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Jonathan I Huz, Larry Frohman, Roger E. Turbin, Neelakshi Bhagat; Optic Neuropathy Following Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5094.
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Optic neuropathy following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) is a rare occurrence with no clear etiology. The current study is a retrospective review performed to describe demographics, characteristics, and outcomes of cases of optic neuropathy following PPV for RRD.
Medical, surgical, and anesthesia records of eyes with optic neuropathy following PPV were retrospectively reviewed.
Three females and one male were identified with a mean age of 32 years (range 20-55). Three of four patients (Patients 2, 3, and 4) had fovea-sparing detachments with initial visual acuities (VA) ranging from 20/20 to 20/40. Patient 1’s VA was 20/200. Past medical history was significant only in Patient 1 (Protein C deficiency) and Patient 2 (hypertension). No patient had prior known ocular disease. Patient 3 had a minor smoking history. Patient 2 reported use of sildenafil. Mean operating time was 103.5 minutes (range 74-135). All patients received general anesthesia and were maintained at an oxygen saturation of 100%. Silicone oil was used as the tamponade agent in 3 eyes and perfluoropropane in one eye. Intraoperative mean arterial pressure values for each patient are shown in the attached figure. Maximum post-operative IOP ranged from 15.5 to 26mmHg. Final VA ranged from 20/100 to NLP. Three eyes developed a definite afferent pupillary defect and all four eyes developed optic disc pallor. Visual field testing showed an altitudinal defect in Patient 2, superior and inferior defects in Patient 3, and sparing of only the inferotemporal quadrant in Patient 4. Fluorescein angiography in Patient 3 showed decreased perfusion to the temporal optic disc and in Patient 4 showed areas of leakage on the optic disc. Extensive pro-thrombotic evaluation was performed in all patients and showed a Factor V Leiden mutation, elevated sedimentation rate, and elevated anti-cardiolipin antibodies in Patient 1, hyperlipidemia in Patient 2, and hyperlipidemia and a slightly elevated C4 in Patient 4.
Optic neuropathy following PPV for RRD is a rare occurrence with no clear etiology. Possible pre-disposing factors in our study were a hypercoagulable disorder, history of sildenafil use, transient high MAP values, hyperlipidemia and slight C4 elevation. The current cases suggest a predilection towards young women.
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