Pachychoroid as a Risk Factor for Exudative Retinal Detachment After Panretinal Photocoagulation: A Report of Two Cases

In this case series of two patients, we discuss pachychoroid as a risk factor for predicting exudative retinal detachment (RD) after panretinal photocoagulation (PRP). The first patient was a 55-year-old diabetic male with unstable proliferative diabetic retinopathy (PDR), serous pigment epithelial detachment (PED), and pachychoroid confirmed via fluorescein angiography (FA) and optical coherence tomography (OCT), who underwent PRP. Post-PRP, the patient complained of visual loss in both eyes. Subsequent FA and OCT confirmed the presence of exudative RD, which resolved after a course of non-steroidal anti-inflammatory eyedrops. The second patient was a 50-year-old male with PDR, serous PED, and pachychoroid confirmed via OCT, who underwent PRP. Post-PRP, he had reduced vision due to exudative RD. His vision improved upon the resolution of the exudative RD after three weeks. Pachychoroid is known to be associated with PDR. In the presence of pachychoroid, PRP-induced inflammation overwhelms the retinal pigment epithelium due to preexisting choroidal thickening, leading to exudative RD. These cases highlight how the identification of pachychoroid before laser PRP can help in predicting exudative RD as a post-procedure complication.