Bullous Exudative Retinal Detachment after Retinal Pattern Scan Laser Photocoagulation in Diabetic Retinopathy

Pachychoroid as a Risk Factor for Exudative Retinal Detachment After Panretinal Photocoagulation: A Report of Two Cases

In this case series of two patients, we discuss pachychoroid as a risk factor for predicting exudative retinal detachment (RD) after panretinal photocoagulation (PRP). The first patient was a 55-year-old diabetic male with unstable proliferative diabetic retinopathy (PDR), serous pigment epithelial detachment (PED), and pachychoroid confirmed via fluorescein angiography (FA) and optical coherence tomography (OCT), who underwent PRP. Post-PRP, the patient complained of visual loss in both eyes. Subsequent FA and OCT confirmed the presence of exudative RD, which resolved after a course of non-steroidal anti-inflammatory eyedrops. The second patient was a 50-year-old male with PDR, serous PED, and pachychoroid confirmed via OCT, who underwent PRP. Post-PRP, he had reduced vision due to exudative RD. His vision improved upon the resolution of the exudative RD after three weeks. Pachychoroid is known to be associated with PDR. In the presence of pachychoroid, PRP-induced inflammation overwhelms the retinal pigment epithelium due to preexisting choroidal thickening, leading to exudative RD. These cases highlight how the identification of pachychoroid before laser PRP can help in predicting exudative RD as a post-procedure complication.

Choroidal and retinal exudative changes following extensive endolaser pan retinal photocoagulation

BACKGROUND

In this report, we describe a case of proliferative diabetic retinopathy that developed into exudative changes confusing with central serous chorioretinopathy (CSCR) following extensive endolaser pan retinal photocoagulation.

CASE DESCRIPTION

A 49-year-old male patient with diabetic retinopathy in both eyes presented with vitreous hemorrhage and 6/60 visual acuity in his left eye. Optical coherence tomography (OCT) scans at presentation revealed serous PEDs in both eyes. On day 10 after vitreoretinal surgery and complete peripheral endolaser PRP for the left eye, there was serous retinal detachment (SRD) and an increase in PED heights, mimicking CSCR. No additional treatment was considered. At the three-week post-operative visit, OCT scans revealed that the SRD had resolved and the PED heights had decreased without rupture. At the final follow-up visit, 12 weeks after surgery, the SRD had not recurred, and the PEDs had stabilized. Despite no additional ocular therapy for the right eye, the serous PED height had decreased. The choroidal thickness (CT) at the fovea at various points during the follow-up visits revealed a reduction in both eyes.

CONCLUSION

This case demonstrated the course of SRD, PED, and CT following extensive PRP. These changes may be associated with intraocular VEGF changes. In the presence of SRD and serous PED, the PED morphology may help differentiate the condition from CSCR. Although caution should be exercised when performing PRP during surgery or as an outpatient procedure, the SRD usually resolves without problem.

NOVEL OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN SEROUS MACULAR DETACHMENT AFTER PANRETINAL PHOTOCOAGULATION

PURPOSE

To describe a novel optical coherence tomography finding in a case of macular serous retinal detachment after pars plana vitrectomy and panretinal photocoagulation.

METHODS

Retrospective case report.

RESULTS

A 52 year old male with diabetes underwent uncomplicated pars plana vitrectomy with panretinal photocoagulation for non-clearing vitreous hemorrhage, Postoperative course was complicated by significantly decreased vision and a macular serous retinal detachment that was characterized on optical coherence tomography by a reticular network of hyperreflective bands in the subretinal space. Fluid and hyperreflective material in the subretinal space resolved by postoperative Week 6 with standard postoperative eye drops. However, persistent ellipsoid zone disruption was seen up to postoperative Week 20.

CONCLUSION

Extensive subretinal bands can be seen after panretinal photocoagulation. This novel finding can pose diagnostic and management challenges but may resolve with conservative medical management.

IGF-1, Inflammation and Retinal Degeneration: A Close Network

Retinal degenerative diseases are a group of heterogeneous diseases that include age-related macular degeneration (AMD), retinitis pigmentosa (RP), and diabetic retinopathy (DR). The progressive degeneration of the retinal neurons results in a severe deterioration of the visual function. Neuroinflammation is an early hallmark of many neurodegenerative disorders of the retina including AMD, RP and DR. Microglial cells, key components of the retinal immune defense system, are activated in retinal degenerative diseases. In the microglia the interplay between the proinflammatory/classically activated or antiinflammatory/alternatively activated phenotypes is a complex dynamic process that occurs during the course of disease due to the different environmental signals related to pathophysiological conditions. In this regard, an adequate transition from the proinflammatory to the anti-inflammatory response is necessary to counteract retinal neurodegeneration and its subsequent damage that leads to the loss of visual function. Insulin like-growth factor-1 (IGF-1) has been considered as a pleiotropic factor in the retina under health or disease conditions and several effects of IGF-1 in retinal immune modulation have been described. In this review, we provide recent insights of inflammation as a common feature of retinal diseases (AMD, RP and RD) highlighting the role of microglia, exosomes and IGF-1 in this process.