Commercial Air Travel With a Small Intravitreous Gas Bubble

Muzychuk, Adam

doi:10.1001/archophthalmol.2011.144

Cited by 10 publications

(12 citation statements)

References 6 publications

(1 reference statement)

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“…There have been continuous reports on the risks of postoperative travel for vitrectomied eyes before the intravitreous gas or air is completely absorbed [7,8,34,35]. We referred to Boyle’s law to explain the phenomenon, which is also the governing equation incorporated into this app.…”

Section: Discussionmentioning

confidence: 99%

Development and Testing of a Mobile Phone App for Risk Estimation of Gas Volume Expansion and Intraocular Pressure Elevation in Patients With Intravitreous Gas or Air Tamponade: Interobserver Assessment Study

Zhang

et al. 2019

JMIR Mhealth Uhealth

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Background Pars plana vitrectomy (PPV) with intravitreous tamponade of gas or air has been widely used for a series of vitreoretinal diseases. It is estimated that 100,000 patients per year undergo PPV globally, and half of them were subsequently tamponaded with gas or air. According to Boyle’s law (P 1 V 1 =P 2 V 2 ), patients with an intravitreous remnant of gas or air will be under high risk of intraocular pressure (IOP) elevation and subsequent vision loss owing to the expanded intravitreous gas or air when traveling post operation to a place with a significantly higher altitude. We always explain to patients why postoperative travel is potentially risky. Emergency cases of elevated IOP caused by postoperative traveling would sometimes come to surgeons. However, there have been few disease education or reference tools for both the surgeons and patients to have better communication. Objective The aim of this study was to introduce and evaluate a mobile phone app developed by surgeons (the authors) for preliminary risk estimation of volume expansion and IOP elevation in patients with intravitreous gas or air when traveling to a place of higher altitude. Methods The app was developed on the iOS and Android operating systems. Boyle’s law (P 1 V 1 =P 2 V 2 ) was the theoretical basis of the app. Intravitreous gas or air volume and altitude values were independent factors to deduce the risk report. Consecutive patients underwent vitrectomy, and those with an intravitreous remnant of gas or air were recruited. The surgeons judged the vertical height of the fluid/gas interface through the dilated pupil; the patients were instructed to judge it according to their visual field when looking straight ahead and line it out on a chart included in the app. Finally, all the patients were required to fill a Likert scale–based questionnaire with 2 main items to evaluate the participants’ user experience and attitudes toward the app. Results A total of 50 patients were included (30 males and 20 females). All patients could independently operate the app to complete the test. The median heights of the fluid/gas interface independently judged by the surgeon and patients were 40% (range: 10%-75%) and 41% (range: 9%-78%), respectively ( P =.63). The median altitude of the participants’ destinations was 150.0 m (range: 0-3490 m). The Bland-Altman analysis revealed a good agreement between the surgeons’ and patients’ judgments (bias of −0.3%), with 95% limits of agreement of −5.8% to 5.3%. Overall, the Likert scale revealed a positive attitude from the patients toward the app. Conclusions The app is reliable for patients to have preliminary risk estimation of intrav...

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Section: Discussionmentioning

confidence: 99%

Development and Testing of a Mobile Phone App for Risk Estimation of Gas Volume Expansion and Intraocular Pressure Elevation in Patients With Intravitreous Gas or Air Tamponade: Interobserver Assessment Study

Zhang

et al. 2019

JMIR Mhealth Uhealth

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“…For example, patients with underlying glaucoma, ocular hypertension or who are on antihypertensive drops may have a limited ability to accommodate an expanding gas bubble during depressurisation. Indeed, in a case report of a patient with erratic IOPs and a 10% gas bubble, progression of glaucomatous optic neuropathy was noted immediately after air travel 2. Although the baseline IOP was not reported, it was likely high given the patient experienced pain almost immediately after takeoff.…”

Section: Discussionmentioning

confidence: 99%

“…Although most eyes tolerate the presence of intraocular gas without complication, patients are advised to avoid air travel as the low atmospheric pressures encountered at high altitudes can cause expansion of the volume of the gas and induce dangerous elevations in intraocular pressure (IOP) 1–7. This effect has been documented in animal models, case reports in humans and also in a formal investigation using a hypobaric chamber inducing atmospheric depressurisation 2 6 7. Some of the original experimental reports had suggested that eyes with smaller volumes of intravitreal gas (∼10%) may tolerate the atmospheric depressurisation of air travel without undue IOP rise4 8; however, this was not confirmed in a controlled testing environment in humans 7…”

Section: Introductionmentioning

confidence: 88%

Evaluating the safety of air travel for patients with scleral buckles and small volumes of intraocular gas

et al. 2014

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“…Patients with recent vitreoretinal surgery involving intraocular gas should be strongly advised not to undertake air travel, regardless of the volume of gas applied. 25 …”

Section: Advising Travellers With Eye Diseasementioning

confidence: 99%