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Recurrent hemorrhagic choroidal detachment associated with disseminated intravascular coagulation
R W Allinson1, R G Fante, A F List
1Department of Ophthalmology, University of Arizona, College of Medicine, Tucson 85724.
Insights
Recurrent hemorrhagic choroidal detachments after eye surgery can worsen chronic disseminated intravascular coagulation (DIC). This exacerbation highlights the need for thorough hematologic evaluation in patients with bleeding disorders.
Area of Science:
- Ophthalmology
- Hematology
Background:
- Combined cataract and filtering surgery can lead to complications.
- Disseminated intravascular coagulation (DIC) is a complex hemostatic disorder.
Observation:
- A patient experienced recurrent hemorrhagic choroidal detachments post-surgery.
- These detachments were associated with an exacerbation of chronic DIC.
Findings:
- Hemorrhagic choroidal detachment formation and drainage likely induced thrombin generation.
- This led to consumption of coagulation factors and platelets, and fibrinolysis with fibrin-degradation product (FDP) release.
Implications:
- The case suggests that surgical complications can trigger DIC decompensation.
- Complete hematologic evaluation is crucial for patients with pre-existing hemostatic abnormalities undergoing ocular surgery.
Abstract:
We report the case of a patient with recurrent hemorrhagic choroidal detachments after combined cataract and filtering surgery associated with exacerbation of chronic disseminated intravascular coagulation (DIC). It was postulated that the formation and drainage of the hemorrhagic choroidal detachments induced thrombin generation and consequently coagulation factor and platelet consumption. Fibrinolysis resulted in the release of fibrin-degradation products (FDP). Consumption of clotting factors and platelets combined with FDP release may result in decompensation of a chronic DIC state and cause a bleeding diathesis. This case shows the need for complete hematologic evaluation of patients with hemostatic abnormalities.