Profound improvement in vision and electroretinogram after intensive steroid treatment in unexplained visual loss...

Unexplained vision loss after silicone oil removal is a well-documented but incompletely understood entity for which there is no effective treatment described in the existing literature. We present a case where intensive oral and periocular steroid treatment resulted in significant subjective and objective clinical improvement.

After successful pars plana vitrectomy with silicone oil endotamponade to repair a macula sparing retinal detachment, the patient's best corrected visual acuity was 20/20 with silicone oil in the operative eye. However, seven weeks after uncomplicated combined silicone oil removal and cataract extraction with intraocular lens insertion, best corrected visual acuity was 20/250 with no new ophthalmic pathology to explain the vision loss. After a four week course of oral prednisone and three periocular triamcinolone injections over a period of nine weeks, visual acuity improved to 20/25 -2 in the operative eye. Serial multifocal electroretinography initially showed severely diminished amplitudes but improved markedly over the course of steroid treatment.

Although no effective treatments are described in the existing literature, improvement in visual acuity, visual field, and electroretinogram in this case suggests that intensive steroid treatment (periocular and systemic) may be efficacious in treating unexplained vision loss after silicone oil removal.