title: Presumed air by vitrectomy embolisation (PAVE) a potentially fatal syndrome.
abstract: BACKGROUND
  Since first being reported in the ophthalmology literature in 2010, three cases (one fatal) of suspected venous air embolism (VAE) during vitrectomy have received little notice, and the vitrectomy/VAE connection has been described as unproven. We investigated the ability of air to exit the eye through vortex veins after accidental suprachoroidal air infusion.
  
  
  METHODS
  Vitrectomy was performed on four donor eyes. Unsutured cannulas were partially withdrawn during air fluid exchange, producing choroidal detachments that emulated accidental suprachoroidal air infusion from a slipping cannula. Eyes with and without clamping of the vortex vein stumps were partially submerged in a water bath.
  
  
  RESULTS
  Extensive choroidal detachment was created in all eyes during air infusion. All eyes with open vortex veins demonstrated rapid air extravasation/bubbling. An eye with clamped vortex vein stumps showed no air extravasation until the clamps were removed.
  
  
  CONCLUSIONS
  When combined with existing clinical reports of suspected VAE in the eyes of living patients during ocular air fluid exchange, this experiment justifies recognition of presumed air by vitrectomy embolisation (PAVE) as a rare but potentially fatal vitrectomy complication. Simple surgical precautions can change PAVE from a 'rare event' to a 'never event', beginning with acknowledgment of its existence.
authors.affiliation: Helen Keller Foundation for Research and Education, Birmingham, Alabama, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Morris
authors.affiliation: Helen Keller Foundation for Research and Education, Birmingham, Alabama, USA.
authors.forename: Mathew R
authors.initials: MR
authors.lastname: Sapp
authors.affiliation: Helen Keller Foundation for Research and Education, Birmingham, Alabama, USA.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Oltmanns
authors.affiliation: Helen Keller Foundation for Research and Education, Birmingham, Alabama, USA.
authors.forename: Ferenc
authors.initials: F
authors.lastname: Kuhn
mesh_terms: D002404:Catheterization; D015862:Choroid Diseases / Q000209:etiology* / Q000517:prevention & control; D004618:Embolism, Air / Q000209:etiology* / Q000517:prevention & control; D005125:Eye Banks; D006801:Humans; D007431:Intraoperative Complications; D008954:Models, Biological; D014019:Tissue Donors; D014680:Veins; D014821:Vitrectomy / Q000009:adverse effects*
keywords: Anatomy; Choroid; Retina; Treatment Surgery