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Y. Leiderman, R.V. P. Chan, S. Mukai; Hemorrhagic Retinopathy Following Acute Reduction of Intraocular Pressure . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1041.
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Hemorrhagic retinopathy following surgical ocular decompression (sometimes called "decompression retinopathy") is a rare entity that has been reported almost exclusively in association with glaucoma surgery. We present a series of 6 cases of hemorrhagic retinopathy following ocular therapeutic interventions: 3 cases following trabeculectomy, 2 following pars plana vitrectomy (PPV), and one following laser peripheral iridotomy (LPI).
Retrospective review of a small series of cases of hemorrhagic retinopathy in the setting of acute reduction of intraocular pressure (IOP) by intraocular surgery or LPI.
We identified 6 eyes in 6 patients that demonstrated various retinal hemorrhagic events in the perioperative period as follows: 3 cases of intraretinal hemorrhage following mitomycin–C (MMC) trabeculectomy, one also with low–lying choroidal detachment; PPV followed by the appearance of white–centered intraretinal hemorrhages (Roth spots); the appearance of preretinal, intraretinal, and subretinal hemorrhage during PPV and lensectomy in the setting of phacoantigenic glaucoma; and the appearance of vitreous, intraretinal, and subretinal hemorrhage following Nd:YAG LPI. Each of the 6 cases described herein demonstrated a hemorrhagic retinopathy in association with elevated preoperative IOP, followed by a sudden reduction of IOP – either via intraocular surgery or laser iridotomy.
Atraumatic hemorrhagic retinopathy is a rare complication following glaucoma surgery such as MMC trabeculectomy. We have shown that this can also occur after PPV or LPI. Increased IOP in the preoperative period appears to be an associated risk factor; additional potential risk factors include intraocular inflammation and local or systemic hemodynamic or vascular pathology. The rate of reduction of IOP may also be a factor. It can occur quickly, as early hemorrhages were noted during PPV in one case.
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