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Optic neuropathy causing vertical unilateral hemianopsia after pars plana vitrectomy for a macular hole: A case report.

Abstract Recent progress in medical technology has resulted in improved surgical outcomes of pars plana vitrectomy (PPV); with microincision systems, the incidence of procedure-related complications during surgery has been reduced. However, unpredictable visual field defects after PPV remain an unresolved issue. A few reports have shown that damage to the retinal neurofibers owing to dry-up during air/fluid exchange or retinal neurotoxicity of the dye used to visualize the internal limiting membrane (ILM), as well as unintentional removal of retinal neurofibers during ILM peeling, are responsible for such visual field disorders. In this report, we present a case of extensive visual field defect due to optic neuropathy exhibiting vertical hemianopsia after PPV.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29702978
OWN - NLM
STAT- MEDLINE
DCOM- 20180514
LR  - 20180516
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 17
DP  - 2018 Apr
TI  - Optic neuropathy causing vertical unilateral hemianopsia after pars plana
      vitrectomy for a macular hole: A case report.
PG  - e0321
LID - 10.1097/MD.0000000000010321 [doi]
AB  - INTRODUCTION: Recent progress in medical technology has resulted in improved
      surgical outcomes of pars plana vitrectomy (PPV); with microincision systems, the
      incidence of procedure-related complications during surgery has been reduced.
      However, unpredictable visual field defects after PPV remain an unresolved issue.
      A few reports have shown that damage to the retinal neurofibers owing to dry-up
      during air/fluid exchange or retinal neurotoxicity of the dye used to visualize
      the internal limiting membrane (ILM), as well as unintentional removal of retinal
      neurofibers during ILM peeling, are responsible for such visual field disorders. 
      In this report, we present a case of extensive visual field defect due to optic
      neuropathy exhibiting vertical hemianopsia after PPV. CASE SUMMARY: A 50-year-old
      woman underwent PPV and cataract surgery for a macular hole and mild cataract
      under retrobulbar anesthesia with 3.5 mL of xylocaine. At the time of opening an 
      infusion cannula for PPV, the intraocular lens was herniating, with an acute
      increase in pressure from the posterior eyeball; thus, intraocular pressure
      configuration level had to be decreased from the default level, whereas the other
      procedures including 20% SF6 injection were performed without any modification.
      The macular hole was closed postoperatively. However, the patient experienced
      nasal hemianopsia, which turned out to be optic neuropathy, as assessed via
      electric physiological examinations. The pattern of the visual field defect was
      not typical for glaucoma or anterior ischemic optic neuropathy. Her optic nerve
      head was pale at the temporal side soon after the surgery, and her blood pressure
      was low, suggesting that there may have been a congestion of the optic nerve
      feeder vessels because of the relatively high pressure in the orbit. The space
      occupancy with xylocaine and extensively stretched and plumped out eye ball with 
      infusion during PPV may have pressed the surrounding tissue of the optic nerve
      and the feeder vessels. CONCLUSION: PPV is safe for most patients; however,
      individual variations in local and/or systemic conditions may cause
      complications. Future studies to optimize the surgical condition for each
      individual patient may be warranted.
FAU - Kawashima, Hirohiko
AU  - Kawashima H
AD  - Laboratory of Retinal Cell Biology.
AD  - Department of Ophthalmology, Keio University, School of Medicine, 35
      Shinanomachi, Shinjukuku Tokyo, Japan.
FAU - Nagai, Norihiro
AU  - Nagai N
AD  - Laboratory of Retinal Cell Biology.
AD  - Department of Ophthalmology, Keio University, School of Medicine, 35
      Shinanomachi, Shinjukuku Tokyo, Japan.
FAU - Shinoda, Hajime
AU  - Shinoda H
AD  - Department of Ophthalmology, Keio University, School of Medicine, 35
      Shinanomachi, Shinjukuku Tokyo, Japan.
FAU - Tsubota, Kazuo
AU  - Tsubota K
AD  - Department of Ophthalmology, Keio University, School of Medicine, 35
      Shinanomachi, Shinjukuku Tokyo, Japan.
FAU - Ozawa, Yoko
AU  - Ozawa Y
AD  - Laboratory of Retinal Cell Biology.
AD  - Department of Ophthalmology, Keio University, School of Medicine, 35
      Shinanomachi, Shinjukuku Tokyo, Japan.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Female
MH  - Hemianopsia/etiology
MH  - Humans
MH  - Middle Aged
MH  - Optic Nerve Diseases/complications/*etiology
MH  - Retinal Perforations/*surgery
MH  - Vitrectomy/*adverse effects
PMC - PMC5944518
EDAT- 2018/04/29 06:00
MHDA- 2018/05/15 06:00
CRDT- 2018/04/29 06:00
PHST- 2018/04/29 06:00 [entrez]
PHST- 2018/04/29 06:00 [pubmed]
PHST- 2018/05/15 06:00 [medline]
AID - 10.1097/MD.0000000000010321 [doi]
AID - 00005792-201804270-00010 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Apr;97(17):e0321. doi: 10.1097/MD.0000000000010321.