Echography in extreme postoperativne ocular hypotony: case report

A case is presented of excessive optic disk edema upon evacuation of the silicon oil instilled after vitrectomy. Retinal detachment in the right myopic eye of a 45-year-old female patient was the indication for vitrectomy with instillation of silicon oil. Consecutive cataract formation, shallow anterior chamber and corneal edema with slight ocular hypertonus lasting for two months were the reasons to perform phacoemulsification with posterior chamber lens implantation and silicon oil evacuation. Shallow anterior chamber and corneal edema persisted, accompanied by excessive hypotony. Echography revealed a highly echogenic massive lesion protruding from the posterior pole into the vitreal space without initial double spike, casting a shadow upon distal structures. The retrobulbar part of the optic nerve was not visible. Echographic presentation of the massive lesion was not corresponding to choroidal detachment and the diagnosis of excessive papilledema was established. Another procedure with refilling of the eye with silicon oil to restore the hypotony was performed. Regression of the papilledema was gradual, intraocular pressure normalized, and control echography showed flat optic nerve head.