CPAP and Vitreoretinal Surgery – Be Aware


ABSTRACT

Introduction:

Obstructive sleep apnea (OSA) is a common chronic disorder that often requires lifelong care. Continuous positive airway pressure (CPAP) and weight loss are the cornerstones of therapy. The use of CPAP therapy has been associated with ocular complications such as dryness and irritation resulting from the air leak from the mask, a higher rate of bacterial conjunctivitis and elevation of intraocular pressure. The authors present a case of recurrent intraocular hemorrhage following vitrectomy, in possible asso ciation with full face mask CPAP therapy.

Clinical Case:

We report a case of a 56-years-old patient, with a previous history of high blood pressure, OSA on CPAP therapy, high myopia, bilateral radial keratotomy (35 years ago) and previous rhegmatogenous retinal detachment in the right eye (in 2014). The patient presented to our emergency room with acute vision loss in the left eye and ophthalmologic examination revealed an inferotemporal rhegmatogenous retinal detachment. He was submitted to small gauge vitrectomy, cryotherapy, endolaser and gas tamponade, with no complications. The day after, the patient presented with exuberant hyphema and vitreous cavity hemorrhage, with normal intraocular pressure. Fundus observation was impossible. In the ultrasound exam the retina seemed attached. The hyphema progressively reabsorbed but vitreous hemorrhage persisted. 30 days after the first surgery we suspected of inferior retinal detachment recurrence so we decided to re-operate. We performed encircling scleral buckling followed by c ataract surgery and revision of the vitrectomy. At the end, we tamponade with silicone oil. The procedure occurred without any complications. First day post-operative observation revealed, again, intraocular hemorrhage, with hyphema and blood mixed in the silicone oil. Second day post-operative observation showed that the bleeding had increased. Faced with this unexpected situation, we wondered and talked with the patient. We questioned together about any anticoagulant therapies, other treatments or comorbidities that could explain this complication. The patient told us about the use of CPAP, so we asked him to bring the device. We then realized that it was a full-face mask CPAP, that exerted pressure in the eye, even more in the recommended post-operative head positioning. We suspect that the CPAP interface could be the cause of these post-operative repeated complications. The patient contacted his sleep specialist and adjustments to the mask (full-face to nasal pillows switch) and air pressure, were made. We performed a third intervention, with revision of vitrectomy and silicone oil replacement. This time there were no more complications in the post-operative period.

Conclusion:

In our literature review, we didn’t find any reports of intraocular hemorrhage following vitreoretinal surgery in association with CPAP therapy. We believe there is a possible correlation between the mechanical and air pressures exerted onto the eye, and the ophthalmological complications after the retinal detachment surgery, because of the configuration of the full-face mask CPAP, in our patient. We present this case as a warning for the use of CPAP treatment, mainly mask configuration, in patients submitted to vitreoretinal procedures.


CONTACT DETAILS

 

Ines Matias & David Martins
Setubal, Portugal
Email : iffmatias@gmail.com
Email : drdavidmartins@hotmail.com
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