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Alok S. Bansal, Jason Hsu, Sunir J. Garg, Arunan Sivalingam, Mark Moster, Joseph I. Maguire, Carl D. Regillo; Post-Vitrectomy Optic Neuropathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3785.
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To describe the clinical characteristics of optic neuropathy following pars plana vitrectomy (PPV) for macula-sparing primary rhegmatogenous retinal detachment (RRD) and explore the potential role of reduced intraoperative ocular perfusion pressure as an etiologic factor.
This is a retrospective, observational, case-control series. We reviewed the medical records of 8 patients who experienced optic neuropathy following PPV for RRD and 25 consecutive patients who underwent PPV for RRD. We analyzed the intraoperative mean arterial pressure (MAP) and calculated the mean ocular perfusion pressure (MOPP) from the formula: MOPP = 115/130 x MAP - intraocular pressure (IOP). Based on prior studies, we defined reduced MOPP as a MOPP of ≤ 30 mm Hg. Postoperative details regarding visual acuity, IOP, presence of rAPD, complete dilated fundus exam with optic nerve appearance, ancillary retinal diagnostic tests, visual field assessment, and neuro-imaging (if performed) were recorded. We analyzed the proportion of patients with low intraoperative ocular perfusion pressure in the optic neuropathy cohort compared to the control cohort.
Eight eyes of 8 patients experienced optic neuropathy (defined by rAPD, optic nerve pallor, and/or visual field defects) following PPV for macula-sparing primary RRD. Five of 8 (63%) patients demonstrated low intraoperative ocular perfusion pressure, while one of 25 (4%) patients in the control cohort demonstrated low intraoperative ocular perfusion pressure.
Optic neuropathy following PPV for macula-sparing RRD can be a rare, devastating complication of vitreous surgery. Although the etiology is often unclear, reduced intraoperative ocular perfusion due to intraoperative systemic hypotension may be a contributing risk factor in certain eyes.
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