Choroidal Ischemia and Serous Macular Detachment Associated with Severe Postoperative Pain

To report the association of a unilateral serous macular detachment with severe postoperative pain. A 71-year-old woman presented with a sudden decrease in vision in the right eye, seven days after a total knee replacement arthroplasty. The patient's history was unremarkable except for a severe pain greater than the visual analog scale of 8 points for about 2 days after surgery. Retinal examination showed a well differentiated serous detachment that was about 3.5 disc diameter in size and located in the macular area. Fluorecein angiography and indocyanine green angiography showed delayed perfusion of the choriocapillaris without leakage points in the early phase and persistent hypofluorescence with pooling of dye in the subretinal space in the late phase. There was a spontaneous resolution of the serous detachment and the choroidal changes with residual pigment epithelial changes. Severe postoperative pain may influence the sympathetic activity and introduce an ischemic injury with a focal, choroidal vascular compromise and secondary dysfunction of overlying RPE cells in select patients.

The Effect of Photodynamic Therapy in Chronic Central Serous Chorioretinopathy

PURPOSE: To determine whether photodynamic therapy (PDT) is effective and safe for the treatment of chronic central serous chorioretinopathy (CSC) in Korean patients. METHODS: Eleven eyes of 11 patients with chronic CSC underwent PDT. The laser spot size was chosen to cover the hyperfluorescent area on indocyanine green (ICG) angiography principally and to cover wide area including leaking point or detachment of retinal pigment epithelium on fluorescein angiography. We analyzed the medical records retrospectively to know the changes in visual acuity and serous detachment. RESULTS: The mean follow-up was 14.2+/-6 months and exudative macular detachments resolved completely in 11 eyes within 1 month. In addition, eight weeks after treatment, the visual acuity improved in 3 eyes, and remained unchanged in 7 eyes and decreased in one eye. However, in 2 eyes, visual acuity decreased immediately after PDT due to choroidal hypoperfusion, and in one of them, the final visual acuity did not recover to the pre-treatment level. CONCLUSIONS: In Korean patients, PDT seems to be effective for treatment of chronic CSC in the short term, but the long-term efficacy still must be determined. In addition, in PDT used for treatment of choroidal neovascularization (CNV), there was a possibility of irreversible occlusion in normal choroidal capillaries. Further studies are needed to determine the treatment parameters of PDT.

Acute Central Serous Choricoretinopathy and Choroidal Circulatory Changew: Indocyanine Green Angiographic Findings

We performed indocyanine green angiography(ICGA) in 21 eyes of 21 patients with acute central serous chorioretinopathy(CSC) to investigate choroidal cirulatory changes in this disease. Heidelberg retina angiograph (HRA) that using confocal scanning laser ophthalmoscope was used for ICGA. In the very early phase of HRA, 19 eyes(90%) demonstrated focal areas of delayed filling usually followed by distinctively fluorescent, dilated choroidal vessels running through or around these areas. After mid-phase, diffuse intrachoroidal hyperfluorescence surrounding these dilated vessels and suggesting increased leakage from them was seen in 19 eyes(90%). The focal delays of choroidal filling seemed to reveal choroidal ischemia involved in this disease process rather than physiological delays as they were topographically associated with choroidal hyperfluorescence in the later phase of HRA and leaking points on fluoresecein angiogram. Based on these findings, we suggest the choroid as the primary pathologic focus of acute CSC. Also we propose a scenario of pathogenesis, beginning with choroidal ischemia that leads to increased leakage from choroidal vessels, secondary changes of retinal pigment epithelium and passage of fluid in the subretinal space.

Ischemic Changes in Hypertensive Choroidopathy by Fluorescein Angiography

The retinal and choroidal blood vessels respond independently to the abruptly increased arterial pressure due to their differences in the anatomic and physiologic properties, which induce hypertensive retinopathy and hypertensive choroidopathy respectively. The authors reviewed the fluorescein angiogram retrospectively to observe the ischemic changes of the choroid in 15 cases of hypertensive choroidopathy. The ischemic changes of the choroid in hypertensive choroidopathy were characterized by generalized or sectorial filling delay which was followed by staining or leakage of dye. These findings suggest that the choroidal circulation may lead to the sectorial and generalized ischemic conditions following the abruptly increased arterial pressure due to their differences in the anatomic structures. The fluorescein angiographic findings in the hypertensive choroidopathy depend on both the degree of the circulatory disturbance and the levels of the affected choroidal vessels.