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Show Journal of Neuro- Ophthalmology 14( 3): 155- 156, 1994. © 1994 Raven Press, Ltd., New York Images Section Greg Kosmorksy, D. O.- Section Editor Silicone and Blindness: Computed Tomography Imaging R. Tang, M. D., K. Carter, M. D., J. Woodward, M. D., G. Pardo, M. D., F. Sabates Jr., M. D., M. H. Heravi, M. D., L. A. Hayman, M. D. Complications of intravitreal silicone have been confined to retinal toxicity, corneal decompensation, cataract formation, and glaucoma. We report computed tomography ( CT) imaging considerations in a case of blindness following silicone oil replacement of the vitreous. A 44- year- old white male developed a giant retinal tear with detachment in the left eye. His preoperative vision was 20/ 25 OU. The patient underwent total pars plana vitrectomy ( TPPV), scleral buckle, endophotocoagulation, air fluid exchange, and silicone oil replacement of the vitreous OS From the Department of Ophthalmology ( R. T., J. W., G. P., F. S., M. H. H.), U. T. M. B., Galveston; Department of Ophthalmology ( R. T.), U. T. M. S. H.; Department of Radiology ( L. A. H.), Baylor College, Houston, Texas; Department of Ophthalmology ( K. C.), University of Florida, Gainesville, Florida, U. S. A. This paper was supported in part by a grant from Research to Prevent Blindness. Address correspondence and reprint requests to Rosa A. Tang, M. D., 2476 Bolsover # 359, Houston, Texas 77005, U. S. A. without intraoperative complications. Postoperative pressure was 14 mm Hg; 12 hours later the patient had no light perception in the involved eye. An afferent pupillary defect was present, and visual evoked responses were absent for the same eye. CT scan done 24 hours postoperatively, showed silicone oil in the globe and also around the optic nerve ( see Fig. 1A, B). The patient underwent optic nerve sheath decompression, and silicone oil was drained from the subarachnoid space within the optic nerve sheath. In the months that the patient has been followed, his vision has not improved. We conclude that imaging may play an important role in assessing the patient with monocular blindness after intravitreal silicone surgery, helping to distinguish central retinal artery occlusion, acute glaucoma, and ischemic optic neuropathy from hematoma, or tracking of silicone, as in this case. 155 156 R. TANG ET AL. FIG. 1. CT scans of the orbits in axial ( A) and coronal ( B) projections show hyperdense silicone within the left optic nerve sheath ( arrows) and posterior aspect of the left globe. Incidentally identified in Fig. A is a left scleral band. ; Neuro- Ophthalnwl, Vol. 14, No. .3. 1994 |
