Bilateral pulmonary emboli following macular hole surgery with postoperative prone positioning

Abstract

Purpose To report a rare case of bilateral pulmonary emboli following pars plana vitrectomy with postoperative prone positioning. Observations A 60 year-old female presented with a fourmonth history of unilateral distorted vision. Ocular coherence tomography revealed a full thickness macular hole. Two weeks later, the patient underwent a 23-gauge pars plana vitrectomy with internal limiting membrane peeling and 12% perfluoropropane gas tamponade. Postoperatively, she completed two weeks of prone positioning. Five days later, she presented with a two day history of abdominal pain and shortness of breath. Computed tomography angiography revealed bilateral pulmonary emboli. The patient received six months of anticoagulation to prevent further thromboembolic events. Conclusions Life threatening blood clots can form due to prolonged immobilization from prone positioning. Patients should be educated to perform light exercise postoperatively to prevent complications of blood stasis.

Review: Ophthalmic Surgery as a cause of Pulmonary Emboli

“…The contemporary literature consists of a case series [3], from Turkey and 2 case reports [4,5]. The case series from Turkey reported 6 cases of PE following ophthalmic surgeries.…”

“…The posture would allow for the gas to tamponade the retina against the other layers of the globe and the apposition is thought to improve the surgical outcomes [12]. The instructions are often 30-50 minutes for 2 weeks following surgery, but as pointed out by authors, patients often put themselves in that position longer than instructed in hope to improve their outcomes [5]. Weeks of reduced mobility would contribute to the venous stasis arm of the Virchow's triad in the pathogenesis of a VTE.…”

Ophthalmic nurses’ knowledge, attitude, and practice toward venous thromboembolic prevention: a dual-center cross-sectional survey

“…Although VTE among ophthalmic surgical patients is less reported, a growing body of evidence suggests that ophthalmic surgical patients are at an increased risk of VTE ( Kaplan & Reba, 1972 ; Huang & Wei, 2016 ; Brill et al, 2019 ; Law, Chan & Cheng, 2018 ; Wang et al, 2016 ). Studies have shown that VTE is the leading cause of death in patients undergoing ophthalmic surgery ( Kaplan & Reba, 1972 ; Kanbay et al, 2011 ).…”

“…Most ophthalmic surgical patients are middle-aged or older adults ( Lei et al, 2019 ) and are comorbid with other chronic illnesses such as obesity, coronary heart disease, and diabetes ( Liu et al, 2017 ; Gong et al, 2021 ), which are all well-known risk factors for VTE. In addition, most ophthalmic surgeries take more than 30 min and the prolonged immobility in a postoperative prone position after retina surgery also predisposes patients to VTE ( Brill et al, 2019 ). Therefore, VTE prevention for ophthalmic surgical patients deserves closer attention.…”

Face-Down Posture versus Non-Face-Down Posture following Large Idiopathic Macular Hole Surgery: A Systemic Review and Meta-Analysis

“…According to a survey by the American Society of Retina Specialists in 2018 [ 6 ], 86.9% of retinal surgeons incorporate the FDP in clinical practice. However, maintaining a FDP is arduous, particularly for older and obese people, and may lead to some complications such as pulmonary embolism, ulnar nerve neuropathy, and pressure sore [ 7 , 8 , 9 ].…”