# Intraoperative management of suspected ocular venous air embolism (OVAE) during vitrectomy for retinal detachment

## TL;DR

A rare case of ocular venous air embolism during retinal surgery is reported, emphasizing early detection and quick action to prevent severe complications.

## Contribution

Highlights intraoperative management strategies for a rare and potentially fatal complication during vitrectomy.

## Key findings

- Abrupt hemodynamic instability during air-fluid exchange suggested air embolism.
- Immediate cessation of air infusion and cardiovascular support stabilized the patient.
- Postoperative imaging confirmed right heart strain but no long-term complications.

## Abstract

report a rare case of ocular venous air embolism (OVAE) occurring during pars plana vitrectomy for retinal detachment and to highlight key intraoperative management steps that led to a successful outcome.

A 57-year-old patient undergoing 23-gauge vitrectomy developed abrupt hemodynamic instability during air-fluid exchange. Intraoperative signs—including sudden drops in end-tidal CO2 and oxygen saturation—prompted suspicion of air embolism, likely due to suprachoroidal air infusion via a dislodged trocar. Immediate cessation of air infusion, internal tamponade, cardiovascular support, and surgical revision of the infusion system stabilized the patient. Postoperative imaging supported right heart strain consistent with venous air entry. The retinal detachment was successfully treated, and the patient recovered without long-term systemic or ocular complications.

This case underscores the potentially fatal risk of OVAE during vitrectomy and the importance of early recognition, prompt intervention, and secure cannula placement. Increased awareness and surgical vigilance are critical for prevention and management of this underreported complication.