Optic neuropathy after vitrectomy for retinal detachment: clinical features and analysis of risk factors.

Abstract

PURPOSE:

To describe the clinical characteristics of and risk factors for the development of optic neuropathy after pars plana vitrectomy (PPV) for macula-sparing primary rhegmatogenous retinal detachment (RRD) repair.

DESIGN:

Retrospective case-control study.

PARTICIPANTS:

Seven patients who underwent PPV for macula-sparing primary RRD with subsequent development of optic neuropathy and 42 age- and gender-matched control patients undergoing PPV for macula-sparing primary RRD.

METHODS:

Retrospective chart review of medical and surgical records.

MAIN OUTCOME MEASURES:

Clinical features of patients who developed optic neuropathy after PPV for macula-sparing RRD and analysis of potential risk factors (age, gender, medical history, surgical technique, intraoperative ocular perfusion pressure [OPP], and operative time).

RESULTS:

At last follow-up, all 7 patients with optic neuropathy had visual acuity less than 20/200, relative afferent pupillary defects, optic nerve pallor, and visual field defects. A total of 5 of 7 patients (71%) demonstrated intraoperative reduced OPP with associated systemic hypotension compared with 7 of 42 patients (17%) in the control cohort (P = 0.01).

CONCLUSIONS:

Optic neuropathy after PPV for macula-sparing primary RRD is a rare but potentially devastating complication. Although the cause is often unclear, reduced ocular perfusion due to intraoperative systemic hypotension may be a contributing risk factor in some eyes.

• Authors: Alok S Bansal, Jason Hsu, Sunir J Garg, Arunan Sivalingam, James F Vander, Mark Moster, Joseph I Maguire, Carl D Regillo
• Journal: Ophthalmology (Ophthalmology) Vol. 119 Issue 11 Pg. 2364-70 (Nov 2012) ISSN: 1549-4713 [Electronic] United States
• PMID: 22840420 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Case-Control Studies
• Endotamponade
• Female
• Fluorescein Angiography
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Ocular Hypotension (diagnosis, etiology)
• Optic Disk (pathology)
• Optic Nerve Diseases (diagnosis, etiology)
• Postoperative Complications
• Pupil Disorders (diagnosis, etiology)
• Retinal Detachment (surgery)
• Retrospective Studies
• Risk Factors
• Vision Disorders (diagnosis, etiology)
• Visual Acuity (physiology)
• Visual Fields
• Vitrectomy