Ciliochoroidal Detachment Research Articles

Relation between the position of the eyeball in the orbit and ciliochoroidal detachment

The aim of our studies was to find out whether the position of the eyeball in the orbit was associated with the occurrence of corneal collapse during cataract extraction as well as with the occurrence of vascular detachment in the postoperative period. We followed up 87 patients (35 men and 52 women) aged 44 to 87 with immature, mature, and over-mature age-related cataract. Eyeball elevation was measured using a Hertel mirror exophthalmometer. The patients were divided into three groups according to the position of the eyeball in the orbit. The distance was less than 16 mm for Group 1 patients (29 patients), 16-20 mm for Group 2 (46 patients), more than 20 mm for Group 3 (12 patients).

Pseudophakic Choroidal Detachment With Cyclodialysis Cyst

Two cases of spontaneous pseudophakic ciliochoroidal detachment, associated with extracapsular cataract extraction, posterior chamber intraocular lens implantation with intact posterior capsules, and small cyclodialysis clefts are documented. In both patients, the choroidal detachments occurred in a delayed fashion following uncomplicated cataract surgery and both presented with characteristic ocular hypotony. Although one patient required surgical management, both patients regained excellent vision after closure of the clefts and resolution of the ciliochoroidal detachments.

Chronic and Recurrent Choroidal Detachment after Glaucoma Filtering Surgery

Chronic and recurrent choroidal (ciliochoroidal) detachments developed following glaucoma filtration surgery in 14 eyes of 13 patients during a 9 year period. Three specific subgroups were identified: recurrent, inflammatory, and chronic (present for more than 6 months). The factors that may be related to the development of chronic and recurrent choroidal detachments included patient age (mean, 68.8 years), systemic hypertension or atherosclerotic heart disease, hyperopia, aqueous suppressant therapy, ocular inflammation, and full-thickness filtration surgery. A total of 46 choroidal detachments in 14 eyes were recorded and required drainage of suprachoroidal fluid on 34 occasions. All eyes developed visually significant cataracts, and complete resolution of the recurrent or chronic choroidal detachment occurred following cataract extraction in six eyes. Treatment of chronic and recurrent choroidal detachments should include intense therapy of ocular inflammation, discontinuation of medications that can incite ocular inflammation, discontinuation of topical and systemic aqueous suppressant therapy, and when a visually significant cataract is present, cataract extraction combined with a choroidal tap should be performed.

Hypotony and Ciliochoroidal Detachment Following Pharmacologic Aqueous Suppressant Therapy in Previously Filtered Patients

This is the first report describing the syndrome of hypotony and ciliochoroidal detachment following pharmacologic aqueous suppressant therapy in previously filtered eyes. Four patients had a history of advanced primary open-angle glaucoma treated with multiple medical therapies, including timolol for 11 to 36 months. They then underwent filtration surgery, which failed in two cases. Timolol and/or acetazolamide therapy was instituted 1 to 18 months following surgery. The patients then developed hypotony and ciliochoroidal detachment, which resolved spontaneously after cessation of the pharmacologic aqueous suppressant therapy. In three of the cases, the episode of hypotony and ciliochoroidal detachment recurred after a second challenge with timolol and/or acetazolamide therapy. Inflammation, tumor, wound leakage, retinal detachment and cyclodialysis cleft were excluded. A mechanism of formation of ciliochoroidal detachment in this syndrome is proposed. Long-term timolol therapy followed by filtration surgery and its attendant postoperative hypotony and ciliochoroidal detachment sensitizes the ciliary epithelium. Subsequent pharmacologic aqueous suppressant therapy results in almost total reduction of aqueous production, causing hypotony and ciliochoroidal detachment.

A New B-Scan Ultrasonographic Technique for Observing Ciliary Body Detachment

We developed a new B-scan ultrasonographic technique for observing ciliary body detachment. Our technique uses a water-bath immersion method in which a real-time A- and B-mode contact scanner is employed. A ciliary body detachment can be ultrasonographically observed either as a separation of the ciliary body from the sclera or as a swelling of the ciliary body region. This technique makes it possible to diagnose ciliochoroidal detachment accurately while a pathologic change is still localized in the ciliary body region.

UVEAL EFFUSION ATTENDING SCLERITIS POSTERIOR

A report is given of a patient with exudative ciliochoroidal and retinal detachment associated with posterior scleritis. The history and clinical findings were similar to earlier described cases and initially led to suspicion of a malignant melanoma. Ultrasonic examination performed by combination of standardized A-scan and contact B-scan technique allowed the diagnosis to be established and the regression of this condition to be followed. There was complete recovery after treatment with atrophine and topical steroids.

Medical therapy for experimental hypotony.

Experimental hypotony was induced in rhesus monkeys by the following procedures: ciliochoroidal detachment, retinal detachment, or cyclodialysis. Two days later, at the time of greatest hypotony, 10% methacholine chloride was deposited in the cornea by iontophoresis, and 0.25% physostigmine salicylate ointment was applied topically to each eye. The intraocular pressure rose to normal levels in all eyes for eight to 24 hours. The peak rise in IOP occurred one to four hours after drug administration and was 7.2, 6.8, and 11.3 mm Hg higher than the pretreatment levels in eyes with ciliochoroidal detachment, retinal detachment, and cyclodialysis, respectively. In a group of normal eyes, this drug combination caused a transient 5.7 mm Hg fall in IOP. The mechanism of pressure elevation by methacholine and physostigmine probably is caused by stimulation of aqueous humor formation or reduced uveoscleral outflow, or both.

Choroidal Detachment: Clinical Manifestation, Therapy and Mechanism of Formation

One hundred and twelve eyes of 103 patients were analyzed during a 9½-year period after surgical drainage of a choroidal (ciliochoroidal) detachment (CD). Choroidal detachment in five groups of postoperative patients was studied. CD after surgery for cataract, for cataract and glaucoma, and for glaucoma alone had different time courses, but in all of these, there were similar amounts of protein (67% of plasma protein concentration) in the suprachoroidal fluid (SCF). In marked contrast was a group of patients with intraoperative choroidal effusions and very little protein (18% of plasma concentration) in the SCF. Identified also was a chronic recurrent form of CD that usually persisted for more than three months. Three distinct mechanisms by which choroidal effusion is formed were recognized, (1) one with evidence for the effusion occurring through an intact isoporous membrane (groups 1–3) ; (2) a second in which hemorrhagic SCF appeared acutely or subacutely (groups 1 and 2) through a disrupted isoporous membrane; and (3) a third form, an intraoperative choroidal effusion in patients with elevated episcleral venous pressure. Increased filtration rate of serum through an intact choriocapillary membrane caused molecular sieving of serum proteins. Inflammation, infection, cataract formation, and corneal edema were uncommonly encountered. Indications for surgery and recommended surgical technique are outlined in detail.

Experimental ciliochoroidal detachment. Effect on intraocular pressure and aqueous humor flow.

Ciliochoroidal detachments were produced in rhesus monkeys by injecting glutathione bicarbonate Ringer's solution, autologous serum, or silicone oil into the anterior suprachoroidal space. Silicone oil detachments, like sham operations, caused a transient 2 mm Hg reduction in intraocular pressure. Detachments with glutathione bicarbonate Ringer's solution or serum caused a 6 mm Hg reduction in intraocular pressure, which normalized in three weeks. Aqueous humor flow in serum-detached eyes was normal, indicating that the hypotonia does not result from reduced aqueous humor formation. Blood was present in Schlemm's canal in most eyes with hypotonia, which suggests that hypotonia is not the result of enhanced conventional aqueous humor outflow. Therefore, it is postulated that hypotonia might result from enhanced aqueous humor outflow from the anterior chamber into the suprachoroidal space and out of the eye through the emissarial channels of the sclera (uveoscleral outflow).

Ciliochoroidal detachment and pseudophakos implantation

Ciliochoroidal detachment perhaps occurs more frequently than is actually recognized and/or looked for. The majority of cases spontaneously resolve without sequelae. A pre-operatively soft eye and a well-closed, clean wound are the best prophylactic measures; even then, detachment may not be prevented. Perhaps something could be said for the lower incidence of wound separation when the limbal incision is small. Extreme caution and care must be exercised when the plastic lens approaches corneal endothelium. The possiblity of ciliochoroidal detachment must be contemplated. Depending upon the type of impant and its relationship to the corneal endothelium, early surgical intervention may be indicated.

System of Ophthalmology.

Volume IX,<i>Diseases of the Uveal Tract</i>, by Duke-Elder and Perkins is the most recent addition in the<i>System of Ophthalmology</i>edited by Duke-Elder. In keeping with the standards expected of these authors, the volume is a fine synthesis of current knowledge of diseases affecting the uvea. The book is divided into seven chapters, including: circulatory disturbances, uveal manifestations of systemic illnesses, atrophic and degenerative changes, cysts and tumors, and ciliochoroidal detachments. Each of these problems is treated in depth. The chapter dealing with inflammatory diseases is the most extensive and very well done. A certain amount of desirable duplication results from the authors' attempts to discuss the general aspects of uveitis apart from the specific etiologic agents. Such a division has merit in that it allows diverse material to be compartmentalized and accessible. The numerous illustrations, many in color, are a delight. All are well chosen, of fine quality,