[Choroidal effusion after uncomplicated cataract surgery].
BACKGROUND
Intake of ACE inhibitors may promote angioedema which can appear months and years after the medication has been stopped. Surgery and local anaesthesia can further aggravate angioedema. A 61-year-old patient with age-related cataract was admitted to our hospital for elective out-patient cataract surgery. A few days after surgery, the patient complained of pain and reduced vision in the operated eye.


RESULTS
Postoperative findings were elevated intraocular pressure (28 mmHg) and a significant reduction of vision. The anterior chamber was shallow. Ophthalmoscopy showed a circumferential choroidal and focal exudative retinal detachment. Local and systemic therapy with antiglaucomatous medications as well as steroids (methylprednisolone) and antibiotics (ciprofloxacin) resulted in control of the eye pressure and an increase of vision. After two weeks, the choroidal detachment disappeared. Important preexisting diseases included a minimal change glomerulonephritis under treatment with low doses of cortisone (4 mg), as well as arterial hypertension. An ACE inhibitor (ramipril) was taken.


CONCLUSIONS
ACE inhibitor intake might be associated with choroidal effusion. A preoperative change to another antihypertensive medication should be considered in patients with a tendency to develop angioedema. A glomerulonephritis might also support edema. Patients with such edema should undergo diagnostic evaluation and receive treatment before cataract surgery.
Augenheilkunde, Gemeinschaftspraxis, St. Wendel. irisfromberg@gmx.de
I
I
Fromberg
M
M
Krause
K
K
Brückner
M
M
Lang
B
B
Seitz
D000799:Angioedema / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002387:Cataract Extraction; D015862:Choroid Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D002939:Ciprofloxacin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000150:complications; D009404:Nephrotic Syndrome / Q000150:complications; D009798:Ocular Hypertension / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy; D011183:Postoperative Complications / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D017257:Ramipril / Q000009:adverse effects* / Q000627:therapeutic use; D012163:Retinal Detachment / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D012307:Risk Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002939:Ciprofloxacin; D017257:Ramipril; D008775:Methylprednisolone