Ocular decompression retinopathy after anterior chamber paracentesis - Case series and systematic review

To elucidate the mechanisms underlying multilayered retinal hemorrhage following anterior chamber paracentesis and to provide a comprehensive overview of the clinical features, risk factors, and prognosis for this complication. We conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was carried out up to March 1, 2024, across the PubMed/MEDLINE, Cochrane Library, and EMBASE databases. Studies reporting the cases of retinal hemorrhage following anterior chamber paracentesis were included. In addition, we present three cases of multilayered retinal hemorrhage that developed postparacentesis, with underlying diagnoses of uveitic glaucoma, neovascular glaucoma, and endophthalmitis. We reviewed the literature on seven patients, in addition to three cases from our institution, who developed retinal hemorrhage following anterior chamber paracentesis. Uveitis was the most prevalent diagnosis, accounting for four of the cases. Other diagnoses included neovascular glaucoma, macular branch arterial occlusion, and primary open-angle glaucoma. Fundus examinations revealed preretinal hemorrhage in six patients, superficial hemorrhage in three, blot hemorrhage in nine, and Roth spots in seven. The overall prognosis was favorable, with none of the patients requiring additional interventions for ocular decompression retinopathy (ODR). The reliability of this systematic review is constrained by the limited number of available studies and the inherent biases in case reports. Nevertheless, evidence suggests that anterior chamber paracentesis can cause ODR. ODR can mimic central retinal vein occlusion in fundus images, making accurate diagnosis essential, as the prognosis and therapeutic approaches for these two conditions can differ significantly.