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

OBJECTIVE

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.

OBSERVATIONS: 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.

CONCLUSION

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.