Breyer-Pacurar A., Gerke E.

Augenklinik des Klinikum Wuppertal GmbH, Klinikum der Universität Witten-Herdecke, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf, Heusnerstr.40, 42283 Wuppertal

Background: Valsalva-like retinal hemorrhages have sometimes been described after laparoscopic surgery. These bleedings are thought to be caused by venous dilation due to the intraoperativ elevated intra-abdominal pressure as well as the hypercarbia. We are reporting on the case of a woman who experienced acute bilateral intra- but also subretinal bleeding after laparoscopic surgery.
Patient and method: A 38 year old, obese otherwise healthy woman noticed an acute visual loss after having undergone an elective laparoscopic sterilisation. Two days later she was admitted to the hospital with the diagnosis of a bilateral central retinal vein occlusion. On first examination the visual acuity was 20/60 in her right and 20/200 in her left eye. The intraocular pressure was 18 mmHg in both eyes and the anterior segments revealed no pathological findings on slitlamp examination. Kinetic perimetry showed a bilateral diffuse decrease in average central field sensitivities. Ophthalmoscopy showed butterfly-shaped submacular bleeding in both eyes, some intraretinal hemorrhages and dilation of the retinal veins. A bleeding source could not been found in fluorescein angiography. Laboratory findings, especially immunological parameters and coagulation factors were within the normal range. Without any specific treatment visual acuity improved during the following months as the hemorrhages were continuosely resorped. At the last examination 4 months later the vision was 20/20 in the right and 20/50 in the left eye. Ophthalmoscopy as well as fluorescein angiography did not show any pathological findings. Also perimetry, ERG and EOG were normal.
Conclusion: This case strongly indicates, that the bleeding could be due to the elevated intraabdominal pressure during laparoscopy reinforced by the intraoperativ head down position and the hypercarbia. However, to our knowledge, subretinal hemorrhages has not been described yet in this condition.

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