Retrolaminar infiltration of optic nerve with intraocular tamponade following silicone oil instillation

Abstract

Eyes after intravitreal silicone oil injection may suffer various complications. We report on a patient with deep retrolaminar changes in the optic nerve after silicone oil instillation with secondary angle-closure glaucoma. A 69-year-old female patient with aphakic retinal detachment of the right eye was treated by pars plana vitrectomy with silicone oil injection. After 41 months the patient presented with absolute secondary angle-closure glaucoma with rubeosis iridis. The intraocular pressure was elevated up to 55 mmHg. There was a peripheral retinal detachment and a pale deeply cupped optic disc. Due to increasing pain the blind eye was enucleated. Histology showed a mainly detached retina and silicone oil occupying the vitreous cavity. The optic nerve was deeply cupped and the parenchyma presented multiple cavernous spaces of various sizes. These presumptive silicone oil bubbles reached beyond the line of surgical transection, nine millimeters behind the globe. In comparison to Schnabel's cavernous optic atrophy the vacuoles in the optic nerve in this patient were filled with silicone oil instead of acid mucopolysaccharides. A posterior migration of silicone oil into the orbital optic nerve can not be excluded, after long-term silicone oil tamponade and elevated intraocular pressure.