We report a case of a highly myopic patient who presented a serous macular detachment at 24 hours after uncomplicated cataract surgery.
Surprisingly, after six days from surgery, a reabsorption of the detachment was noticed and the macular area returned to be anatomically normal without any surgical intervention. This early postoperative complication could be caused by changes in the vitreoretinal interface and ocular fluid dynamics or to a rupture of blood-retinal barriers due to postoperative inflammation.
Conclusions and importance
Our case reports on the occurrence of an early transient macular detachment after uneventful cataract surgery in a highly myopic eye. This finding suggests the importance of an OCT-based control in the immediate postoperative hours.
High myopia is defined as axial length greater than or equal to 26 mm and it is an established risk factor for pseudophakic retinal detachment as previously described. , These data refer to a long-term follow-up and a rhegmatogeneous retinal detachment. Retinal foveal elevation following cataract surgery caused by vitreomacular traction has been already reported. , However, those cases were not highly myopic eyes.
We describe an unusual case of an extreme highly myopic patient who presented a macular detachment after 24 hours from uncomplicated cataract surgery.
A 55 years-old man was referred to our service for a general ophthalmological visit. No significant general diseases nor family history for ocular diseases were registered. Best corrected visual acuity (BCVA) was 20/25 with refraction of −15.00 sphere diopters (D) in the right eye (RE) and 20/40 with −22.00D in the left eye (LE). The anterior segment biomicroscopy revealed a nuclear sclerosis of the lens without any other remarkable alterations. A myopic chorioretinopathy was evidenced bilaterally without any vitreoretinal tractions, posterior vitreous detachment (PVD) nor retinal tears at fundus examination. A macular optical coherence tomography (OCT, Cirrus 4000 HD-OCT, Carl Zeiss Meditec, Dublin, CA) was performed which evidenced a normal foveal profile ( Fig. 1 ). A IOL master (Carl Zeiss Meditec AG, Germany) was performed showing an axial length of 30.44mm in RE and 34.65mm in LE. Cataract surgery was performed uneventfully in both eyes at one week distance (firstly LE) to each other with a coaxial technique with main incision 2.2 mm and topical anesthesia with Oxybuprocaine Hydrochloride 0.4% (Novesina 0, 4%, Novartis Farma, Origgio, Italy). Posterior capsule was intact at the end of surgery in both eyes. During surgery the patient did not present blood pressure elevations. A MA60 intraocular lens (Alcon, Fort Worth, TX, USA) was implanted bilaterally with a +1.00 D in LE and +8.00 D in RE. Intracameral cefuroxime (Aprokam®, Thea Laboratories, France) at the dose of 1mg/0.1 ml was injected in the anterior chamber at the end of each surgery, as per ESCRS cataract guidelines. Post-operative therapy consisted of netilmicin/dexamethasone eyedrops 4 times a day for 15 days.
At 1-day follow-up from RE intervention, the patient referred blurry vision in the RE and the BCVA was 20/40 with −2.00D. Anterior chamber was quiet and IOL well positioned with intraocular pressure of 12 mmHg. Fundoscopy revealed macular thickening without any evidence of PVD; no peripheral choroidal detachment was evidenced. An OCT-scan revealed the presence of a serous macular detachment (Fig0.2) with a hyper-reflectivity of the inner retinal layers.
Observation was carried out in the immediate post-operative follow up. We prescribed topical (Bromfenac 0.09% eye drops twice/day) and systemic (Indomethacin 50mg oral capsules to be assumed twice/day) non-steroidal anti-inflammatory drugs along with oral acetazolamide and rest in bed other than the antibiotic/steroid drops already prescribed after surgery.
Surprisingly, after six days, the OCT revealed an almost complete reabsorption of the serous macular detachment (with a very little fluid still present only in the inferior part of the macula) and the macular area returned to be anatomically normal ( Fig. 3 ) without any evidence of a PVD at fundoscopy. BCVA was 20/20 with −2.00D refraction. No metamorphopsia or decreased visual acuity was encountered at 1 month from surgery.