Multiple retinal haemorrhages (decompression retinopathy) following paracentesis for macular branch artery occlusion

Inappropriate investigation and management of a retinal vascular occlusion

“…1 We agree with Professor McLeod that it is of fundamental importance to determine whether the initial event in our patient's disorder was arterial or venous in nature, as this could affect future prognosis and would have altered the acute management. Our patient presented within a few hours of a sudden and profound onset of a central scotoma, which reduced his visual acuity to hand movements.…”

“…The ocular symptoms include visual loss, amaurosis fugax, diplopia and eye pain. 1 Ocular ischaemic lesions described are anterior ischaemic optic neuropathy, posterior ischaemic optic neuropathy, central retinal artery occlusion, cilioretinal artery occlusion and CWSs. 1 The symptoms and signs can be seen in a variety of combinations.…”

“…It also obviates any need to postulate an underlying retinal microvasculopathy of systemic origin to account for the 'decompression retinopathy'. 1 Thus, hemisphere retinal vein obstruction predicts and explains the haemorrhagic consequences of a procedure (ie, paracentesis) that is ineffectual anyway in its aim of improving cilioretinal perfusion. I say this having made the same mistake myself 30 years ago.…”

Reply to Professor McLeod

“…5 We would like to thank Professor McLeod's interesting and stimulating comments regarding our recent case report concerning the formation of Roth spots and retinal haemorrhages after paracentesis for a presumed segmental retinal artery occlusion. 1 We agree with Professor McLeod that it is of fundamental importance to determine whether the initial event in our patient's disorder was arterial or venous in nature, as this could affect future prognosis and would have altered the acute management. Our patient presented within a few hours of a sudden and profound onset of a central scotoma, which reduced his visual acuity to hand movements.…”

Ocular Decompression Retinopathy : A Case Series

“…This was followed by other reports corroborating the occurrence of this entity after glaucoma surgery. Thereafter it was described after minor procedures in the gamut of glaucoma management like iridotomy, iridoplasty, anterior chamber paracentesis by Gupta et al (2005) and rarely following medical management. Other surgical procedures implicated in its aetiology are also orbital decompression, phacoemulsification and vitrectomy.…”