Multiple Retinal Hemorrhage following Anterior Chamber Paracentesis in Uveitic Glaucoma

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Abstract

Purpose

We describe the occurrence of a massive retinal hemorrhage following anterior chamber paracentesis in uveitic glaucoma.

Methods

A 33-year-old man who suffered from uveitic glaucoma was transferred to our hospital. The IOP in both his eyes was documented to vary between 11 mmHg and 43 mmHg and remained at a continuously high level for 7 months despite maximally tolerable medical treatment. A paracentesis was performed bilaterally to lower the IOP.

Results

Immediately after the paracentesis, massive retinal hemorrhages occurred in the left eye. Multiple round blot retinal hemorrhages with white centers occurred in the equator and peripheral retina, and small slit hemorrhages were observed in the peripapillary area. A fluorescence angiography(FAG) showed no obstruction of retinal vessels but a slightly delayed arteriovenous time in the left eye.

Conclusions

It is important to be aware that patients who have a persistent relatively high IOP are at an increased risk of developing decompression retinopathy due to paracentesis and filtering surgery.

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Most cited references 13

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Retinal autoregulation in open-angle glaucoma.

R. Stone, Niklaus J. Grünwald, B Petrig … (1984)

The macular blood flow response to an induced change in intraocular pressure (autoregulation) was studied using the blue field entopic phenomenon in 11 open angle glaucoma patients, eight glaucoma suspects and 13 normal volunteers. A suction cup was used to raise the intraocular pressure (IOP) above its resting state (IOPrest). IOPmax, the highest acutely increased IOP for which blood flow can be maintained constant by autoregulation, was 24.9 +/- 1.5 mmHg (+/- 1 SD) in the glaucoma patients, 30.8 +/- 4.6 mmHg in the glaucoma suspects and 29.9 +/- 3.6 mmHg in the normal subjects. The values for IOPmax - IOPrest were 3.7 +/- 4.3 mmHg, 4.7 +/- 3.3 mmHg, and 14.3 +/- 3.1 mmHg, respectively. After the release of the suction cup, a hyperemic response was observed by 16 of 17 normal eyes, 10 of 14 glaucoma suspect eyes and only 9 of 19 glaucomatous eyes. These results suggest an abnormal autoregulation of macular retinal blood flow in open-angle glaucoma.

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Postsurgical hypotony: relationship to fistulization, inflammation, chorioretinal lesions, and the vitreous.

H D Schubert (2015)

Hypotony is a natural occurrence, symptom, and complication of surgical treatment. With more sophisticated and aggressive techniques, postsurgical hypotony recently has been given increased attention as an obstacle to success of surgery for glaucoma and retinal detachment. Whereas two standard deviations below normal pressure (15.9-5.8 = 10.1 mm Hg) can be called hypotonous, most eyes, depending on scleral rigidity, lid pressure, eye rubbing, or corneal or retinal edema, will be symptomatic at < 5 mm Hg. Hypotony can be defined as the low pressure (whether acute, transient, chronic or permanent) which, in an individual eye, leads to functional changes (whether asymptomatic or symptomatic) and structural changes (whether reversible or irreversible). Depending on its duration and degree, postsurgical hypotony produces characteristic tissue changes that often are modified by, but separate from, the tissue changes caused by an underlying disease or its surgical treatment. This review summarizes the situations, variably associated with hypotony, that occur after such interventions as cataract extraction, filtering surgery, cyclodialysis, cyclodestruction, and vitreoretinal surgery, in addition to the reported pathomechanisms of hypotony and its proposed treatments.

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Complications of glaucoma surgery. Ocular decompression retinopathy.

F R Fechtner, Robert N. Weinreb, G Frangei … (1992)

In seven eyes of four patients, retinal hemorrhages were observed following trabeculectomy under both local and general anesthesia. The hemorrhages were diffuse, both deep and superficial, and many had white centers when first observed. Two patients were young healthy male myopes undergoing primary trabeculectomy. The third patient was a young man with chronic uveitis. The fourth patient was an elderly man with primary open angle glaucoma who had an acute rise in intraocular pressure following cataract extraction. Intraocular pressure and visual results appeared unaffected by the hemorrhages. Retinal hemorrhages associated with ocular decompression appear to be relatively benign.

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Author and article information

Journal

Journal ID (nlm-ta): Korean J Ophthalmol

Journal ID (publisher-id): KJO

Title: Korean Journal of Ophthalmology : KJO

Publisher: The Korean Ophthalmological Society

ISSN (Print): 1011-8942

Publication date (Print): June 2006

Publication date (Electronic): 30 June 2006

Volume: 20

Issue: 2

Pages: 128-130

Affiliations

Department of Ophthalmology, College of Medicine, Kosin University, Pusan, Korea.

Author notes

Reprint requests to Sang Joon Lee, MD. Gospel Hospital, Kosin University, #34 Amnam-dong, Suh-gu, Busan 602-702, Korea. Tel: 82-051-990-6215, Fax. 82-051-990-3026, hiatus@ 123456ns.kosinmed.co.kr

Article

DOI: 10.3341/kjo.2006.20.2.128

PMC ID: 2908828

PubMed ID: 16892651

SO-VID: a2717177-34a0-4a9d-bd05-7695aa1be967

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Multiple Retinal Hemorrhage following Anterior Chamber Paracentesis in Uveitic Glaucoma

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Abstract

Purpose

Methods

Results

Conclusions

Related collections

Karger: Ophthalmology

Most cited references 13

Retinal autoregulation in open-angle glaucoma.

Postsurgical hypotony: relationship to fistulization, inflammation, chorioretinal lesions, and the vitreous.

Complications of glaucoma surgery. Ocular decompression retinopathy.

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