively. Estimated 1-, 3-, and 5-year primary-assisted patency was 92.3%, 89.6%, and 89.6%, respectively. The 30- and 60- day mortality rates were 2.9% (n=4) and 5.1% (n=7), none of which were directly attributable to Z-stent placement. Gianturco Z-stent placement is safe and effective for the treatment for chronic central venous occlusive disease with durable short- and long-term patencies.

Sharp Recanalization of Chronic Central Venous Occlusions of the Thorax Using a Steerable Coaxial Needle Technique from a Supraclavicular Approach

To evaluate the technical success and safety of a steerable coaxial sharp recanalization technique that utilizes routine needles in patients with refractory thoracic central venous occlusions. This retrospective study was performed on 36-attempted sharp recanalizations in 35 patients (mean age 50years, 23 male) performed via a supraclavicular approach. In all cases, an 18-gauge trocar needle was custom curved to provide directional control during fluoroscopic triangulation. A 22-gauge Chiba needle was then advanced coaxially across the occlusion. A tractogram was performed to assess for traversal of unintended structures. Procedures were completed by catheter placement, angioplasty, or stenting follow successful recanalizations. Sharp recanalization using this steerable coaxial needle technique demonstrated a technical success rate of 94% (34/36). The mean occlusion length was 30mm (range 3-53mm). In 11 patients, success was achieved using this technique after failure of other advanced techniques. In five procedures, stent interstices were traversed. Sharp recanalization was the direct cause of one major complication consisting of pleural transgression causing mild hemothorax treated successfully with a stent graft. The proposed technique is effective and safe for patients who have failed traditional blunt recanalization techniques. Level 4, Case Series.

Central Venoplasty in Patients with Cardiac Implantable Electronic Devices

AbstractObjective The aim of this study was to assess the safety and effectiveness of the central venous angioplasty in patients with central venous occlusion and cardiac implantable electronic device (CIED) without lead extraction.Materials and Methods A retrospective study was used to evaluate the effectiveness of 37 central venous angioplasty procedure for 15 patients with CIED without lead extraction.Results Technical success was achieved in 97% (n = 36/37) and clinical success was achieved in 89% (33/37) of the procedures. One procedure failed recanalization of chronic total occlusion of the left subclavian vein, and the patient required fistula embolization due to severe arm swelling. Another procedure failed initially to recanalize long-segment occlusion involving the right subclavian vein/brachiocephalic vein and superior vena cava in a patient with a history of Hickman line and left-sided CIED. This was successfully recanalized and angioplastied on a subsequent session. No lead fracture or dislodgment was documented in any procedure. No procedure-related complication was documented within 2 weeks after the angioplasty. Six-month primary patency was achieved in 62% (23/37) of the procedures. Ten patients (66%) required an average of 1.4 reinterventions (range: 1–4 interventions) during the follow-up time with mean time to reintervention of 318 days (5–1,380 days). Two patients required early reinterventions within 10 days due to catheter dysfunction.Conclusion Findings of this study support the existing evidence on the safety and effectiveness of balloon angioplasty without lead extraction.

A retrospective cohort study comparing high and low balloon inflation pressure on technical success and patency for treating central venous lesions in patients on chronic hemodialysis

Background We aimed to analyze the success rates and the access patency rates at 12 months between patients on chronic hemodialysis with symptomatic central venous stenosis (CVS) or occlusion (CVO), receiving high or low balloon inflation pressure for treatment. Methods We performed a retrospective study in which angioplasty balloons were inflated using a low-pressure or a high-pressure for the management of hemodialysis patients with CVS/CVO. The outcomes of this study were the success rate and the access patency rates at 12 months after balloon angioplasty, and the differences between groups were compared. Results We included a total of 74 patients on hemodialysis and assigned them to the low-pressure or the high-pressure groups. Success rates in patients of the high-pressure group (94.12%) were higher than those in patients of the low-pressure group (67.50%) (p = 0.005). With a total of 59 patients with technical success, at 6 and 12 months after angioplasty, the rates of access patency in the low-pressure group were 68 and 48%, respectively; on the other hand, the primary patency rates in the high-pressure group were 86.67% (6-months) and 76.67% (12-months). The 6 and 12 months post-interventional patency rates were higher in patients of the high-pressure group than those in patients of the low-pressure group (p = 0.10 at 6 months and p = 0.03 at 12 months). Conclusions Compared to balloon angioplasty using a low inflation pressure, hemodialysis patients with CVS/CVO receiving angioplasty using a high inflation pressure have significantly higher technical success and 12-month patency rates.

Central Retinal Arterial and Venous Occlusion in a Patient with Systemic Sclerosis and a Review of the Related Literature

Systemic sclerosis (SSc) is known to cause serious complications at an advanced stage. However, serious ocular complications such as central retinal artery occlusion (CRAO) and/or central retinal vein occlusion (CRVO) have only been reported in a few cases to date. A 51-year-old man with severe Raynaud’s phenomenon, scleroderma up to the forearm and a negative anti-nuclear antibody (ANA) finding developed pulmonary fibrosis (PF) and was admitted to the hospital for the treatment of dyspnea under the diagnosis of SSc. A transbronchial lung biopsy performed 10 days after admission demonstrated mucoid intimal thickening (MIT) of the small arteries in the peripheral lung tissue and the bronchial wall. Prednisolone (PSL), ciclosporin and nintedanib were prescribed for PF treatment but failed to induce any apparent improvement in dyspnea. Finally, methylprednisolone pulse therapy (1.0 g, 3 times) and intravenous cyclophosphamide (IVCY, 500 mg, 6 times) therapy were instituted with a subsequent decrease in the patient’s Krebs von den Lungen 6 (KL-6) and surfactant protein D (SP-D) levels. During IVCY therapy, the patient experienced blurred vision in the right eye, and this was diagnosed as being due to CRAO and CRVO. However, the patient did not manifest any embolic, coagulopathic, or vasculitic symptoms, and there were no abnormal laboratory data suggesting these diseases in relation to this symptom. Therefore, the ocular occlusion was presumed to be due to MIT of small arteries, in addition to severe Raynaud’s phenomenon. Thus, we report the findings of this important case, despite the fact that it lacks a retinal pathology.

Outcomes of interventions for central venous catheter occlusions in patients with intestinal failure on home parenteral nutrition

Outcomes of interventions for central venous catheter occlusions in patients with intestinal failure on home parenteral nutrition

Effects of Tranexamic Acid Prophylaxis on Bleeding Outcomes in Hematologic Malignancy: The a-TREAT Trial

Background: Despite optimal prophylactic platelet (plt) transfusion therapy for severe thrombocytopenia in patients undergoing treatment for hematologic malignancy, WHO Grade 2 or greater bleeding continues to occur at rates of 43% to 70%. Although antifibrinolytic therapy has been shown to reduce bleeding and transfusion needs in patients with inherited bleeding disorders and in multiple surgical settings, evidence in therapy-induced thrombocytopenia in hematologic malignancy is lacking. The American Trial Using Tranexamic Acid (TXA) in Thrombocytopenia (A-TREAT) evaluated the effects of prophylactic TXA as an adjunct to routine transfusion therapy on bleeding and transfusion requirements in a multicenter, double blind placebo controlled randomized clinical trial in patients undergoing treatment for hematologic malignancy. Methods: Adult patients at 3 US academic medical centers with hematologic malignancy undergoing chemotherapy or hematopoietic stem cell transplantation (HSCT) anticipated to have hypoproliferative thrombocytopenia were enrolled between June 15, 2016 and February 4, 2020. Randomization was stratified by site and therapeutic group: Chemotherapy, Allogeneic transplant, or Autologous transplant. Patients received study drug intravenously (1,000mg TXA or saline) or orally (1300mg TXA or placebo) every 8 hours beginning when the plt count was ≤30,000/µL and continued until platelet count recovery &amp;gt;30,000/ul or if a diagnosis of thrombosis was made. Patients were transfused prophylactically for counts of ≤10,000/µL or if indicated in the judgement of the treating physician. Daily assessments for bleeding were made by trained research staff (inpatients) or by self-assessment in a patient diary (outpatients), and by patient interview and chart review. The primary endpoint was the proportion of patients with bleeding of WHO grade 2 or above over 30 days after activation of study drug. A score test based on logistic regression was used, adjusted for study site and therapeutic group and adjusted for sequential monitoring. Multiple imputations were used to account for missing data. Secondary endpoints were number of transfusions and number of days alive without WHO grade 2+ bleeding during the first 30 days post activation of study drug. Results: 3,788 patients were screened and 360 patients consented. 330 patients were activated and evaluable; 327 received at least one dose of study drug. The adjusted odds ratio of grade 2+ bleeding was 0.86 (95% CI: 0.52, 1.38; p-value=0.74). The difference in mean number of transfusions was 0.1 (95% CI: -1.9, 2.0; p-value=0.94), while the average difference in days alive without grade 2+ bleeding was 0.1 (95% CI: -1.4, 1.5; p-value=0.94). No differences in exploratory outcomes were observed. The mean difference in transfusions per thrombocytopenic day was -0.02 (95% CI: -0.09, 0.04; p-value=0.51). The mean difference in RBC transfusions per thrombocytopenic day was 0.03 (95% CI: -0.05, 0.11; p-value=0.43). The average number of days with thrombocytopenia or bleeding was similar across treatment arms (9.2 [SD=6.7] TXA vs. 9.1 [6.2] placebo). The hazard ratio of time to grade 2+ bleeding or death was 0.96 (95% CI: 0.43, 2.16; p-value=0.92). The mean difference in highest grade of bleeding was -0.1 (95% CI: -0.2, 0.1; p-value=0.42). There were no deaths due to bleeding. VOD was observed in 3/164 TXA subjects (1.8%) and 2/163 (1.2%) placebo subjects. An increase in the incidence of central venous line occlusions and the use of tissue plasminogen activator was noted in the TXA arm. (11.0% vs. 19.5% and 25.8% vs. 42.1% for placebo and TXA groups, respectively). Recurrent line occlusion led to permanent discontinuation of drug in 4.9% of TXA and 1.8% of placebo subjects. No increase in any other non-catheter thrombotic events was noted. No patient died from a thrombotic event in 120 days following activation of study drug. Conclusions: Prophylactic TXA has no effect on the incidence of WHO Grade 2+ bleeding when given in addition to routine plt transfusions to severely thrombocytopenic patients undergoing therapy for hematologic malignancy. An increased incidence of line occlusion in the TXA arm was observed but no increase in other types of thrombotic events was detected. Disclosures Gernsheimer: Rigel Corporation: Consultancy, Research Funding; Principia: Research Funding; Sanofi: Consultancy; Vertex: Consultancy; Dova Pharmaceuticals: Consultancy; Cellphire: Consultancy; Novartis: Consultancy; Amgen Corporation: Consultancy, Honoraria. Triulzi:Cerus Corp: Research Funding; Fresenius Kabi: Consultancy. Key:Uniqure: Consultancy; Takeda: Research Funding; Novo Nordisk: Other: Chair of Grants Committee; Grifols: Research Funding. OffLabel Disclosure: Tranexamic Acid is an antifibrinolytic agent approved for treatment of bleeding in patients with hemophilia to reduce the risk of hemorrhage during and following tooth extraction. The oral form is indicated for the treatment of cyclic heavy menstrual bleeding.

Angled, long‐segment central venous occlusion in a hemodialysis patient recanalized by a novel “two‐step” strategy based on percutaneous superior vena cava puncture

Angled, long‐segment central venous occlusion in a hemodialysis patient recanalized by a novel “two‐step” strategy based on percutaneous superior vena cava puncture

Rescuing the nephrologist’s main central vein – placement of a right jugular vein catheter in a patient with thoracic central venous occlusion by use of the Surfacer® device

Rescuing the nephrologist’s main central vein – placement of a right jugular vein catheter in a patient with thoracic central venous occlusion by use of the Surfacer® device

Case report \u2013 Acute Corneal Subepithelial Hydrops (ACSH) during Micropulse Transscleral Cyclophotocoagulation (MPTSC)

BackgroundTo present an unusual intra-operative complication of micropulse transscleral cyclophotocoagulation (MPTSC).Case presentationA 72-year old Chinese gentleman, who had primary angle closure glaucoma and had received bilateral laser iridotomy, presented with progressive left eye blurred vision (visual acuity of 20/40 OD and 20/200 OS). Examination reviewed left eye central retinal venous occlusion. The intraocular pressure (IOP) was 19 mmHg OS and was on maximally tolerated topical medications. Four weeks later, the left eye was complication by neovascular glaucoma; the IOP was raised to 26 mmHg despite additional oral acetazolamide and remained elevated after pan-retinal photocoagulation as well as cataract extraction by phacoemulsification. MPTSC was performed 8 days after the phacoemulsification. During the procedure, a sudden protrusion was formed on the corneal surface. On-table examination with operating microscope and portable slit-lamp reviewed an intact corneal epithelium with a globular-shaped collection of fluid at the subepithelial layer – acute corneal subepithelial hydrops (ACSH). The anterior chamber was formed and the globe was intact. After approximately 10–15 minutes, the swelling spontaneously ruptured and became a corneal epithelial defect. The defect healed on the tenth day after the event with conservative management. There was no irreversible corneal damage and the patient subsequently underwent a successful second MPTSC of the left eye because of poorly controlled IOP.ConclusionACSH is a possible intra-operative complication of MPTSC. We have proposed the possible mechanisms of ACSH. It is best to exercise caution when using MPTSC shortly after any incisional intraocular surgery.