Logo image
Back
Post-operative intracranial gas migration with optic nerve infiltration and atrophy following retinal detachment repair
Journal article   Open access   Peer reviewed

Post-operative intracranial gas migration with optic nerve infiltration and atrophy following retinal detachment repair

James M Harris, Ian C Han, Mira M Sachdeva, Alice Y Zhang and Nazlee Zebardast
American journal of ophthalmology case reports, Vol.20, p.100920
12/2020
DOI: 10.1016/j.ajoc.2020.100920
PMCID: PMC7494461
PMID: 32984655
url
https://doi.org/10.1016/j.ajoc.2020.100920View
Published (Version of record) Open Access

Abstract

To report a patient with post-operative gas migration into the optic nerve and lateral ventricles after retinal detachment repair. A 78-year-old pseudophakic man developed a temporal visual field cut in his non-operative, right eye 3 weeks after repair of a recurrent, shallow, macula-involving retinal detachment with perfluoropropane intraocular gas in the left eye. Visual acuity in the right eye measured 20/40, and static perimetry demonstrated temporal visual field loss that respected the vertical midline. Dilated fundus examination of the right eye was unrevealing for any retinal cause, raising suspicion for an intracranial etiology. An urgent CT scan of the brain demonstrated gas in all segments of the left optic nerve and lateral ventricles, consistent with intracranial gas migration along the optic nerve. Given the absence of systemic neurologic symptoms, cautious observation was advised on consultation with neuroradiology and neurosurgery, and follow-up CT scan 1 week later showed resolution of the intracranial gas. By 10-weeks post-operatively, vision returned to 20/20 in the right eye with persistent temporal field loss, and the left eye was hand motions (20/70 pre-operatively) with evidence of optic nerve atrophy and severe cupping. Intracranial gas migration is a rare complication of retinaldetachment repair with intraocular gas and may occur in the setting of structural defects of the optic nerve and high post-operative intraocular pressure. Clinicians should be alert to this rare but serious complication, which can cause neurologic symptoms and result in vision loss in both the operative and non-operative eyes.
 Glaucoma Optic nerve Pneumocephalus Retina Retinal detachment Vitrectomy

Details

Metrics

19 Record Views
Logo image