Choroidal ischemia and serous macular detachment associated with severe postoperative pain.
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.
Jung
Jee Woong
JW
Department of Ophthalmology, Gachon University, Gil Medical Center, Incheon, Korea.
Lee
Dae Young
DY
Nam
Dong Heun
DH
D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D002829:Choroid / Q000098:blood supply*; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology*; D010147:Pain Measurement; D010149:Postoperative Pain; D012163:Retinal Detachment / Q000175:diagnosis / Q000209:etiology*; D044967:Serum; D014786:Vision Disorders / Q000209:etiology
D004396:Coloring Agents; D007208:Indocyanine Green