Jester Dane A, Smith Jesse M
Department of Ophthalmology, University of Colorado School of Medicine, 1675, Aurora Ct, Aurora, CO, USA.
Am J Ophthalmol Case Rep. 2024 Feb 15;36:102023. doi: 10.1016/j.ajoc.2024.102023. eCollection 2024 Dec.
Unexplained vision loss after silicone oil removal is a well-documented but incompletely understood entity for which there is no effective treatment described in the existing literature. We present a case where intensive oral and periocular steroid treatment resulted in significant subjective and objective clinical improvement.
After successful pars plana vitrectomy with silicone oil endotamponade to repair a macula sparing retinal detachment, the patient's best corrected visual acuity was 20/20 with silicone oil in the operative eye. However, seven weeks after uncomplicated combined silicone oil removal and cataract extraction with intraocular lens insertion, best corrected visual acuity was 20/250 with no new ophthalmic pathology to explain the vision loss. After a four week course of oral prednisone and three periocular triamcinolone injections over a period of nine weeks, visual acuity improved to 20/25 -2 in the operative eye. Serial multifocal electroretinography initially showed severely diminished amplitudes but improved markedly over the course of steroid treatment.
Although no effective treatments are described in the existing literature, improvement in visual acuity, visual field, and electroretinogram in this case suggests that intensive steroid treatment (periocular and systemic) may be efficacious in treating unexplained vision loss after silicone oil removal.
硅油取出术后不明原因的视力丧失是一个有充分文献记载但尚未完全理解的现象，现有文献中未描述针对此现象的有效治疗方法。我们报告一例通过强化口服及眼周类固醇治疗后，主观和客观临床症状均有显著改善的病例。
在成功进行了经平坦部玻璃体切除术并使用硅油内填塞修复了黄斑未受累的视网膜脱离后，患眼内有硅油时患者的最佳矫正视力为20/20。然而，在顺利进行联合硅油取出及白内障摘除并植入人工晶状体术后七周，最佳矫正视力为20/250，且无新的眼科病变可解释视力丧失的原因。在口服泼尼松四周并在九周内进行三次眼周曲安奈德注射后，患眼视力提高到20/25 -2。系列多焦视网膜电图最初显示振幅严重降低，但在类固醇治疗过程中显著改善。
尽管现有文献中未描述有效治疗方法，但该病例中视力、视野和视网膜电图的改善表明，强化类固醇治疗（眼周和全身）可能对治疗硅油取出术后不明原因的视力丧失有效。
