Paracentral and Cecocentral Scotomas After Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Abstract

To describe novel paracentral and cecocentral visual scotomas after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) repair over a 5-year period. Retrospective case series. This was a retrospective review of all patients who reported visual scotomas after 23- or 25-gauge PPV (Constellation Vision System, Alcon, Fort Worth, Texas, USA) for RRD repair by a single surgeon (RNK) from January 2013 through December 2018. All patients had multimodal imaging (fundus photography, fluorescein angiography, autofluorescence, and spectral-domain optical coherence tomography [OCT] and standardized central Humphrey visual field [HVF] testing) to further characterize the visual scotomas. Nine patients reported visual scotomas after PPV for RRD from January 2013 to December 2018 with incidence of 6.4% (9/140). The average age was 61 years (range 53-71 years) and 3 of 9 were female. The preceding RRD was macula-sparing for 6 of 9 patients; all of them involved the right eye. Seven of 9 patients reported the central scotoma within the first week after surgery. All 9 patients noted paracentral or cecocentral location of scotomas involving the inferior temporal visual field. Multimodal imaging was only significant for corresponding focal superior nasal ganglion cell loss on spectral-domain OCT. Two of 9 patients had symptomatic visual loss from the scotoma because it involved the center of fixation. We report a novel central/paracentral visual field defect after PPV for RRD repair. The paracentral scotoma is located inferotemporally and correlates anatomically with ganglion cell loss on spectral-domain OCT. The visual field defect and corresponding anatomic ganglion cell loss suggests a focal retinal injury. We propose that it could be caused by trauma from air flow from the infusion cannula during the air-gas exchange, angled directly toward the superior nasal paracentral retina. Surgeons should be aware of this complication and take precautions to slowly inject the gas after the air-gas exchange.