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Choroidal ischemia and serous macular detachment associated with severe postoperative pain.

Jung JW, Lee DY, Nam DH - Korean J Ophthalmol (2008)

Bottom Line: The patient's history was unremarkable except for a severe pain greater than the visual analog scale of 8 points for about 2 days after surgery.Retinal examination showed a well differentiated serous detachment that was about 3.5 disc diameter in size and located in the macular area.Fluorecein angiography and indocyanine green angiography showed delayed perfusion of the choriocapillaris without leakage points in the early phase and persistent hypofluorescence with pooling of dye in the subretinal space in the late phase.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Gachon University, Gil Medical Center, Incheon, Korea.

ABSTRACT
To report the association of a unilateral serous macular detachment with severe postoperative pain. A 71-year-old woman presented with a sudden decrease in vision in the right eye, seven days after a total knee replacement arthroplasty. The patient's history was unremarkable except for a severe pain greater than the visual analog scale of 8 points for about 2 days after surgery. Retinal examination showed a well differentiated serous detachment that was about 3.5 disc diameter in size and located in the macular area. Fluorecein angiography and indocyanine green angiography showed delayed perfusion of the choriocapillaris without leakage points in the early phase and persistent hypofluorescence with pooling of dye in the subretinal space in the late phase. There was a spontaneous resolution of the serous detachment and the choroidal changes with residual pigment epithelial changes. Severe postoperative pain may influence the sympathetic activity and introduce an ischemic injury with a focal, choroidal vascular compromise and secondary dysfunction of overlying RPE cells in select patients.

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Follow-up examination 6 months following the first clinic visit shows complete resolution of the serous detachment of macula. (A) Early phase fluorescein angiogram shows three hyperfluorescent spots (arrow), not seen on previous exam, and (B) late phase fluorescein angiogram shows one of the points leaking slightly and two fade out slowly. Horizontal (C) and vertical (D) crosshair scan of optical coherence tomography at fovea and the leakage point show no serous detachment or pigment epithelium detachment.
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Figure 4: Follow-up examination 6 months following the first clinic visit shows complete resolution of the serous detachment of macula. (A) Early phase fluorescein angiogram shows three hyperfluorescent spots (arrow), not seen on previous exam, and (B) late phase fluorescein angiogram shows one of the points leaking slightly and two fade out slowly. Horizontal (C) and vertical (D) crosshair scan of optical coherence tomography at fovea and the leakage point show no serous detachment or pigment epithelium detachment.

Mentions: A 71-year-old woman presented with a complaint of sudden decrease in vision in the right eye, 7 days after TKRA. The patient's history was unremarkable except a severe pain of more than the visual analog scale of 8 points for about 2 days, because the analgesic dose given was not adequate for the pain after the surgical operation. On examination the best corrected visual acuity (BCVA) was 20/100 in the right eye and 20/20 in the left eye. Retinal examination showed a well differentiated serous detachment that was about 3.5 disc diameter in size and located on the macular area in the right eye. No disc edema, retinal cotton wool spots, hemorrhages, or vascular abnormalities were noted in both eyes (Fig. 1). A fluorescein angiography (FA) of right eye performed at the first visit revealed choroidal hypoperfusion and a serous detachment without any leakage points in the early phase of the angiogram (Fig. 2A). In the mid and late phases, the area of non-perfusion showed pooling of the dye in the subretinal space without a leakage point (Fig. 2B, C). Indocyanine green (ICG) angiography was also performed on the same day and showed delayed perfusion of the choriocapillaris without a leakage point in the early phase followed by slow filling of neurosensory detachment without a focal source of leakage in the late phase (Fig. 3A, B). The areas of choroidal hypoperfusion corresponded to the serous detachment seen clinically. There was no disturbance of the retinal pigment epithelium (RPE). After 2 months, the symptoms and clinical findings began to improve gradually and at the follow-up examination 6 months after the first clinic visit, there was a complete resolution of the serous detachment of macula. The BCVA had improved to 20/20 in the right eye and the fluorescein angiogram showed minor disturbances in the RPE only (Fig. 4).


Choroidal ischemia and serous macular detachment associated with severe postoperative pain.

Jung JW, Lee DY, Nam DH - Korean J Ophthalmol (2008)

Follow-up examination 6 months following the first clinic visit shows complete resolution of the serous detachment of macula. (A) Early phase fluorescein angiogram shows three hyperfluorescent spots (arrow), not seen on previous exam, and (B) late phase fluorescein angiogram shows one of the points leaking slightly and two fade out slowly. Horizontal (C) and vertical (D) crosshair scan of optical coherence tomography at fovea and the leakage point show no serous detachment or pigment epithelium detachment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2629935&req=5

Figure 4: Follow-up examination 6 months following the first clinic visit shows complete resolution of the serous detachment of macula. (A) Early phase fluorescein angiogram shows three hyperfluorescent spots (arrow), not seen on previous exam, and (B) late phase fluorescein angiogram shows one of the points leaking slightly and two fade out slowly. Horizontal (C) and vertical (D) crosshair scan of optical coherence tomography at fovea and the leakage point show no serous detachment or pigment epithelium detachment.
Mentions: A 71-year-old woman presented with a complaint of sudden decrease in vision in the right eye, 7 days after TKRA. The patient's history was unremarkable except a severe pain of more than the visual analog scale of 8 points for about 2 days, because the analgesic dose given was not adequate for the pain after the surgical operation. On examination the best corrected visual acuity (BCVA) was 20/100 in the right eye and 20/20 in the left eye. Retinal examination showed a well differentiated serous detachment that was about 3.5 disc diameter in size and located on the macular area in the right eye. No disc edema, retinal cotton wool spots, hemorrhages, or vascular abnormalities were noted in both eyes (Fig. 1). A fluorescein angiography (FA) of right eye performed at the first visit revealed choroidal hypoperfusion and a serous detachment without any leakage points in the early phase of the angiogram (Fig. 2A). In the mid and late phases, the area of non-perfusion showed pooling of the dye in the subretinal space without a leakage point (Fig. 2B, C). Indocyanine green (ICG) angiography was also performed on the same day and showed delayed perfusion of the choriocapillaris without a leakage point in the early phase followed by slow filling of neurosensory detachment without a focal source of leakage in the late phase (Fig. 3A, B). The areas of choroidal hypoperfusion corresponded to the serous detachment seen clinically. There was no disturbance of the retinal pigment epithelium (RPE). After 2 months, the symptoms and clinical findings began to improve gradually and at the follow-up examination 6 months after the first clinic visit, there was a complete resolution of the serous detachment of macula. The BCVA had improved to 20/20 in the right eye and the fluorescein angiogram showed minor disturbances in the RPE only (Fig. 4).

Bottom Line: The patient's history was unremarkable except for a severe pain greater than the visual analog scale of 8 points for about 2 days after surgery.Retinal examination showed a well differentiated serous detachment that was about 3.5 disc diameter in size and located in the macular area.Fluorecein angiography and indocyanine green angiography showed delayed perfusion of the choriocapillaris without leakage points in the early phase and persistent hypofluorescence with pooling of dye in the subretinal space in the late phase.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Gachon University, Gil Medical Center, Incheon, Korea.

ABSTRACT
To report the association of a unilateral serous macular detachment with severe postoperative pain. A 71-year-old woman presented with a sudden decrease in vision in the right eye, seven days after a total knee replacement arthroplasty. The patient's history was unremarkable except for a severe pain greater than the visual analog scale of 8 points for about 2 days after surgery. Retinal examination showed a well differentiated serous detachment that was about 3.5 disc diameter in size and located in the macular area. Fluorecein angiography and indocyanine green angiography showed delayed perfusion of the choriocapillaris without leakage points in the early phase and persistent hypofluorescence with pooling of dye in the subretinal space in the late phase. There was a spontaneous resolution of the serous detachment and the choroidal changes with residual pigment epithelial changes. Severe postoperative pain may influence the sympathetic activity and introduce an ischemic injury with a focal, choroidal vascular compromise and secondary dysfunction of overlying RPE cells in select patients.

Show MeSH
Related in: MedlinePlus