Herbert E N, Habib M, Steel D, Williamson T H
St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
Graefes Arch Clin Exp Ophthalmol. 2006 Feb;244(2):248-52. doi: 10.1007/s00417-005-0076-6. Epub 2005 Jul 27.
Unexplained sudden visual loss after removal of silicone oil from the eye has recently been described. We report the occurrence and features of unexplained central scotoma developing with silicone oil in situ in the vitreous cavity.
A retrospective case series of five patients (from two centres) who reported a central scotoma commencing during silicone oil tamponade was studied. All patients had vitrectomy for macula-on retinal detachment, with ultra-purified silicone oil tamponade (four out of five had giant retinal tear). Investigations included visual acuity, intraocular pressure, optical coherence tomography, fluorescein angiography, visual fields and electrophysiology.
All patients reported a central scotoma that appeared during oil tamponade. Visual acuity fell by a mean of 0.93 LogMAR units after onset of the scotoma. After cataract extraction and oil removal, vision remained reduced by a mean of 0.8 units. The mean duration of oil in the eye was 2.7 months when the scotoma was noted by the patient. Investigations were performed after removal of oil. Fluorescein angiography (FFA) was performed in two cases and optical coherence tomography (OCT) in five patients. No abnormality was demonstrated. Electrophysiology was performed in five patients with pattern electroretinography suggestive of macular dysfunction in four patients.
This is the first case series describing central scotoma associated with silicone oil in situ. Electrophysiology indicated macular dysfunction in most cases. We suggest that early removal of oil in cases with good visual potential should be considered to avoid this sight-threatening complication.
近期有关于眼内硅油取出后不明原因的突然视力丧失的报道。我们报告了玻璃体腔中硅油原位存在时出现的不明原因的中心暗点的发生情况及特征。
对来自两个中心的5例报告在硅油填塞期间开始出现中心暗点的患者进行回顾性病例系列研究。所有患者均因黄斑部视网膜脱离行玻璃体切除术，并用超纯硅油填塞（5例中有4例存在巨大视网膜裂孔）。检查包括视力、眼压、光学相干断层扫描、荧光素血管造影、视野检查和电生理检查。
所有患者均报告在油填塞期间出现中心暗点。暗点出现后视力平均下降0.93 LogMAR单位。白内障摘除和油取出后，视力仍平均下降0.8单位。患者发现暗点时眼内硅油的平均存留时间为2.7个月。油取出后进行了检查。2例患者进行了荧光素血管造影（FFA），5例患者进行了光学相干断层扫描（OCT），均未发现异常。5例患者进行了电生理检查，其中4例的图形视网膜电图提示黄斑功能障碍。
这是首个描述与硅油原位相关的中心暗点的病例系列。大多数病例的电生理检查提示黄斑功能障碍。我们建议，对于视力预后良好的病例，应考虑尽早取出硅油，以避免这种威胁视力的并发症。
