Abstract

FR.23.09

Philipp Müther, Sandra Liakopoulos, Bernd Kirchhof

Netzhaut- und Glaskörperchirurgie, Zentrum für Augenheilkunde, Klinikum der Universität zu Köln, Köln

Objective
A greek patient presented with a complex history: condition after retinal detachment due to pit of the disk on his right eye, treated with vitrectomy and gastamponade. Thereafter treatment of PVR-redetachment twice by re-ppV with silicone oil and re-ppV with densiron oil, cataract surgery and oil removal. According to medical history internal limiting membrane (ILM) was supposedly peeled during PVR-surgery. Visual acuity (VA) was 1/35, (-5,0dpt). Left eye unremarkable, VA 1,0 sc. Clinical examination showed IOL in loco with capsule opacification and pronounced silicone oil emulsifications within the posterior pole. Retina was attached. High resolution OCT (Spectralis) revealed distinct prominent cystoid swelling of the retina in the area of funduscopically visible silicone oil bubbles. Differential diagnosis included sub-ILM, intra- or subretinal silicone oil. Impaired scan quality impeded exact evaluation of OCT. On the basis of funduscopic aspects patient was recommended to undergo re-ppV with subretinal lavage.
Methods
Intraoperatively the edge of the emulsification area was manipulated with a vacuum flute needle. Oil could not be aspirated, but was visibly mobile beneath a clear membranous structure. Nonwithstanding prior ILM-peeling according to history, ICG-dyeing was performed. An ILM-like structure could be prepared outside the emulsification area with a peeling-forceps. As membrane was peeled into emulsification area, oil bubbles ascended. After complete peeling all bubbles could be removed. Macula appeared atrophic.
Results
Vitreous bleeding occured postoperatively, VA was hand movements with intact light projection. Patient had to travel back to Greece immediately making further follow-up impossible. Suretinal oil after vitrectomy in patients with optic pit has been described as well as oil disclocated into the cerebral ventricles. OCT-examinations have already revealed schisis-like intraretinal spaces of the macula. Oil dislocated into sub-ILM or intraretinal space has not been described. It remains unclear at which site oil may dislocate in patients with optic pit. With this patient, it is possible that epiretinal membranes had been peeled before, injuring the ILM forming an entry gate.
Conclusions
Video shows features of OCT and fundus photography as well as surgical procedure. OCT is being interpreted and anatomical anomalies are discussed.

Copyright: 2009 Porstmann Kongresse GmbH. All rights reserved. Impressum, Disclaimer.