Korean J Ophthalmol.  2005 Jun;19(2):128-131. 10.3341/kjo.2005.19.2.128.

Decompression Retinopathy after Trabeculectomy

• Jea SY
• Jung JH

• KMID: 754410
• DOI: http://doi.org/10.3341/kjo.2005.19.2.128

Abstract

PURPOSE
To present a case of a unilateral diffuse retinal hemorrhage in a 15-year-old girl, who underwent bilateral trabeculectomy for steroid induced glaucoma. METHODS: Despite the maximally tolerable medical treatment, IOP in the right eye remained above 50 mmHg for four months, and was simultaneously elevated in the left eye. So we performed bilateral trabeculectomy. RESULTS: On the first postoperative day, diffuse retinal hemorrhages were observed in the right eye; however, no retinal hemorrhage was found in the left eye. The hemorrhages resolved completely without consequences two months later. CONCLUSIONS: In the case of high IOP for a long period, sudden lowering of IOP may acutely increase the blood flow and consequently rupture multiple retinal capillaries because of altered autoregulatory function. Special care is therefore needed to prevent an abrupt fall in IOP before, during, and after surgery, especially when IOP has been highly elevated for an extended period.

Keyword

Diffuse retinal hemorrhage; Ocular decompression syndrome; Retinal autoregulation; Trabeculectomy

MeSH Terms

Administration, Topical
Adolescent
Female
Fluorescein Angiography
Fundus Oculi
Glaucoma/chemically induced/*surgery
Humans
Retinal Hemorrhage/diagnosis/*etiology/pathology
Steroids/administration & dosage/adverse effects/therapeutic use
Trabeculectomy/*adverse effects
Uveitis/drug therapy

Figure

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  Fig. 1 Bleb photograph of the right eye on the first postoperative day. Note the diffuse and well-elevated bleb (black arrow). A white steroid crystal is observed in the sub-tenon capsule (white arrow).

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  Fig. 2 (A) Fundus photograph of the right eye on the first postoperative day. Diffuse retinal hemorrhages with a white center are observed in the posterior pole and peripheral fundus. (B) Fluorescein angiogram also shows multiple, blocked fluorescence due to the retinal hemorrhages, but the vascular filling appears normal. (C) Hemorrhages are almost completely resolved two months later.

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