Purchase this article with an account.
T. Y. Kao, Y. Han, A. J. Flach; Intraoperative Flash Pulmonary Edema During Phacoemulsification Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1463.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To report a case of intraoperative flash pulmonary edema (FPE) during phacoemulsification cataract extraction (PCE) and compare it to an identical, uncomplicated PCE performed upon the same patient one month previously.
This is a retrospective, parallel case review involving a 66-year-old man with significant cardiac comorbidities, including congestive heart failure (CHF) with an ejection fraction of 30%, who underwent two separate PCE procedures one month apart. A comparison of these cases is made with special attention to preoperative and postoperative medication adherence, intraoperative volume of fluid and sympathomimetic administration, intraoperative events, and length of surgical time.
In both surgeries, the patient had poor cardiac medication adherence prior to surgery, including the lack of regular diuretic use, and had received minimal intravenous fluids. Differences between these consecutive surgeries include 0.08 mg intracameral epinephrine administered 30 minutes prior to onset of tachycardia, which was treated with 0.5 mg metoprolol, and a 15 minute increase in surgery time each in the complicated PCE. Although these differences between the surgeries exist, a small pulmonary embolus or increased cardiac ischemia remain as potential etiologies for the FPE as will be discussed.
This is the first reported case of FPE occurring during cataract surgery. The potential precipitating factors of this patient’s FPE remain unclear, but include intraoperative intracameral epinephrine, increased length of surgical time, pulmonary embolus, and increased cardiac ischemia. It is clear that the light sedation during surgery allowing the surgeons to communicate with the patient throughout the procedure provided an opportunity to treat the respiratory distress prior to the need for resuscitation.
This PDF is available to Subscribers Only