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Is silicone oil optic neuropathy caused by high intraocular pressure alone? A semi- biological model.
  1. Pascal Bruno Knecht (pascal.knecht{at}usz.ch),
  2. Peter Groscurth,
  3. Urs Ziegler,
  4. Hubert R Laeng,
  5. Gregor P Jaggi,
  6. Hanspeter Esriel Killer (killer{at}ksa.ch)
  1. Department of Anatomy, University of Zurich, Switzerland
  2. Department of Anatomy, University of Zurich, Switzerland
  3. Department of Anatomy, University of Zurich, Switzerland
  4. Institute of Pathology, Kantonsspital Aarau, Switzerland, Switzerland
  5. 3) Department of Ophthalmology, Kantonsspital Aarau, Switzerland, Switzerland
  6. Department of Ophthalmology, Kantonsspital Aarau, Switzerland, Switzerland

    Abstract

    Background: Silicone oil endotamponade is used for the repair of complicated retinal detachments. Cataract, glaucoma and corneal endothelial dysfunction are the most frequent complications of silicone oil tamponade. Clinical and histopathological studies have revealed that silicone oil can penetrate into the optic nerve and into the brain. The mechanism by which silicone oil moves from intraocular into the optic nerve is still under debate. In order to render information about the effect of intraocular pressure only, we performed a post mortem experimental histological study to determine whether silicone oil penetration from the globe into the optic nerve after vitrectomy and silicone oil instillation is a purely pressure-related phenomenon. Although a post mortem study excludes physiological processes, it serves as a model for the study of pure physical forces onto "biological" structures.

    Methods: The study was carried out on twenty human eyes with their optic nerves attached. All specimens had been harvested from patients without known eye disease. The vitreous body was removed with a syringe and the globe was filled with silicone oil. A lipophil fluorescence marker (Bodipy) was added in eight eyes. The mean intraocular pressure after silicone oil filling measured 40 mm Hg and the globes stayed under pressure for up to 16 weeks. The eyes and optic nerves were stained with hematoxylin and eosin and examined with light, phase-contrast and fluorescence microscopy.

    Results: None of the twenty specimens examined showed silicone oil in the retrolaminar portion of the optic nerve.

    Conclusions: We were not able to demonstrate migration of silicone oil into the optic nerve in this human post mortem study. We conclude that other factors, such as pre-existing glaucomatous damage to the disc region and/or active transport mechanisms must be involved in the development of silicone oil associated optic neuropathy.

    • Silicone oil associated optic neuropathy
    • Silicone oil migration.
    • glaucoma
    • intraocular pressure
    • vitrectomy

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