Título / Title

SPONTANEOUS HEMORRHAGIC CHOROIDAL DETACHMENT (HCD) CAUSING SECONDARY ACUTE ANGLE-CLOSURE GLAUCOMA (AACG): CASE REPORT

Introdução / Purpose

To report a case of HCD and serous retinal detachment leading to AACG.

Material e Método / Methods

Based on medical records and literature revision.

Resultados / Results

female, 59 years old, admitted at Botucatu Medical School with pulmonary thromboembolism, under anticoagulant therapy, referring pain and acute vision loss in left eye (OS). Visual acuity (VA) of hand movement in OS. Biomicroscopy revealed hyposphagma, quemosis, corneal edema and diffuse epithelial defects, shallow anterior chamber with inflammatory cells, microhyphema, mid-dilated pupil and posterior synechiae. Gonioscopy showed blood and an inferior mass effect. Intraocular pressure (IOP) was 60 mmHg. Fundus displayed choroidal detachment with temporal inferior serous retinal detachment and adjacent pigment dispersion. After IOP control an extensive search for intraocular and other primary tumors proved to be negative. Angio resonance and Orbit CT scan showed a blood like mass behind retinal detachment and no tumor or venous thrombosis signs. Ultrasonography showed significant choroidal thickening. Angiofluorescence demonstrated pinpoint like areas. She was diagnosed as having AACG secondary to choroidal hemorrhage. Systemic steroid therapy was iniciated 5 weeks later and after 5 weeks of treatment OS VA improved to 20 ̷60 with no pain and reabsortion of the retinal fluid and regression of choroidal detachment.

Discussão e Conclusões / Conclusion

Anticoagulant therapy and hypertension have been implied as possible risk factors in reported cases of spontaneous HDC causing secondary AACG. Source of bleeding appears to be a macular lesion with neovascularization or neoplastic (leukemia/intraocular tumors), both not present in this case. Due to pulmonary condition, Valsava maneuver could play an important role here. Probable unilateral Vogt-Koyanag-Harada disease is a rare but already documented disorder. Unilateral involvement, atypical onset presentation and systemic anticoagulation make this a challenging case.

Palavras Chave

choroidal hemorrhage, serous retinal detachment, angle-closure glaucoma, anticoagulant