Choroidal Ischemia and Serous Macular Detachment Associated with Severe Postoperative Pain.
10.3341/kjo.2008.22.2.133
- Author:
Jee Woong JUNG
1
;
Dae Young LEE
;
Dong Heun NAM
Author Information
1. Department of Ophthalmology, Gachon University, Gil Medical Center, Incheon, Korea. eyedawns@gilhospital.com
- Publication Type:Case Report
- Keywords:
Choroidal ischemia;
Pain;
Serous retinal detachment;
Total knee replacement arthroplasty
- MeSH:
Aged;
*Arthroplasty, Replacement, Knee;
Choroid/*blood supply;
Coloring Agents/diagnostic use;
Female;
Fluorescein Angiography;
Humans;
Indocyanine Green/diagnostic use;
Ischemia/diagnosis/*etiology;
Pain Measurement;
*Pain, Postoperative;
Retinal Detachment/diagnosis/*etiology;
Serum;
Vision Disorders/etiology
- From:Korean Journal of Ophthalmology
2008;22(2):133-136
- CountryRepublic of Korea
- Language:English
-
Abstract:
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.
