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

Abstract

Purpose To report a patient with post-operative gas migration into the optic nerve and lateral ventricles after retinal detachment repair. Observations 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. Conclusions 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.

Orbital Gas after 25-Gauge Pars Plana Vitrectomy with Incorrect Gas Mixture

“…Final VAs following orbital gas removal in the Enriquez et al [2] study ranged from 20/40 to no light perception, with nearly 63% experiencing an objective decline in best-corrected VA and over 74% having a final vision of 20/200 or worse. Visual field defects and nerve fiber layer damage occur after retrobulbar gas, caused by vascular compromise and direct compressive damage to the optic nerve [1, 6].…”

“…Perfluoropropane (C3F8) and sulfur hexafluoride (SF6) gases are common internal tamponade agents used in routine vitreoretinal surgery. Intraocular gas expansion has been reported to lead to gas migration into the anterior chamber, subretinal, intracranial, subconjunctival, and retrobulbar spaces [1][2][3][4][5][6]. Pure intravitreal C3F8 quadruples and pure SF6 gas doubles in 3-4 days [1,7].…”