Immediate Manifestation of Ocular Decompression Retinopathy following Anterior Chamber Paracentesis

Abstract

Ocular decompression retinopathy (ODR) is a complication of rapid lowering of intraocular pressure (IOP) resulting in hemorrhages in multiple retinal layers. We report a case of ODR that developed within minutes following anterior chamber paracentesis in an adult female with primary open-angle glaucoma. A 61-year-old Black woman with primary open-angle glaucoma presented with marked elevation of IOP (46 mm Hg in the right eye and 30 mm Hg in the left) despite maximal medical therapy and bilateral selective laser trabeculoplasty. Vision in the right eye decreased from counting fingers at 3 feet 1 week earlier to no light perception at the time of presentation. Anterior chamber paracentesis was performed on the right eye to reduce IOP and stabilize the eye until further surgical intervention could be performed. IOP in the right eye decreased to 6 mm Hg postoperatively. Within minutes of the procedure, several intraretinal blot hemorrhages appeared in the periphery of the right eye. During this time, visual acuity remained at no light perception. The findings were consistent with decompression retinopathy. By 12 weeks postoperatively, the ODR had resolved with visual acuity of light perception and normal fundoscopy except for profound cupping. Our case demonstrates how rapidly ocular decompression can form following IOP reduction.

Weather as a possible risk factor for massive ocular decompression retinopathy: A case report

“…Moreover, a sudden anterior shift of the lamina cribrosa may obstruct vascular and axonal flow in the optic nerve, venous stasis, optic disc oedema, thus leading to the variant of central retinal vein occlusion. 2,8…”

“…Moreover, a sudden anterior shift of the lamina cribrosa may obstruct vascular and axonal flow in the optic nerve, venous stasis, optic disc oedema, thus leading to the variant of central retinal vein occlusion. 2,8 Retinal haemorrhages in ODR should be primarily differentiated against central retinal vein occlusion, Valsalva retinopathy, Terson syndrome, ocular ischemic syndrome, diabetic retinopathy, coagulopathies, and other systemic abnormalities. 2 However, after careful observation and various evaluations, no signs of previous retinopathy or systemic disease were detected that could have contributed to these conditions.…”

<p>Reduction of Intraocular Pressure Spikes Due to Intravitreal Bevacizumab Injections by Scleral Indentation with Cotton Swab or Digital Ocular Massage: Innovative Techniques Compared</p>

“…So, it could decrease too quickly or too much, with risk of ocular decompression retinopathy, a complication of rapid lowering of IOP resulting in haemorrhages in multiple retinal layers. 37 In contrast, an ocular digital massage is a closed globe strategy that potentially allows a modulation of the IOP decrease: if performed by an experienced operator, it could also be possible to feel with fingers the ocular hypertension and, if necessary, to apply the required pressure, being able to stop in case of emerging excessive hypotension. So, ocular manipulation seems to be less invasive and safer than AC paracentesis to control post-IVI hypertonia.…”

<p>Intraoperative Ocular Decompression Retinopathy During 23 Gauge Transconjunctival Vitrectomy: A Case Report</p>

“…13 The mean time to diagnosis of ODR is 1.5±2.0 days following surgery, 3 but occurrence as early as within minutes has been reported. 7,8 In spite of the fact that fundus finding in ODR is prominent, 80% of patients are symptomless, with 3,6,9,14 The retinal hemorrhages associated with ODR are relatively benign with 85% of eyes regaining baseline vision.…”