Two Tears and a Choroidal Tale: Post-Cataract Vision Loss
- poojanpatel9199
- Aug 27
- 2 min read
A patient presented to our OPD two days ago with complaints of sudden diminution of vision in the left eye for the past 4 days. The patient had undergone cataract surgery in the left eye two months earlier.
On slit-lamp examination, a white reflex was noted from the posterior pole. Indirect ophthalmoscopy (IDO) revealed a bullous retinal detachment (RD) with two peripheral retinal tears—one in the inferonasal quadrant (INQ) and another inferiorly (not visible on Optos photograph).
The patient initially denied any history of trauma, but later reported a fall on the left side of the head two years ago.
On IDO, the detachment appeared smooth and multilobulated, raising suspicion of an associated choroidal detachment (CD). The patient was subsequently advised B-scan ultrasonography, which confirmed the presence of both RD and CD.
B-Scan findings:
Signs of RD and CD.
The small space at the optic disc (seen in the top left image) was consistent with CD, as RD typically remains attached at the disc, while CD shows separation at the disc.
Management Considerations
In isolated RD, oral steroids are not required.
In this case, due to associated choroidal detachment, oral steroids were initiated to reduce inflammation and promote CD resolution.
In diabetic patients where oral steroids are contraindicated, intravitreal triamcinolone can be considered.
If CD does not resolve even after intravitreal triamcinolone, a suprachoroidal drainage procedure prior to pars plana vitrectomy (PPV) is advisable to prevent infusion misdirection into the suprachoroidal space.
The OCT of the left eye further supported these findings.
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