Positive End-Expiratory Pressure as a Risk Factor for Severe Positive Vitreous Pressure During Combined Penetrating Keratoplasty and Cataract Extraction

Pillar, Angelique; Jeng, Bennie H.; Munir, Wuqaas M.

doi:10.1097/ico.0000000000000945

Cited by 3 publications

(6 citation statements)

References 11 publications

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Section: Patient-related Risk Factorsmentioning

confidence: 99%

“… 16 Pillar et al reported 2 cases of increased PVP caused by the use of positive end-expiratory pressure (PEEP) during general anesthesia. 20 …”

Section: Introductionmentioning

confidence: 99%

“…Increased systemic venous pressure due to a variety of causes including positioning of the head below the heart, congestive heart failure, pulmonary edema, obstructive sleep apnea, chronic obstructive pulmonary disease, 20 Valsalva maneuver, severe obesity, a bull-necked patient poorly positioned so that venous pressure in the head is elevated, and rarely an arteriovenous fistula are predisposing factors for PVP. 6 Younger age is also a predisposing factor for increased intraoperative positive vitreous pressure.…”

Section: Introductionmentioning

confidence: 99%

“… 4 , 22 At the beginning of surgery, avoiding positioning the patient, particularly obese patients, in the Trendelenburg position to avoid increased thoracic and intraorbital pressure. 20 …”

Section: Introductionmentioning

confidence: 99%

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Incidence, Pathophysiology, Complications, and Management of Positive Vitreous Pressure During Penetrating Keratoplasty: A Literature Review

Alkharashi¹,

AlAbdulhadi²,

Otaif³

et al. 2023

OPTH

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Positive vitreous pressure (PVP) is common during open anterior segment surgery and penetrating keratoplasty (PKP) has a reported incidence rate of 40–50%. Despite adequate perioperative preventive precautions, positive pressure occurs during surgery and optimum management of PVP is required to avoid serious complications. Many pharmacological and mechanical approaches can be employed either preoperatively or intraoperatively to decrease vitreous pressure. Surgical techniques such as graft-over-host technique, the modified graft-over-host technique, techniques employed mattress sutures and needle, or Vitreous aspiration or vitrectomy can be effectively used to manage intraoperative PVP during PPK. This article reviews the incidence, risk factors, prevention, and different approaches to the management of positive vitreous pressure during PKP to analyze the available evidence in order to improve the safety profile of PKP and prevent sight-threatening complications.

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Section: Patient-related Risk Factorsmentioning

confidence: 99%

“… 16 Pillar et al reported 2 cases of increased PVP caused by the use of positive end-expiratory pressure (PEEP) during general anesthesia. 20 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Incidence, Pathophysiology, Complications, and Management of Positive Vitreous Pressure During Penetrating Keratoplasty: A Literature Review

Alkharashi¹,

AlAbdulhadi²,

Otaif³

et al. 2023

OPTH

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“…Other risk factors associated with the open-sky state and the patient's health status, such as previous ocular surgery, ocular trauma, internal diseases (arterial hypertension, coronary heart disease, diabetes, atherosclerosis, etc. ), and the choice of general anaesthesia, may also constitute contraindications for IOL implantation during a single surgery [ 5 – 9 ]. However, secondary IOL implantation is a challenging surgical procedure and demands suitable ocular conditions.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Techniques of Secondary Intraocular Lens Implantation after Penetrating Keratoplasty

Krysik¹,

Dobrowolski

Wróblewska‐Czajka

et al. 2018

Journal of Ophthalmology

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Aim To conduct a retrospective analysis of secondary IOL implantation in patients who underwent PK with no simultaneous IOL implantation. Materials and Methods The retrospective study of the secondary implantation of IOLs was conducted in 46 eyes that underwent a primary operation with PK and cataract/lens extraction with no IOL implantation due to capsule rupture or combining corneal or intraocular complications. The minimum period from PK was 12 months. All secondary IOL implantations were performed from January 2011 to August 2017. Aphakic postkeratoplasty patients were treated using one of the surgical techniques for secondary IOL implantation. In-the-bag IOL implantation was possible if the posterior capsule was complete. If the lens capsule remnants were sufficient to provide secure IOL support, an in-the-sulcus IOL implantation was performed. Scleral fixation was offered in eyes with extensive capsular deficiency or the presence of the vitreous body in anterior chamber. BCVA and expected and achieved refraction were evaluated; we included using two biometry devices, and results were compared. Results The corrected distance visual acuity (CDVA) before surgery ranged from 0.1 to 0.8 (mean 0.54 ± 0.17). After secondary IOL implantation, CDVA ranged from 0.2 to 0.8 (mean 0.43 ± 0.14) at postoperative 1 month and from 0.3 to 0.9 (mean 0.55 ± 0.15) at postoperative 6 months (p < 0.05). Comparison of the final refraction using two methods of biometry showed no statistically significant difference in the group that underwent scleral fixation of the IOL, similar to the findings for the in-the-bag and in-the-sulcus IOL implantation groups. In the scleral-fixation group, p=0.55 for the USG biometry technique and p=0.22 for the OB technique. p values for the IOL-implantation group were p=0.49 and p=0.44, respectively. Conclusion Both implantation methods are safe for the patients. Final refraction is depending on the technique and indication to keratoplasty. Both biometry techniques deliver precise data for IOL choice.

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Factors to be Considered when Performing Cataract Surgery in Patients Unable to Recline Flat

Rentka

Kemény-Beke

2017

Seminars in Ophthalmology

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Positive End-Expiratory Pressure as a Risk Factor for Severe Positive Vitreous Pressure During Combined Penetrating Keratoplasty and Cataract Extraction

Abstract: During open-sky procedures, PEEP may be a risk factor for severe positive posterior vitreous pressure. Given the rising use of PEEP, surgeons should be aware and cautious of this potential complication.

Cited by 3 publications

References 11 publications

Incidence, Pathophysiology, Complications, and Management of Positive Vitreous Pressure During Penetrating Keratoplasty: A Literature Review

Incidence, Pathophysiology, Complications, and Management of Positive Vitreous Pressure During Penetrating Keratoplasty: A Literature Review

Comparison of the Techniques of Secondary Intraocular Lens Implantation after Penetrating Keratoplasty

Factors to be Considered when Performing Cataract Surgery in Patients Unable to Recline Flat

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