Systemic Steroid Therapy for Serous Retinal Detachment Caused by Excessive Endolaser during Diabetic Retinopathy Surgery

Ji Soo Shin; Chung Hwan Kim; Young Suk Chang; Young Hoon Lee

doi:10.3341/jkos.2016.57.6.1004

Journal List > J Korean Ophthalmol Soc > v.57(6) > 1010323

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Shin, Kim, Chang, and Lee: Systemic Steroid Therapy for Serous Retinal Detachment Caused by Excessive Endolaser during Diabetic Retinopathy Surgery

Case Report

J Korean Ophthalmol Soc 2016;57(6):1004-1011.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.6.1004

Systemic Steroid Therapy for Serous Retinal Detachment Caused by Excessive Endolaser during Diabetic Retinopathy Surgery

Ji Soo Shin, MD, Chung Hwan Kim, MD, Young Suk Chang, MD, Young Hoon Lee, MD

Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea

Address reprint requests to Young Hoon Lee, MD Department of Ophthalmology, Konyang University Hospital, #158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Korea Tel: 82-42-600-9258, Fax: 82-42-600-9251 E-mail: Astrix001@gmail.com

Received 5 June 2015 Revised 30 October 2015 Accepted 30 December 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report cases of macular serous retinal detachment caused by excessive intraoperative endolaser in patients with diabetic vitreous hemorrhage. Macular serous retinal detachment was improved by systemic steroid therapy.

Case summary

A 64-year-old male (case 1) and a 67-year-old female (case 2) treated with vitrectomy and endolaser (case 1, 3,184 shots; case 2, 1,734 shots) because of diabetic vitreous hemorrhage visited our outpatient clinic with blurred vision. Best corrected visual acuity (BCVA) in case 1 was hand motion and 0.03 in case 2. Fundus examination and optical coherence tomography (OCT) revealed extensive subretinal fluid accumulation of the posterior pole. With the diagnosis of macular serous retinal detachment caused by excessive intraoperative endoaser, oral steroid (40 mg/qd, 5 days) was administered and then later reduced in case 1. In case 2, we administered intravenous high-dose steroid (250 mg/qid, 3 days). After systemic steroid therapy, BCVA was improved to 20/30 in case 1 and 20/40 in case 2 and OCT showed the subretinal fluid was resolved.

Conclusions

During diabetic retinopathy surgery, excessive endolaser induced macular serous retinal detachment and systemic steroid therapy was necessary in diabetic patients. Thus, physicians should be well acquainted with this complication.

Keywords: Endolaser, Macular serous retinal detachment, Systemic steroid therapy, Vitrectomy

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Figure 1.

Fundus photographs and B-scan ultrasonography at the time of initial examination. The fundus of Case 1 (A) and Case 2 (B) were invisible due to vitreous hemorrhage. The B-scan ultrasonography of case 1 (C) and case 2 (D) show vitreous opacity indicating vitreous hemorrhage.

Figure 2.

Fundus photographs, fluorescein angiography (FAG) and optical coherence tomography (OCT) of case 1. (A) The fundus photograph shows serous retinal detachment of macula. (B) The FAG shows no remarkable leakage of fluorescein dye at the posterior pole. Late staining of fluorescein dye was observed. (C) The OCT at the first visiting after operation shows serous retinal detachment with marked retinal elevation caused by fluid displacement. (D) 2 weeks after steroid therapy, Subretinal fluid was not observed on OCT.

Figure 3.

Fundus photographs, fluorescein angiography (FAG) and optical coherence tomography (OCT) of case 2. (A) The fundus photograph shows serous retinal detachment of macula. (B) The FAG shows late leakage and late staining of fluorescein dye. (C) The OCT at the first visiting after operation shows serous retinal detachment with marked retinal elevation caused by fluid displacement. (D) 2 weeks after steroid therapy, Minimal subretinal fluid was observed on OCT. Disruption of inner segment/outer segment of photoreceptor cell (IS/OS) junction was recovered progressively.

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