Vision Distortion and Optic Nerve Degeneration After Silicone Oil Surgery

Post-aspiration visual field and optic nerve degeneration?

Hello, Doctor.
I underwent silicone oil removal surgery for my left eye (with a myopia degree of over 500) on January 19.
After a week, during my follow-up appointment, I informed the surgeon that my central vision was still blurry and distorted (my vision was 0.3 at that time, compared to 0.1 before the oil removal and over 0.6 before the surgery).
The doctor mentioned that it was possible that the macula was injured during the detachment.
The next day, I consulted another doctor, who told me that the macula was fine and healthy, and that my vision would gradually recover.
He explained that the retina is like wallpaper, and when we use oil to reattach it, it may not align perfectly, leading to some distortion, and that the photoreceptor cells would also need time to reorganize.
A month later, I returned to the original surgeon for a follow-up (my vision was still only 0.1, and my central vision remained obscured by a haze).
He asked if there had been any changes in my vision over the month, and I replied that my central vision was still distorted and blurry.
After examining my eyes, he informed me that cataracts would likely develop and that my optic nerve showed some signs of degeneration.
The next day, I scheduled an appointment with a neuro-ophthalmologist.
After the examination, the doctor noted that half of my optic nerve appeared white and asked if my vision was blurry.
Since my vision had not yet recovered from the detachment, I was unable to provide an answer.
He then arranged for a visual field test and intraocular pressure check, both of which were normal.
Doctor, I would like to ask:
1.
If the macula is injured during surgery, would it be detected immediately?
2.
After the silicone oil removal, is it normal for the visual field to be distorted and blurry? Could this condition occur due to misalignment of the retina?
3.
According to the other doctor, how long does it typically take for the photoreceptor cells to reorganize?
4.
Is the degeneration of the optic nerve related to the silicone oil being injected into the eye?
5.
How can I prevent further degeneration of the optic nerve? Can I still use electronic devices? Currently, the doctor has prescribed ginkgo biloba to improve blood circulation.
Thank you, Doctor, and I apologize for the lengthy message.

Mr. Wu, 20~29 year old female. Ask Date: 2022/02/18

Dr. He Jianxian reply Ophthalmology

1.
Macular degeneration cannot be detected during surgery.

2.
Irregularities or improper repositioning of the retina after reattachment may lead to visual distortions.

3.
There is no precise timeline; typically, a duration of six months to a year is possible.

4.
It should not be related to silicone oil injection, as silicone oil is usually used in more complicated cases, so it is likely more related to the severity of your retinal detachment.

5.
Currently, there are no specific methods to prevent further degeneration of the optic nerve.
Regular use of electronic devices is not an absolute contraindication.

Director He Jianxian, Ophthalmology Department, Nantou Hospital.

Reply Date: 2022/02/18

More Info

After undergoing silicone oil surgery for retinal detachment, it is common to experience various visual disturbances, including distortion and blurriness. Your concerns regarding the potential damage to the macula, the recovery of visual function, and the health of your optic nerve are valid and warrant a thorough understanding.

1. Detection of Macular Damage: Damage to the macula during surgery may not always be immediately evident. The macula is responsible for central vision, and any injury can lead to significant visual impairment. Surgeons typically assess the macula during the procedure, but subtle injuries may only become apparent after some time. If your vision remains distorted or blurry, further imaging studies, such as optical coherence tomography (OCT), may be necessary to evaluate the macula's condition.

2. Visual Distortion Post-Surgery: It is not uncommon for patients to experience visual distortion and blurriness immediately after silicone oil injection. This can be attributed to several factors, including the positioning of the retina and the silicone oil itself. If the retina does not adhere perfectly, it can lead to a misalignment that causes visual distortion. Additionally, the healing process of the retina and the reorganization of photoreceptor cells can take time, leading to temporary visual disturbances.

3. Time for Photoreceptor Recovery: The recovery of photoreceptor cells and the restoration of normal vision can vary significantly among individuals. While some may notice improvements within weeks, others may take several months to see substantial changes. It is essential to maintain regular follow-ups with your ophthalmologist to monitor your progress and make any necessary adjustments to your treatment plan.

4. Optic Nerve Degeneration and Silicone Oil: The relationship between silicone oil injection and optic nerve degeneration is complex. While silicone oil itself is not directly responsible for optic nerve damage, the underlying conditions that necessitate its use, such as severe retinal detachment, may contribute to optic nerve health. Factors such as prolonged retinal detachment and the severity of the initial condition can influence the health of the optic nerve.

5. Preventing Further Optic Nerve Degeneration: To prevent further degeneration of the optic nerve, it is crucial to manage any underlying conditions, such as diabetes or hypertension, that may affect eye health. Regular eye examinations, adherence to prescribed medications, and a healthy lifestyle can also contribute to maintaining optic nerve function. Regarding the use of digital devices, moderation is key. While there is no absolute prohibition, prolonged screen time can lead to eye strain. Taking regular breaks and ensuring proper lighting can help mitigate discomfort.

In summary, your experience of visual distortion and concerns about optic nerve health are not uncommon after silicone oil surgery. Continuous monitoring and communication with your healthcare providers are essential for managing your recovery. If you have further questions or if your symptoms worsen, do not hesitate to seek additional medical advice. Your vision is important, and proactive management can help optimize your outcomes.

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