UNSUSPECTED CENTRAL VISION DECREASE FROM MACULAR GANGLION CELL LOSS AFTER POSTERIOR SEGMENT SURGERY

To describe a novel postsurgical complication of circumscribed macula ganglion cell loss as an apparent cause of unsuspected vision loss following posterior segment surgery.

Patients were seen in referral and were evaluated with comprehensive examination to include optical coherence tomography and microperimetry.

All eight patients had a sudden central vision loss following vitrectomy, and many patients suspected the central loss was present even before the eye patch was removed on the first postoperative day. Of the eight patients, one had a vitrectomy with no membrane peeling, whereas the remaining seven had membrane peeling. The mean postoperative visual acuity was 20/200. The mean ganglion cell layer volume was 0.69 µm3 in the involved eye and 1.035 µm3 in the fellow eye (P < 0.001). The global retinal nerve fiber layer thicknesses in the involved and fellow eyes were 81.3 and 90 µm, respectively (P = 0.08). The outer retinal architecture was unremarkable in the involved eyes and did not appear to explain the poor acuity. The ganglion cell layer volume loss was not necessarily associated with retinal nerve fiber layer thicknesses that were in the abnormal range or in optic nerve pallor. Microperimetry showed severe depression of the threshold sensitivities.

Severe loss of the macular ganglion cells may occur after vitrectomy and is associated with central vision loss. The diagnosis is made by having a high index of suspicion when examining optical coherence tomography B-scan images and by evaluating ganglion cell layer volumes. The frequency of this occurrence is currently unknown.