Sapporo Medical Journal

Abstract : Blunt trauma may cause traumatic cataracts severe enough to cause pupillary block. A dislocated lens from the coup-countercoup mechanism may also result in secondary angle closure and raised IOP. Therapies are to relieve narrow angles from the lens-iris apposition by performing cataract surgery. However, sudden reduction of IOP may result in extensive retinal hemorrhages as the globe decompresses. We present a case of decompression retinopathy after phacoemulsification. A 47-year-old man who works as a wallpaper assembler was hit by his own hand while working. He complained of hazy vision. Initial visit revealed high IOP treated with 3 topical antiglaucoma. A month later, his VA (visual acuity) at presentation was 3/60, IOP of 40 mmHg and closed angle. It was found stellate cataract but no phacodonesis. He underwent an uneventful cataract surgery. Postoperatively, the IOP remained high and decompression retinopathy was seen. He underwent augmented trabeculectomy to further control his IOP. Decompression retinopathy resolved without visual loss. VA at final follow-up was 6/18 with IOP of 12. Risk of developing decompression retinopathy exist particularly when IOP is not adequately lowered prior to surgery. It causes rupture of the retinal microvasculature, especially in defective vessels autoregulation. IOP should be sufficiently reduced prior to surgery to prevent decompression retinopathy or more sinister complications. Reducing the IOP in a stepwise manner is essential.