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Impressum
Silicon oil in the subarachnoidal space - a possible route to the brain?
1Papp A., 1Tóth J., 2Kerényi T, .2Jäckel M., 1Süveges I.
11st Dept. of Ophthalmology Semmelweis University, Budapest; 22nd Dept. of Pathology Semmelweis University, Budapest
Objective: To report the evidence that macrophages may play a
role in the transport of intraocular silicon oil from the vitreous cavity
to the optic nerve and to the subarachnoidal space.
Methods: Vitrectomy
combined with silicon oil implantation was performed in the right eye
of a 72 -year- old woman with type II diabetes complicated by advanced
proliferative diabetic retinopathy. Silicon oil was removed a few months
later because she had elevated IOP. The blind and painful eye was subsequently
enucleated. In the enucleated eye presumed silicon oil bubbles were found
by light microscopy in the optic nerve and in the subarachnoidal space.
The vacuoles -which were suspicious for silicon oilwere examined by scanning
laser electron microscopy in combination with energy dispersion X-ray
analysis (EDAX) to positively identify the presence of silicon oil. CD
68 positive macrophages were demonstrated by immunohistochemistry around
the silicon vacuoles inside the optic nerve, the central retinal artery
and in the subarachnoidal space.
Results: Silicon oil infiltration was demonstrated by light microscopy
and confirmed by EDAX in the optic nerve, in the central retinal artery
and in the subarachnoidal pace. The presence of macrophages in the silicon
filled vacuoles was proven with the marker CD 68.
Conclusion: Silicon oil used for endotamponade may infiltrate the
optic nerve and may be present even in the subarachnoidal space. This
fact supports the theory that silicon oil -under special circumstances-
may even migrate into the brain. The role of macrophages in this process
has yet to be determined, however the present case is an argument in favour
of the active participation of these cells in the transport of silicon
oil. To avoid this complication silicon oil has to be removed as early
as possible from the eye.