Ocular Venous Air Embolism (OVAE): A Review

Morris, Robert E.; Boyd, Gwendolyn L.; Sapp, Mathew; Oltmanns, Matthew H; Kuhn, Ferenc; Albin, Maurice S.

doi:10.1177/2474126418822892

Cited by 6 publications

(5 citation statements)

References 26 publications

(96 reference statements)

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“…In the second case, close monitoring for air embolism enabled prompt detection and treatment of this complication, with complete recovery, despite the presence of a patent Rice et al [9] were the first to describe fatal air embolism during endoresection of choroidal melanoma. Morris et al [11] reviewed 13 cases of ocular venous air embolism and found 3 cases associated with choroidal mela-noma endoresection. In their review, all patients had air infusion during the surgery, and all developed acute pulmonary embolism intraoperatively, minutes after air infusion was started.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Fatal Air Embolism after Choroidal Melanoma Endoresection without Air Infusion: A Case Report

et al. 2021

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Background: The aim of this study was to report 2 cases of pulmonary air embolism developing several hours after choroidal melanoma endoresection without the use of air infusion during the surgery, with fatality in 1 patient. Methods: The method of this study was case report. Participants: Two patients with large choroidal melanomas who collapsed several hours after endoresection without air infusion as a result of pulmonary air embolism. Results: A 72-year-old man collapsed 4 h and 30 min after endoresection without air infusion. Computerized tomography angiography confirmed air embolism. The patient died after 86 min of cardiopulmonary resuscitation. A 41-year-old woman collapsed 5 h and 30 min after endoresection, performed without air infusion and with close monitoring, which included right internal jugular vein catheterization intraoperatively. Transthoracic and transesophageal echography, performed preoperatively, intraoperatively, and postoperatively, revealed air embolism only after collapse occurred. Imaging showed the embolism to be biventricular because of patent foramen ovale. The patient was treated promptly with extracorporeal membrane oxygenation and mechanical ventilation, which resulted in a full recovery. Conclusions: Air embolism can develop after endoresection for choroidal melanoma, despite avoiding air infusion. Further studies are needed to understand how this occurs. Special measures are indicated to detect this complication and to treat it promptly and effectively.

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Section: Discussion/conclusionmentioning

confidence: 99%

Fatal Air Embolism after Choroidal Melanoma Endoresection without Air Infusion: A Case Report

et al. 2021

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“…7 Morris et al performed the largest literature review of venous air embolism in vitreoretinal surgery, which included 13 cases and reported an overall mortality rate of 69%; five occurred during vitrectomy for retinal detachment, one for choroidal detachment, four for ocular trauma repair, and three for choroidal melanoma endoresection. 8 Although choroidal melanoma endoresection is not a frequently performed procedure, there are several case reports of venous air embolism in this setting. 4,8,9,10,11 This may imply a particularly high risk of venous air embolism.…”

Section: Discussionmentioning

confidence: 99%

“…8 Although choroidal melanoma endoresection is not a frequently performed procedure, there are several case reports of venous air embolism in this setting. 4,8,9,10,11 This may imply a particularly high risk of venous air embolism. The hypothesized mechanism seems to be entrapment of air through an abnormal venous access formed at the choroidal or vortex veins during removal of the tumor.…”

Section: Discussionmentioning

confidence: 99%

“…Morris and collaborators clinically defined venous air embolism as a precipitous drop in end-tidal CO 2 , a choroidal detachment or a choroidal wound, followed by signs of impending or actual cardiovascular collapse during vitrectomy air infusion. 8 They established that if a case met the aforementioned criteria, descriptions of "possible, presumed or suspected" ocular venous air embolism should be abandoned because air entry was found each time it was sought. Although we did not have access to diagnostic tools in the acute event, the abrupt decrease in end-tidal CO 2 , hypoxemia and hemodynamic instability observed in our patient fills the clinical criteria to make the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Venous-air embolism during vitrectomy for endoresection of choroidal melanoma: Case report

Gutiérrez

Rodriguez

Cifuentes

et al. 2021

European Journal of Ophthalmology

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Introduction: The purpose of this study is to report a case of venous-air embolism during a vitrectomy for endoresection of choroidal melanoma. Case description: A 31-year-old man went to the clinic because of photopsias and vision loss in his right eye. On fundoscopy of the right eye, a choroidal mass with an associated retinal detachment was found near the inferotemporal vascular arcade. Multimodal imaging was performed and diagnosis of choroidal melanoma was made. Metastatic workup ruled out systemic extension. The patient underwent pars plana vitrectomy for endoresection of the lesion. During the application of laser under air, he started complaining of chest pain and dyspnea. He presented signs of supraventricular tachycardia, tachypnea, hypotension and oxygen desaturation. He was managed with orotracheal intubation, bronchodilators and vasopressor support, and stabilization was achieved. He was discharged 2 days after with no sequalae. After 1-year of follow-up, the patient has a visual acuity of counting fingers and no signs of tumor recurrence or systemic extension. Conclusions: Although rare, vitreoretinal surgeons should be aware of this potentially fatal complication and take steps to prevent it.

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“…A per uorocarbon-silicon oil direct exchange was carried out at the end of the surgery. Fluid-air exchange has never been used to avoid venous air embolization 41,42,43 . In all cases, a standard silicon oil 1300cs was used as endotamponade.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Anatomical and functional outcomes after endoresection and adjuvant ruthenium brachytherapy for uveal melanoma: a single center case series

Mazzini

Vicini

Pieretti

et al. 2022

Preprint

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Purpose: To evaluate the anatomical and functional outcomes after endoresection and adjuvant Ruthenium(Ru)-106 brachytherapy for uveal melanoma (UM). Methods: Retrospective case series of 15 UM patients (15 eyes) treated at our centre (Careggi University Hospital, Florence). Results: Six patients (40%) were male and 9 females (60%). The mean age of patients at the time of treatment was 61.6 years (±19.41). The mean BCVA at baseline was 20/50. In all cases UM originated from the choroid. The mean tumor thickness at baseline was 7.14 mm (± 2.05), and the mean largest basal diameter was 11.2 mm (± 1.92). A concurrent retinal detachment was diagnosed in 11 patients (73.3%). Two patients (13.3%) showed vitreous seeding at baseline. Eleven patients (73.3%) were treated with primary endoresection, while 4 patients (26.7%) were treated with a “salvage endoresection” after primary treatment failure (previous radiation treatment). The mean follow-up time was 28.9 months (± 10.6). Thirteen out of 15 patients were alive and with no evidence of local recurrence or distance metastasis at the last follow-up visit. The treatment achieved local control of the disease in 14 out of 15 cases (93.3%). In one case patient underwent enucleation for disease recurrence. The overall-survival rate at the end of the follow-up was 93.3%. The mean BCVA at last follow-up visit was 20/40. Treatment was well tolerated, without significant complications. Conclusions: Endoresection is a valuable conservative option for selected UM patients and can be used both as a primary treatment and as a salvage therapy. It allows to control melanoma and avoid enucleation, reduces the radiation-related complications, and provides tumor tissue for chromosomal analysis and prognostic testing.

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Ocular Venous Air Embolism (OVAE): A Review

Cited by 6 publications

References 26 publications

Fatal Air Embolism after Choroidal Melanoma Endoresection without Air Infusion: A Case Report

Fatal Air Embolism after Choroidal Melanoma Endoresection without Air Infusion: A Case Report

Venous-air embolism during vitrectomy for endoresection of choroidal melanoma: Case report

Anatomical and functional outcomes after endoresection and adjuvant ruthenium brachytherapy for uveal melanoma: a single center case series

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