Visual Loss after Use of Nitrous Oxide Gas with General Anesthetic in Patients with Intraocular Gas Still Persistent Up to 30 days after Vitrectomy

Abstract

INTRAOCULAR gas may enter an eye in a variety of ways: penetrating injury, infection, rapid decompression, gas bubble disease, or from therapeutic interventions by ophthalmologists. 1 Therapeutic use of intraocular gas provides internal retinal tamponade for retinal breaks or detachment, macular hole repair, and complicated diabetic vitrectomy. Unfortunately, gases used in intraocular surgery introduce a variety of potential problems. One problem is posed for patients requiring subsequent surgery (not necessarily ophthalmic) in the postoperative period while intraocular gas may still be present in the eye. We report three cases from three different centers where adverse events occurred after nitrous oxide (N 2 O)-induced general anesthesia in patients following recent vitrectomy with use of intraocular gas. A of principles of intraocular gases is provided, including recommendations for prevention and management of N 2 O-induced anesthesia-related intraocular gas complications.