|Year : 2022 | Volume
| Issue : 2 | Page : 189-190
Posterior choroidal effusion following uneventful cataract surgery
B Koshal Ram, Anusha Koshal Ram, S Balasubramanian
Department of Ophthalmology, Ponnammal Duraiswamy Eye Hospital, Coimbatore, Tamil Nadu, India
|Date of Submission||22-Apr-2021|
|Date of Acceptance||10-Jan-2022|
|Date of Web Publication||30-Jun-2022|
B Koshal Ram
Department of Ophthalmology, Ponnammal Duraiswamy Eye Hospital, Coimbatore, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Posterior choroidal effusion occurs in the setting of sudden changes in intraocular pressure which facilitates the influx of fluid in the suprachoroidal space. The reason for sudden intraocular pressure fluctuation can be due to varied causes such as filtering surgery, use of antiglaucoma medication. In our case, it was following an uneventful cataract surgery in which the patient presented with a choroidal elevation on the first postoperative day. He was treated with systemic steroids and the choroidal elevation settled in 2 weeks. We present a serial optical coherence tomography imaging of the patient which showed a resolution.
Keywords: Choroidal elevation, posterior choroidal effusion, subretinal fluid, suprachoroidal space
|How to cite this article:|
Ram B K, Ram AK, Balasubramanian S. Posterior choroidal effusion following uneventful cataract surgery. TNOA J Ophthalmic Sci Res 2022;60:189-90
|How to cite this URL:|
Ram B K, Ram AK, Balasubramanian S. Posterior choroidal effusion following uneventful cataract surgery. TNOA J Ophthalmic Sci Res [serial online] 2022 [cited 2022 Nov 30];60:189-90. Available from: https://www.tnoajosr.com/text.asp?2022/60/2/189/349524
| Introduction|| |
Choroidal effusion occurs when the fluid collects in the suprachoroidal space, which is a potential space between the choroid and the sclera. The primary cause of choroidal effusion and hemorrhage is low intraocular pressure (IOP), although inflammation can sometimes play a role. Other risk factors include anticoagulation, aphakia, high myopia, prior ocular surgery, hypotony, straining, hypertension, and heart and respiratory disease.
| Case Report|| |
A 72-year-old male underwent uneventful cataract surgery with implantation of hydrophobic IOl. He was a known patient with primary open angle glaucoma on medical treatment with prostaglandin analog. He presented with a blurred vision on the first postoperative day after uneventful cataract surgery. Intraoperatively, the surgeon had experienced a tense eye ball during the final stages of nuclear emulsification and completed the case uneventfully with implantation of hydrophobic intraocular lens. On examination, the best-corrected visual acuity in the right eye was 6\60. No improvement with pinhole. Anterior segment examination RE reveals a well-placed IOL in the capsular bag. The anterior chamber depth was normal. Fundus revealed an enlarged cup-disc ratio of 0.7 a dome-shaped swelling in the posterior pole in the right eye. Examination of the other eye was normal with 6/6 vision an optical coherence tomography (OCT) imaging of the macula revealed a dome-shaped elevation with a convexity at the macula with a shallow subretinal fluid [Figure 1]. The elevation was located only in the posterior pole in the macular region. There was no choroidal thickening in ultrasound B-scan. There was no disc swelling. An angiogram revealed no leakage or hyperflurescence. The patient was started on oral steroid 1 mg/kg body weight. After 7 days, the patient had symptomatic improvement of vision to 6/24 in the right eye. The dome-shaped elevation gradually receded and the convexity had decreased considerably [Figure 2]. The subretinal fluid in the posterior pole and macula had considerably decreased. After 14 days, the BCVA had improved to 6/6. The elevation had subsided in the posterior pole. OCT revealed no subretinal fluid and normal organization of the choroid and retinal layers [Figure 3].
|Figure 1: Optical coherence tomography first postoperative day line scan at the fovea right eye showing choroidal bulge and serous detachment in the macula in the initial presentation|
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|Figure 2: Optical coherence tomography after 1 week of surgery line scan at the fovea right eye showing the decreased choroidal bulge and persistent serous detachment|
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|Figure 3: 2 weeks optical coherence tomography line scan at the fovea right eye showing almost flattening of choroid with minimal serous detachment|
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| Discussion|| |
The primary cause of choroidal effusion and hemorrhage is low IOP, although inflammation can sometimes play a role. If a choroidal effusion, outcomes can be good with prompt recognition and management. The key is to prevent a posterior choroidal effusion from developing into supra choroidal hemorrhage if left untreated which can become a potential visually significant problem.
Patients with nanophthalmos, choroidal hemangioma, carotid cavernous fistula, Sturge − Weber syndrome, and other conditions associated with increased episcleral venous pressure are also predisposed to choroidal effusion and hemorrhage. Intraoperatively, the surgeon may notice a decreased red reflex 3 and positive posterior pressure causing shallowing of the anterior chamber. The patient may note an increased intensity of pain. In our patient, there was a tense eye intraoperatively after the implantation of the intraocular lens. The surgeon immediately had noticed and closed the wound. The most important step in the management of choroidal effusion is to recognize intraocular pressure fluctuation and close the incision as quickly as possible. In this case, the presence of preexisting glaucoma and sudden intraocular pressure change intraoperatively resulted in choroidal elevation in the posterior pole. This was a reported case of posterior choroidal effusion presenting with posterior pole elevation after uneventful cataract surgery which resolved with steroids.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Roa TM, Sara De La Rosa, Netland PA. Five Pointers on Choroidal Effusion and Suprachoroidal Hemorrhage How to Avoid, Recognize, and Manage these Conditions as a Glaucoma Specialist Today. Glaucoma Today; July/August 2019.
Learned D, Eliott D. Management of delayed suprachoroidal hemorrhage after glaucoma surgery. Semin Ophthalmol 2018;33:59-63.
Chu TG, Green RL. Suprachoroidal hemorrhage. Surv Ophthalmol 1999;43:471-86.
[Figure 1], [Figure 2], [Figure 3]