目的:已经描述了原位硅油和去油后眼睛中心视力突然丧失的情况。这篇综述的目的是提供有关硅油对视网膜神经元方面的毒性以及阿布扎比克利夫兰诊所对这种视网膜病变(黄斑病变)的经验的最新数据。
方法:使用术语“硅油”和/或“毒性”和/或“神经节细胞”和/或“神经纤维”进行了PubMed审查,以确定病例报告,案例系列,和展示硅油毒性的原创文章。视力丧失的时间,以及SD-OCT数据和RNFL/GCC分析,被收集。从克利夫兰诊所阿布扎比玻璃体视网膜数据库中收集了选定的病例,以进一步加强研究结果。
结果:确定了24篇论文(病例/系列/文章)。符合我们标准的最早论文似乎报告了在去除硅油时或之后的视力丧失;然而,最近的研究已经描述了在原位填充硅油后1至6个月的这种毒性。自从第一次描述硅油的中心视力丧失以来,所有研究人员都描述了用SD-OCT测量的中央凹神经节细胞变薄,虽然就RNFL的变化而言没有一致性,一些作者描述了变薄,另一些作者描述了增厚,但两者都没有明显与视力丧失有关。内部视网膜中的SD-OCT超反射杯状物质与视网膜内油滴迁移的组织学描述之间的相关性似乎暗示了硅油在视网膜层中渗透的实例。
结论:在一小部分使用硅油进行视网膜填塞的病例中,神经节细胞可以受到直接损害,无论是从在视网膜中迁移的油颗粒或直接接触。间接损伤可能是由于硅油的透明性质引起的光毒性或由夹在油和视网膜之间的细胞因子引起的炎症损伤引起的。
OBJECTIVE: Cases of sudden loss of central vision in eyes with silicone oil in situ and after oil removal have been described. The aim of this review is to present current data on silicone oil toxicity to the neuronal aspects of the retina as well as the Cleveland Clinic Abu Dhabi experience with this retinopathy (maculopathy).
METHODS: A PubMed review using the terms \"silicon oil\" and/or \"toxicity\" and/or \"ganglion cell\" and/or \"nerve fiber\" was conducted to identify
case reports,
case series, and original articles presenting toxicity from silicon oil. Timing of visual loss, as well as SD-OCT data and RNFL/GCC analysis, was collected. Selected cases were pooled from Cleveland Clinic Abu Dhabi Vitreoretinal database to further reinforce the findings.
RESULTS: Twenty-four papers were identified (
case/series/articles). The earliest papers that met our criteria seemed to report vision loss at the time of or after silicone oil removal; however, more recent studies have described such toxicity from 1 to 6 months after tamponade with silicone oil in situ. Since the first description of central visual loss from silicone oil, all researchers describe a thinning of perifoveal ganglion cells measured with SD-OCT, while there is no concordance as far as RNFL changes, with some authors describing a thinning and others a thickening, but neither was ever clearly associated with visual loss. The correlation between SD-OCT hyperreflective goblets in the inner retina and histological description of intraretinal oil droplets migration seems to suggest instances of silicone oil penetration in the retinal layers.
CONCLUSIONS: In a small percentage of cases who underwent retinal tamponade with silicone oil, ganglion cells can suffer a direct damage either from particles of oil that migrate in the retina or from direct contact with it. Indirect damage may be caused by phototoxicity due to the transparent nature of silicon oil or by inflammatory damage from cytokines sandwiched between oil and retina.