J Korean Ophthalmol Soc.  2009 May;50(5):785-789. 10.3341/jkos.2009.50.5.785.

A Case of Decompression Retinopathy After Resolution of Acute Primary Angle-Closure Glaucoma

• Kim JH
• Huh JW

• KMID: 2212325
• DOI: http://doi.org/10.3341/jkos.2009.50.5.785

Abstract

PURPOSE:To report a case of ocular decompression retinopathy after resolution of acute primary angle closure (APAC) subsequent to medical treatment and laser peripheral iridotomy (LPI).
CASE SUMMARY
A patient presented with APAC of the right eye with markedly elevated intraocular pressure (IOP) and a LPI was done after lowering the IOP with medical treatment. On presentation, visual acuity was 0.3 in the right eye (OD) and IOP was 74 mmHg OD. Two hours after medical treatment IOP was found to be 16 mmHg OD. Ten hours after resolution of the acute attack, the patient's visual acuity was 0.2 OD and IOP was 11 mmHg OD. LPI was subsequently performed in the right eye. The post-LPI IOP was 10 mmHg and the patient complained of visual disturbance and floaters OD. Three days after LPI the IOP was normal but her visual acuity had decreased to counting fingers OD. In addition, scattered retinal hemorrhages including alarge pre-retinal hemorrhage on the macula were found upon dilated funduscopic examination. After three months the retinal hemorrhage had been absorbed and her visual acuity was 0.7 OD.
CONCLUSIONS
Decompression retinopathy can develop in the posterior pole of the retina in patients with APAC after medical treatment and LPI.

Keyword

Acute primary angle closure glaucoma; Decompression retinopathy; Laser peripheral iridotomy

MeSH Terms

Decompression
Eye
Fingers
Glaucoma, Angle-Closure
Hemorrhage
Humans
Intraocular Pressure
Retina
Retinal Hemorrhage
Visual Acuity

Figure

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  Figure 1. (A) Fundus photograph of the right eye taken 3 days after laser peripheral iridotomy. Diffuse deep retinal hemorrhages with a white center are observed in the posterior pole. Optic nerve hemorrhages, disc edema and disc hyperemia were also present. There were dilations and slight tortuosity or irregularity of the veins compared to normal vasculature of the left eye (B). (C) Fluorescein angiogram also shows multiple, blocked fluorescence due to the deep retinal hemorrhages and pre-retinal hemorrhage but the vascular filling appears normal. (D) Hemorrhages, disc edema and disc hyperemia much resolved three months later in the right eye.

Reference

References

1. Saw SM, Gazzard G, Friedman DS. Interventions for angle-closure glaucoma: an evidence-based update. Ophthalmology. 2003; 110:1869–78.

2. Waheeb SA, Birt CM, Dixon WS. Decompression retinopathy following YAG laser iridotomy. Can J Ophthalmol. 2001; 36:278–80.

3. Nah G, Aung T, Yip CC. Ocular decompression retinopathy after resolution of acute primary angle closure glaucoma. Clin Experiment Ophthalmol. 2000; 28:319–20.

4. Landers J, Craig J. Decompression retinopathy and corneal oedema following Nd: YAG laser peripheral iridotomy. Clin Experiment Ophthalmol. 2006; 34:182–92.

5. Alwitry A, Khan K, Rotchford A, et al. Severe decompression retinopathy after medical treatment of acute primary angle closure. Br J Ophthalmol. 2007; 91:121.

6. Oh CH, Kim YY, Jung HR. A case of decompression retinopathy after glaucoma surgery. J Korean Ophthalmol Soc. 2002; 43:2059–63.

7. Fechtner RD, Minckler D, Weinreb RN, et al. Complications of glaucoma surgery: ocular decompressive retinopathy. Arch Ophthalmol. 1992; 110:965–8.

8. Geijer C, Bill A. Effect of raised intraocular pressure on retinal, prelaminar, and retrolaminar optic nerve blood flow in monkeys. Invest Ophthalmol Vis Sci. 1978; 18:1030–42.

9. Sossi N, Anderson DR. Effect of elevated intraocular pressure on blood flow: occurrence in the cat optic nerve head studied with iodoantipyrine I 125. Arch Ophthalmol. 1983; 101:98–101.

10. Riva CE, Grunwald JE, Petring BL. Autoregulation of Human Retinal Blood Flow. Invest Ophthalmol Vis Sci. 1986; 27:1706–12.

11. Minckler DS, Bunt AH. Axoplasimic transport in ocular hypotony and papilledema in the monkey. Arch Ophthalmol. 1977; 95:1430–6.

12. Obana A, Gohto Y, Ueda N, et al. Retinal and subhyaloid hemorrhage as a complication of laser iridectomy for primary angle-closure glaucoma. Arch Ophthalmol. 2000; 118:1449–51.

13. Dudley DF, Leen MM, Kinyoun JL, Mills RP. Retinal hemorrhages associated with ocular decompression after glaucoma surgery. Ophthalmic Surg Lasers. 1996; 27:147–50.

14. Yalvac IS, Kocaoglan H, Eksioglu U, et al. Decompression retinopathy after Ahmed glaucoma valve implantation in a patient with congenital aniridia and pseudophakia. J Cataract Refract Surg. 2004; 30:1582–5.

15. Lai JS, Lee VY, Leung DY, Chung TC. Eye Decompression retinopathy following laser peripheral iridoplasty for acute primary angle-closure. Eye. 2005; 19:1345–7.

16. Ben Simon GJ, Goldberg RA, McCann JD. Bilateral decompression retinopathy after orbital decompression surgery. Br J Ophthalmol. 2004; 88:1605–6.

17. Rezende FALGM, Alcântara S. Decompression Retinopathy After 25-Gauge Transconjunctival Sutureless Vitrectomy: Report of 2 Cases. Arch Ophthalmol. 2007; 125:699–700.

18. Lee SJJJSD. Multiple retinal hemorrhage following anterior chamber paracentesis in uveitic glaucoma. Korean J Ophthalmol. 2006; 20:128–30.

19. Suzuki R, Nakayama M, Satoh N. Three types of retinal bleeding as a complication of hypotony after trabeculectomy. Ophthalmologica. 1999; 213:135–8.

20. Bui CM, Recchia FM, Recchia CC, Kammer JA. Optical coherence tomography findings in ocular decompression retinopathy. Ophthalmic Surg Lasers Imaging. 2006; 37:333–5.

21. Jea SY, Jung JH. Decompression retinopathy after trabeculectomy. Korean J Ophthalmol. 2005; 19:128–31.