Massive Subretinal Fluid Following Wound Indentation For Early Postoperative Intraocular Pressure Elevation After Cataract Surgery

To report a rare case of acute massive subretinal fluid development following manual wound indentation performed to manage severe early postoperative intraocular pressure elevation after cataract surgery complicated by posterior capsule rupture and anterior vitrectomy, and to highlight the potential retinal consequences of sudden intraocular pressure reduction.

This case was managed at a private, high-volume ophthalmology center in Türkiye functioning as a primary eye care and surgical facility. All major anterior and posterior segment eye surgeries are routinely performed at the center.

Post-cataract intraocular pressure (IOP) elevation is a common early postoperative finding, with pressures exceeding 30 mmHg reported in up to 70% of eyes within the first 24 hours. Most IOP spikes are related to retained ophthalmic viscoelastic devices, postoperative inflammation, or impaired trabecular outflow. While medical therapy remains first-line treatment, wound indentation or paracentesis may be required when IOP exceeds 40 mmHg and is unresponsive to medication. However, abrupt decompression may disturb choroidal hydrostatic balance and lead to serous retinal detachment. A 53-year-old man underwent phacoemulsification complicated by posterior capsule rupture, requiring limited anterior vitrectomy and sulcus implantation of a single-piece acrylic intraocular lens. On postoperative day 1, IOP was 53 mmHg measured by air-puff applanation tonometry. Gentle wound indentation reduced IOP to 15 mmHg. A few hours later, the patient reported central visual blurring. Spectral-domain optical coherence tomography revealed a large dome-shaped serous subretinal fluid involving the fovea. Intensive topical corticosteroid and nonsteroidal anti-inflammatory therapy was initiated. Follow-up OCT at 48 hours showed complete resolution of subretinal fluid, and visual acuity returned to baseline within three days. The rapid onset and resolution suggest a hydrostatic mechanism related to sudden ocular hypotony, highlighting the importance of cautious pressure reduction and OCT monitoring.

Early postoperative intraocular pressure elevation after cataract surgery is usually transient, but severe spikes may require intervention. Sudden IOP reduction following wound indentation can rarely lead to transient serous macular detachment due to acute hydrostatic imbalance. Gradual decompression, careful postoperative monitoring, and prompt OCT evaluation in patients with visual complaints are essential. Awareness of this potential complication allows timely diagnosis, conservative management, and favorable visual outcomes.