Bullus Retinal Detahment After Single Photodynamic Therapy

Abstract

Purpose:: We present a case of serous and bullous retinal detachment after photodynamic therapy (PDT) who underwent successful vitrectomy and photocoagulation.

Methods:: In October 2005, a 74-year-old man was presented with loss of visual acuity in his right eye. He had suffered from central serous retinochoroidopathy in his right eye when he was thirty years old.At the time of the initial visit, the best-corrected visual acuity (BCVA) of the involved eye was 9/100. The clinical examination revealed a macular edema with subretinal hemorrhage and pigment epithelial cell atrophy in the lateral area of the macula. In the late phase, IA revealed polypoidal vessels and network vessels in the early phase. We diagnosed the case with PCV from the above findings. We performed an IA-guided PDT with Verteporfin on January 26, 2006. Three months after PDT,the involved eye developed serous and bullous retinal detachment including the macula area. Fundus examination showed no retinal tear; therefore, we confirmed that there was no pigment epithelial tear. FA revealed leakage in several spots in the posterior pole. IA showed low density around the area of PDT, and the choroidal vessel had became narrower in the atrophic area and more distended around the atrophic area compared with those before PDT in IA .We observed the patient for two months, but serous retinal detachment did not improve.

Results:: We performed vitrectomy to photocoagulate the leakage points on June 22, 2006. The retina was reattached after surgery. The leakage was improved in FA. There was no recurrence of retinal detachment in the subsequent follow-up examinations during the first four months after treatment. The patient’s visual acuity remains stable at 9/100.

Conclusions:: This case was supposed to be associated with some kind of choroidal circulation disturbance and pigment epithelial cell weakness before PDT due to his past history of central serous retinochoroidopathy and the presence of pigment epithelial cell atrophy. We considered that a certain level of damage in retinal pigment epithelial cells secondary to choroidal circulation disturbance by PDT might be causative of blood retinal barrier breakdown and pump failure in this case. We should be careful not to invite such a complication in patients with choroidal circulation disturbance and pigment epithelial cell weakness before PDT.

Keywords: age-related macular degeneration • retinal detachment • photodynamic therapy