Bilateral Subretinal Fluid Mimicking Subretinal Neovascularization Within 24 Hours After Selective Laser Trabeculoplasty

Abstract

Purpose: Selective laser trabeculoplasty (SLT), which is widely regarded as a safe procedure, is a frequently used treatment for open-angle glaucoma. Although it is presumed to be associated with an inflammatory cascade and possible postoperative inflammation, only 2 cases of SLT complicated by cystoid macular edema have been previously reported. Until now there are no previous reports of SLT causing subretinal fluid (SRF).

Methods/Importance: Clinical examination, optical coherence tomography, and fluorescein angiography demonstrated a previously unreported clinical entity consisting of bilateral SRF, developing within 24 hours of bilateral inferior 180-degree SLT for open-angle glaucoma.

Results: Rapid bilateral, subjective loss of vision occurred within 24 hours post-SLT. This was associated with bilateral SRF resulting in 48 μm (OD) and 35 μm (OS) increase in macular thickness on optical coherence tomography. Fundus fluorescein angiography demonstrated profuse, well-demarcated subfoveal leakage. SRF resolved within 4 days, but eventual best corrected visual acuity was subjectively and objectively decreased.

Conclusions: The sudden onset of loss of vision and the development of subfoveal SRF within 24 hours of SLT strongly suggests cause and effect. This previously unreported clinical entity of bilateral SRF within 24 hours of SLT may be secondary to an intraocular inflammatory cascade, similar to previous hypotheses regarding 3 cases of cystoid macular edema post-SLT. Given the dramatic initial loss of vision and compromised long-term visual outcome, clinicians and patients need to be informed of this new clinical entity of SLT associated with SRF and permanent retinal pigment epithelial changes.