Indian Journal of Ophthalmology

LETTER TO THE EDITOR
Year
: 2012  |  Volume : 60  |  Issue : 2  |  Page : 162--163

Aggravation of polypoidal choroidal vasculopathy after cataract surgery


Moosang Kim1, Jisang Han2, Seung-Young Yu2, Hyung-Woo Kwak2,  
1 Department of Ophthalmology, School of Medicine, Kangwon National University, Chuncheon, Korea
2 Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea

Correspondence Address:
Seung-Young Yu
#1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702
Korea




How to cite this article:
Kim M, Han J, Yu SY, Kwak HW. Aggravation of polypoidal choroidal vasculopathy after cataract surgery.Indian J Ophthalmol 2012;60:162-163


How to cite this URL:
Kim M, Han J, Yu SY, Kwak HW. Aggravation of polypoidal choroidal vasculopathy after cataract surgery. Indian J Ophthalmol [serial online] 2012 [cited 2020 May 30 ];60:162-163
Available from: http://www.ijo.in/text.asp?2012/60/2/162/94070


Full Text

Dear Editor,

Polypoidal choroidal vasculopathy (PCV) is considered to be variant of choroidal neovascularisation. [1] We report a case where PCV was aggravated shortly after cataract surgery and accompanied by submacular hemorrhage in an asymptomatic PCV patient.

A 68-year-old woman complained of decreased visual acuity (VA) of the left eye. The best-corrected VA was 20/25 in the right eye and 20/40 in the left and the intraocular pressure (IOP) was 16 mmHg in both eyes. A slit-lamp examination showed mild nuclear sclerosis of both lenses. The fundus examination of the left eye revealed what looked like pigment epithelial detachment (PED); therefore, fluorescein angiogram (FA) and indocyanine green angiogram (ICGA) were performed. ICGA showed a branching vascular network (BVN) terminating in polypoidal swelling and serous PED [Figure 1]a. Since the VA was not affected significantly and no additional finding such as metamorphopsia was made, it was decided to conduct follow-up observations. Three years later, the VA of left eye decreased to 20/200, and fundus could not be evaluated precisely. Patient wanted cataract surgery to be performed. The cataract surgery was performed without complication. The VA improved to 20/25 one day after cataract surgery, but the patient continuously complained of dim vision. The VA showed an abrupt drop to 20/50 one week after the surgery and she complained of metamorphopsia. The fundus examination showed submacular hemorrhage [Figure 1]b. Photodynamic therapy was performed and intravitreal bevacizumab (1.25 mg) was given three times every six weeks [Figure 2]. Submacular hemorrhage disappeared but irregular PED was still found on optical coherence tomography (OCT). The BVN and polypoidal lesion also remained. [Figure 1]c; however, the VA improved to 20/30 and the metamorphopsia of the patient disappeared.{Figure 1}{Figure 2}

But the reason why the lesion that had remained asymptomatic for a few years got aggravated in a short time following cataract surgery can be found in terms of the hemodynamics in the choroid in this case. As for the relationship between IOP and blood flow to the eye, Zhao et al., [2] measured IOP during cataract surgery for humans by breaking down the procedure into three phases (A: Cortical cleanup, B: Nuclear disassembly and C: Anterior capsular polishing). They reported on a big fluctuation in IOP ranging from 13±4.7 mmHg preoperatively to 96±6.2 mmHg at the maximum. Normal retinal vessels have a sufficient autoregulative capacity so that the blood flow to the retina can be maintained at a constant level even if there is some change in IOP; [3] however, choroidal vessels have a limited capacity which leads to a diminished blood flow to the choroid even when IOP increases or the arterial pressure decreases slightly. An abrupt fall in the IOP can cause an increase in the blood flow to the choroid and the blood vessels of the elderly patients are so vulnerable that vascular rupture and hemorrhage can occur [4] [Figure 3].{Figure 3}

In summary, we reported a case where an asymptomatic PCV patient showed submacular hemorrhage derived from PCV in a short period of time following cataract surgery.

References

1Uyama M, Wada M, Nagai Y, Matsubara T, Matsunaga H, Fukushima I, et al. Polypoidal choroidal vasculopathy: Natural history. Am J Ophthalmol 2002;133:639-48.
2Zhao Y, Li X, Tao A, Wang J, Lu F. Intraocular pressure and calculated diastolic ocular perfusion pressure during three simulated steps of phacoemulsification in vivo. Invest Ophthalmol Vis Sci 2009;50:2927-31.
3Sossi N, Anderson DR. Effect of elevated intraocular pressure on blood flow: Occurrence in the cat optic nerve head studied with iodoantipyrine I 125. Arch Ophthalmol 1983;101:98-101.
4Givens K, Shields MB. Suprachoroidal hemorrhage after glaucoma filtering surgery. Am J Ophthalmol 1987;103:689-94.