Multimodal imaging analysis of retinal and choroidal microvascular abnormalities in a case of ocular decompression sickness
Purpose: Decompression sickness can result in a variety of ocular manifestations due to barotrauma. The retinal complications of this illness are less defined. In this case report, we describe a case of pigment epithelial detachment (PED) with retinal and choroidal microvasculature changes secondary...
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Elsevier
2024-12-01
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| Series: | American Journal of Ophthalmology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993624002184 |
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| author | Christine Clavell James Dossett Sanya Yadav Ami Patel L. Carol Laxson Ghassan Ghorayeb |
| author_facet | Christine Clavell James Dossett Sanya Yadav Ami Patel L. Carol Laxson Ghassan Ghorayeb |
| author_sort | Christine Clavell |
| collection | DOAJ |
| description | Purpose: Decompression sickness can result in a variety of ocular manifestations due to barotrauma. The retinal complications of this illness are less defined. In this case report, we describe a case of pigment epithelial detachment (PED) with retinal and choroidal microvasculature changes secondary to ocular decompression sickness in a scuba diver. Observations: The parafoveal serous pigment epithelial detachment resulted in a scotoma associated with a kaleidoscope-like visual disturbance and mildly decreased vision which started immediately after the accident. Multimodal imaging was obtained revealing a serous PED without exudation, pooling of dye on fluorescein angiography, and decreased flow signal on optical coherence tomography angiography (OCT-A) in the deep capillary plexus and choriocapillaris in the area of the PED. Over the course of three months, the serous PED spontaneously resolved leaving behind subtle retinal pigment epithelium (RPE) alterations. Visual acuity also improved over the same time period however the visual disturbance had not completely resolved at the date of last follow-up. Conclusions and importance: The imaging findings, temporal association with the diving accident, and short timeframe to resolution of this PED favor an etiology related to ocular decompression sickness. PED formation in this context may be secondary to 1) RPE dysfunction due to endothelial cell damage from free radicals and 2) choroidal ischemia resulting from gas emboli. To our knowledge, this is the first reported case where OCT-A has been used to demonstrate choroidal ischemia in ocular decompression sickness. The patient received hyperbaric oxygen treatments for several weeks following the accident which may have contributed to the rapid resolution of the PED supporting the role of choroidal ischemia in its pathogenesis. |
| format | Article |
| id | doaj-art-34bf877db1eb4d24b92be2e95b600948 |
| institution | Kabale University |
| issn | 2451-9936 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj-art-34bf877db1eb4d24b92be2e95b6009482024-12-18T08:50:48ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362024-12-0136102208Multimodal imaging analysis of retinal and choroidal microvascular abnormalities in a case of ocular decompression sicknessChristine Clavell0James Dossett1Sanya Yadav2Ami Patel3L. Carol Laxson4Ghassan Ghorayeb5West Virginia University Eye Institute, 1 Medical Center Drive, Morgantown, WV, 26506-1200, USA; Eye Associates of New Mexico, 4411 The 25 Way NE Suite 325, Albuquerque, NM 87109-5853, USAWest Virginia University Eye Institute, 1 Medical Center Drive, Morgantown, WV, 26506-1200, USA; Corresponding author. West Virginia University Eye Institute, 1 Medical Center Drive, Morgantown, WV, 26506-1200, USA.West Virginia University Eye Institute, 1 Medical Center Drive, Morgantown, WV, 26506-1200, USAWest Virginia University Eye Institute, 1 Medical Center Drive, Morgantown, WV, 26506-1200, USAWest Virginia University Eye Institute, 1 Medical Center Drive, Morgantown, WV, 26506-1200, USA; United Health Center Ophthalmology, 1370 Johnson Avenue, Suite 200, Bridgeport, WV, 26330-1378, USAWest Virginia University Eye Institute, 1 Medical Center Drive, Morgantown, WV, 26506-1200, USA; United Health Center Ophthalmology, 1370 Johnson Avenue, Suite 200, Bridgeport, WV, 26330-1378, USAPurpose: Decompression sickness can result in a variety of ocular manifestations due to barotrauma. The retinal complications of this illness are less defined. In this case report, we describe a case of pigment epithelial detachment (PED) with retinal and choroidal microvasculature changes secondary to ocular decompression sickness in a scuba diver. Observations: The parafoveal serous pigment epithelial detachment resulted in a scotoma associated with a kaleidoscope-like visual disturbance and mildly decreased vision which started immediately after the accident. Multimodal imaging was obtained revealing a serous PED without exudation, pooling of dye on fluorescein angiography, and decreased flow signal on optical coherence tomography angiography (OCT-A) in the deep capillary plexus and choriocapillaris in the area of the PED. Over the course of three months, the serous PED spontaneously resolved leaving behind subtle retinal pigment epithelium (RPE) alterations. Visual acuity also improved over the same time period however the visual disturbance had not completely resolved at the date of last follow-up. Conclusions and importance: The imaging findings, temporal association with the diving accident, and short timeframe to resolution of this PED favor an etiology related to ocular decompression sickness. PED formation in this context may be secondary to 1) RPE dysfunction due to endothelial cell damage from free radicals and 2) choroidal ischemia resulting from gas emboli. To our knowledge, this is the first reported case where OCT-A has been used to demonstrate choroidal ischemia in ocular decompression sickness. The patient received hyperbaric oxygen treatments for several weeks following the accident which may have contributed to the rapid resolution of the PED supporting the role of choroidal ischemia in its pathogenesis.http://www.sciencedirect.com/science/article/pii/S2451993624002184Ocular decompression sicknessOCT angiographyPigment epithelial detachmentDiving |
| spellingShingle | Christine Clavell James Dossett Sanya Yadav Ami Patel L. Carol Laxson Ghassan Ghorayeb Multimodal imaging analysis of retinal and choroidal microvascular abnormalities in a case of ocular decompression sickness American Journal of Ophthalmology Case Reports Ocular decompression sickness OCT angiography Pigment epithelial detachment Diving |
| title | Multimodal imaging analysis of retinal and choroidal microvascular abnormalities in a case of ocular decompression sickness |
| title_full | Multimodal imaging analysis of retinal and choroidal microvascular abnormalities in a case of ocular decompression sickness |
| title_fullStr | Multimodal imaging analysis of retinal and choroidal microvascular abnormalities in a case of ocular decompression sickness |
| title_full_unstemmed | Multimodal imaging analysis of retinal and choroidal microvascular abnormalities in a case of ocular decompression sickness |
| title_short | Multimodal imaging analysis of retinal and choroidal microvascular abnormalities in a case of ocular decompression sickness |
| title_sort | multimodal imaging analysis of retinal and choroidal microvascular abnormalities in a case of ocular decompression sickness |
| topic | Ocular decompression sickness OCT angiography Pigment epithelial detachment Diving |
| url | http://www.sciencedirect.com/science/article/pii/S2451993624002184 |
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