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N Borodoker, H Rodriguez-Coleman, AP Ciardella, CL Shields, JA Shields, I Donsoff, LA Yannuzzi; Polypoidal Choroidal Vasculopathy and Limited Choroidal Hemorrhage following Cataract Surgery . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1217.
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Purpose: Spontaneous choroidal hemorrhage has been described as a rare but potentially devastating complication of anterior segment surgery. We describe three cases of limited choroidal hemorrhage occurring after cataract surgery in patients with peripheral polypoidal choroidal vasculopathy (PCV). Method: Retrospective Chart Review Results: Three patients developed limited choroidal hemorrhages and retinal detachments secondary to peripheral PCV in the immediate post-operative period following uneventful cataract surgery. The event occurred 6 to 14 days (average of 9 days) after surgery. The past medical history included hypertension(1 patient), cardiovascular disease(1 patient), and emphysema (1 patient). Clinically the mass lesion resembled a choroidal melanoma. B-scan ultrasonography showed mixed reflectivity consistent more with choroidal hemorrhage than melanoma. Indocyanine green angiography identified the presence of peripheral PCV under the area of hemorrhage. The vessels could not be seen with fluorescein angiography because of blockage by the blood. The patients were monitored closely with no surgical intervention and each experienced regression of hemorrhage with fibrovascular scarring after 2 to 24 months (average of 9 months) follow-up. An area of residual localized detachment remained in 2 patients. Because of macular sparing the central vision was not affected in all patients. Conclusion: Pre-existing peripheral PCV may be a risk factor for limited choroidal hemorrhage in some patients following anterior segment surgery. Each of our patients experienced spontaneous organization of the hemorrhage with subretinal scaring and a localized residual detachment. There was a favorable natural course of the PCV with no effect on vision because of sparing of the macula. In the event of limited peripheral choroidal hemorrhage and detachment a conservative management could be considered based on the outcomes of patients in the reported series. Clinicians should be aware of this association between peripheral PCV and its consequences in patients undergoing cataract surgery. Future research is needed to develop methods of minimizing the risk of bleeding in such eyes.
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