Emphysema following vitrectomy with fluid–gas exchange: description of a rare complication

Eduardo F Damasceno,1 Nadyr Damasceno,2 Soraya Horowitz,2 Marcio Mortera Rodrigues3 1Universidade Federal Fluminense, Niterói, Brazil; 2Hospital Naval Marcílio Dias, Rio de Janeiro, Brazil; 3Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil Purpose: To report a case of subcutaneous emphysema involving the orbit, mediastinum, and face after pars plana vitrectomy with fluid–gas exchange. Methods: Case report of a 55-year-old man who presented with bilateral eyelid and face edema and dysphagia in the immediate postoperative period after pars plana vitrectomy. Orbital and chest computed tomographies were performed, revealing emphysema of the orbit and soft tissue of the face, extending from the neck to the upper chest. Results: The patient with a retinal detachment in the right eye underwent 23-gauge vitrectomy surgery with fluid–gas exchange and an implantation of silicone oil. The patient had a previous history of facial trauma for more than 20 years with an orbital fracture. After surgery, the patient developed emphysema of the orbit, soft tissue of the face and upper chest. Systemic prophylactic antibiotics associated with antibiotics and steroid drops performed a satisfactory evolution. Conclusion: The fluid–gas exchange during pars plana vitrectomy in patients with orbital fracture can lead to emphysema of the face, chest, and soft tissue. Keywords: vitrectomy complications, fluid–gas exchange, orbital emphysema, mediastinal emphysema, face emphysema, orbit fractur