EXUDATIVE MACULAR DETACHMENT FOLLOWING UNCOMPLICATED PARS PLANA VITRECTOMY FOR DIABETIC VITREOUS HEMORRHAGE.

Abstract

To describe diagnostic characteristics and management of exudative macular detachment, a rare complication of pars plana vitrectomy and endolaser for diabetic vitreous hemorrhage. Case report including multimodal imaging. Forty-seven-year-old man with diabetes mellitus Type 2 and proliferative diabetic retinopathy underwent uncomplicated 23-gauge pars plana vitrectomy, Triesence-assisted hyaloid peeling, fill-in endolaser, and intravitreal bevacizumab injection in the left eye for nonclearing visually significant vitreous hemorrhage. On the first postoperative day, patient developed significant macular subretinal fluid. Multimodal imaging revealed numerous pigment epithelial detachments around optic nerve, and subretinal fluid throughout the macula on optical coherence tomography in the absence of retinal breaks on widefield raster, late deep leakage on fluorescein angiography, and corresponding hyperautofluorescence in the same region. Diagnosed with macular exudative retinal detachment, patient was treated with topical and systemic corticosteroids, with gradual resolution of subretinal fluid and visual acuity improvement. Exudative retinal detachment following diabetic pars plana vitrectomy with endolaser has been described in as many as 8.78% of cases, however may be missed in the early postoperative period. Multimodal imaging including multiple pigment epithelial detachments on optical coherence tomography, hyperautofluorescence, and late deep leakage on fluorescein angiography can help differentiate this condition from rhegmatogenous retinal detachment and central serous chorioretinopathy, and guide management to include corticosteroids.