Ocular Decompression Retinopathy

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Article initiated by:

Marianna Kavalaraki MD, Msc

All contributors:

Dimitrios Pollalis, Leo A. Kim, MD, PhD, Sun Young (Sunny) Lee, MD, PhD, Marianna Kavalaraki MD, Msc

Assigned editor:

Sun Young (Sunny) Lee, MD, PhD

Review:

Assigned status Up to Date

 by Sun Young (Sunny) Lee, MD, PhD on May 28, 2024.

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Disease Entity

Disease

Ocular decompression retinopathy (ODR) is an rare postoperative complication that occurs as a result of rapid intraocular pressure lowering interventions. The clinical appearance is characterized by multiple round intraretinal hemorrhages, some with white centers, located in the postequatorial retina.

One case of medically treated acute primary angle closure (APAC) resulting in severe visual loss owing to retinal haemorrhage has been report in literature.

The term ocular decompression retinopathy was coined by Fechner et al (1992) to describe retinal changes subsequent to iatrogenic lowering of intraocular pressure after glaucoma filtering surgery

Etiology

Glaucoma drainage implant insertion and trabeculectomy but may also occur after anterior chamber paracentesis, cataract surgery, vitrectomy, silicone oil removal, and pars plana sclerotomies. Despite the small sclerotomy caliber, it has been demonstrated that some patients develop transient hypotony and even choroidal detachment in the immediate postoperative period.

Primary prevention

Care should be taken to prevent ocular hypotony at the end of the procedure, especially in eyes with high preoperative IOP.

Diagnosis

The diagnosis of ocular decompression retinopathy is mainly clinically where about 80% of patients are asymptomatic

Symptoms

Although the fundus findings in ODR can be striking, about 80% of patients remain asymptomatic. When symptomatic, patients present with of decreased vision, a central scotoma, or floaters. In the early postoperative period. Other contributing factors, such as corneal edema, may affect vision, and it may be difficult to determine what portion of the visual loss is due to the retinal hemorrhages.

Signs

Fundoscopic findings most commonly include scattered superficial and deep blot intraretinal hemorrhages, with some white-centered hemorrhages, in the posterior pole and equatorial retina. Subhyaloid and vitreous hemorrhages are less common, but may also be present. Retinal vessels usually have a normal appearance, whereas retinal venous tortuosity and dilation are typically not observed. Choroidal detachment and macular edema are very rare in ODR.

Retinal venous tortuosity and dilation are typically not observed.

Management

Surgery

A small percentage of patients may require vitrectomy for non-resolving vitreous hemorrhage.

Prognosis

In most of the cases the disease follows a benign course with visual acuity usually returning to preoperative levels without treatment.

Pre-operative fundoscopy of a 23-year old woman with neurofibromatosis type 1 and Moyamoya syndrome showing cupped disc from gradually increased intraocular pressure (53 mmHg), which was refractory to maximum medical therapy (A). Postoperative day 1 fundus examination after Ahmed Glaucoma Valve implantation showing disc edema and multifocal retinal hemorrhages with intraocular pressure of 10 mmHg (B). Postoperative week 4 (C) and 10 (D) fundus examination demonstrating gradual improvement of the disc edema and hemorrhages with normalized intraocular pressure.