J Korean Ophthalmol Soc.  2016 Jun;57(6):1004-1011. 10.3341/jkos.2016.57.6.1004.

Systemic Steroid Therapy for Serous Retinal Detachment Caused by Excessive Endolaser during Diabetic Retinopathy Surgery

• Shin JS
• Kim CH
• Chang YS
• Lee YH

• KMID: 2290507
• DOI: http://doi.org/10.3341/jkos.2016.57.6.1004

Abstract

PURPOSE
To report cases of macular serous retinal detachment caused by excessive intraoperative endolaser in patients with diabetic vitreous hemorrhage. Macular serous retinal detachment was improved by systemic steroid therapy.
CASE SUMMARY
A 64-year-old male (case 1) and a 67-year-old female (case 2) treated with vitrectomy and endolaser (case 1, 3,184 shots; case 2, 1,734 shots) because of diabetic vitreous hemorrhage visited our out-patient clinic with blurred vision. Best corrected visual acuity (BCVA) in case 1 was hand motion and 0.03 in case 2. Fundus examination and optical coherence tomography (OCT) revealed extensive subretinal fluid accumulation of the posterior pole. With the diagnosis of macular serous retinal detachment caused by excessive intraoperative endoaser, oral steroid (40 mg/qd, 5 days) was administered and then later reduced in case 1. In case 2, we administered intravenous high-dose steroid (250 mg/qid, 3 days). After systemic steroid therapy, BCVA was improved to 20/30 in case 1 and 20/40 in case 2 and OCT showed the subretinal fluid was resolved.
CONCLUSIONS
During diabetic retinopathy surgery, excessive endolaser induced macular serous retinal detachment and systemic steroid therapy was necessary in diabetic patients. Thus, physicians should be well acquainted with this complication.

Keyword

Endolaser; Macular serous retinal detachment; Systemic steroid therapy; Vitrectomy

MeSH Terms

Aged
Diabetic Retinopathy*
Diagnosis
Female
Hand
Humans
Male
Middle Aged
Outpatients
Retinal Detachment*
Retinaldehyde*
Subretinal Fluid
Tomography, Optical Coherence
Visual Acuity
Vitrectomy
Vitreous Hemorrhage
Retinaldehyde

Figure

• 

  Figure 1. Fundus photographs and B-scan ultrasonography at the time of initial examination. The fundus of Case 1 (A) and Case 2 (B) were invisible due to vitreous hemorrhage. The B-scan ultrasonography of case 1 (C) and case 2 (D) show vitreous opacity indicating vitreous hemorrhage.

• 

  Figure 2. Fundus photographs, fluorescein angiography (FAG) and optical coherence tomography (OCT) of case 1. (A) The fundus photograph shows serous retinal detachment of macula. (B) The FAG shows no remarkable leakage of fluorescein dye at the posterior pole. Late staining of fluorescein dye was observed. (C) The OCT at the first visiting after operation shows serous retinal detachment with marked retinal elevation caused by fluid displacement. (D) 2 weeks after steroid therapy, Subretinal fluid was not observed on OCT.

• 

  Figure 3. Fundus photographs, fluorescein angiography (FAG) and optical coherence tomography (OCT) of case 2. (A) The fundus photograph shows serous retinal detachment of macula. (B) The FAG shows late leakage and late staining of fluorescein dye. (C) The OCT at the first visiting after operation shows serous retinal detachment with marked retinal elevation caused by fluid displacement. (D) 2 weeks after steroid therapy, Minimal subretinal fluid was observed on OCT. Disruption of inner segment/outer segment of photoreceptor cell (IS/OS) junction was recovered progressively.

Reference

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