title: Choroidal detachment after uncomplicated small incision cataract surgery.
abstract: OBJECTIVE
  Angioedema is a well-recognized side effect of angiotensin-converting enzyme inhibitors, but is rarely associated with angiotensin II receptor blockers (ARB). Here, we report the first case of a patient on ARB therapy (telmisartan) for hypertension who developed serous choroidal detachment localized to the posterior pole after sub-Tenon anesthesia for small incision cataract surgery.
  
  
  RESULTS
  An 82-year-old Japanese woman who received oral medications for hypertension underwent cataract surgery with sub-Tenon anesthesia using 2% Xylocaine(®) on her left eye. Her corrected distance visual acuity improved to 20/25 on the first day after the surgery. On the fifth day, however, it decreased to 20/40 and choroidal detachment was detected at the posterior pole. We suspected an increase of choroidal vascular permeability and started oral steroid therapy. After 1 week, the area of detachment was smaller and her acuity improved to 20/20. Subsequently, she underwent cataract surgery without sub-Tenon anesthesia on her right eye, and no choroidal detachment occurred.
  
  
  CONCLUSIONS
  This is the first published case of ARB-induced choroidal detachment after uncomplicated small incision cataract surgery. Sub-Tenon anesthesia may aggravate angioedema associated with ARB therapy, so ophthalmologists should be aware of this rare complication.
authors: Department of Ophthalmology, Tokyo Women's Medical University School of Medicine, Tokyo, and Saiseikai Kurihashi Hospital, Saitama, Japan.
authors: Chikako
authors: C
authors: Suto
authors: Satoru
authors: S
authors: Mita
authors: Sadao
authors: S
authors: Hori