Extensive Serous Retinal Detachment after Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

Abstract

Purpose:To report a case with extensive serous retinal detachment (SRD) after photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV) Case summary: A 72 year old man visited our clinic complaining of visual disturbance in the left eye for 1 week. Visual acuity (VA) was finger counting at 30 cm in the left eye. The fundus was invisible due to vitreous hemorrhage, and so vitrectomy was performed; atrophic scar on the posterior pole and extensive subretinal hemorrhage over the inferior retina were seen during surgery. One week after surgery, best corrected visual acuity was 0.075. Three weeks after vitrectomy, large pigment epithelial detachment superior to the fovea and cystic lesions in the retina were seen on optical coherence tomography, and a branching vascular network and polyps were found on indocyanine green angiography. Thus, PDT was performed for PCV treatment. Two weeks after PDT, the patient complained of decreased vision and superior visual field defect. On fundus examination, extensive retinal detachment (RD) reaching below the fovea was found, but no retinal break or hole was found. Thus, intravitreal anti-vascular endothelial growth factor injection had been performed at 5 months.However, RD gradually progressed to fovea and subretinal fibrosis was developed. Surgical treatment with retinotomy, subretinal fluid drainage and fluid-gas exchange was performed. The retina was flattened after surgery and VA recovered to 0.1. Conclusions:Transient SRD is often seen after PDT for age related macular degeneration or PCV, but extensive SRD is very rare. Surgical treatment may be another treatment option in such cases.