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Gas Concentration Errors in Vitreoretinal Surgery: Insights from a Model of Gas Mass Transfer Dynamics
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DOI：10.1159/000551468.png)
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Abstract
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Introduction: Concentration mix errors of fluorinated gases commonly used in vitreoretinal surgery can lead to catastrophic elevations in intraocular pressure (IOP). The timing and optimal management of this complication is poorly understood. This study aimed to evaluate the impact of controlled venting on IOP elevation following simulated gas mix errors. Methods: A validated mass transfer model of intraocular gas dynamics was used to simulate the properties of isovolumetric gas concentrations of 20% SF6, 16% C2F6, and 12% C3F8, along with the most common concentration mix errors: double concentration, 10/3 (3.33 & times;) concentration, and 100% gas. Simulations were performed on eyes with vitreous cavity volumes of 4.0 mL, 7.2 mL, and 10.0 mL (representing hyperopic to highly myopic eyes). The model calculated gas volume and IOP over time, both before and after controlled venting events to normalise IOP. Results: All gas concentration errors produced complete gas fill and rapid IOP elevations. Only double concentration errors generated IOPs potentially manageable with medical therapy (peak 60 mm Hg for 40% SF6, 75 mm Hg for 32% C2F6, 61 mm Hg for 24% C3F8). Simulated 10/3 (3.33 & times;) and 100% concentrations resulted in extreme IOP elevations incompatible with ocular perfusion. Controlled gas venting on day 1 normalised IOP for SF6 but repeated venting procedures were required for C2F6 and C3F8 due to continued gas re-expansion. Eyes with larger vitreous cavities experienced prolonged IOP elevation and delayed equilibration after venting. Conclusion: Gas concentration mix errors produce rapid and often unsalvageable IOP rises. While limited SF6 over-concentrations may be temporarily stabilised with medical therapy and controlled venting, most scenarios, especially involving C2F6 or C3F8, require urgent surgical complete gas exchange.
Keywords:
Gas concentration errors
Intraocular gas
Pars plana vitrectomy
Venting procedure
Vitreoretinal surgery
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