Postoperative Choroidal Effusion Research Articles

Full Thickness Prophylactic Scleral Windows Decrease the Rate of Choroidal Effusion and Drainage Surgery after Ahmed Glaucoma Valve Implantation.

To evaluate the effect of creating a full-thickness prophylactic scleral window (PSW) during Ahmed glaucoma valve (AGV) surgery on the rate of postoperative choroidal effusion and choroidal drainage surgery. In this retrospective matched case-control study, after insertion of AGV tube a PSW was created in one group. The control-matched group had AGV without a PSW. Primary outcome measures were the rate of choroidal effusion formation and choroidal drainage surgery. In total, 544 patients (604 eyes) had undergone AGV implantation from 2013 to 2017. The PSW group consisted of 111 eyes of 111 patients and the control group had 111 eyes of 98 matched patients. There were no differences for systemic diseases, number of anti-glaucoma drugs, aspirin use, smoking, laterality of the operated eye, axial length, and central corneal thickness between the groups. Out of 12 eyes with choroidal effusion, only one belonged to the PSW group (P=0.02). Six eyes in the control group needed choroidal drainage surgery, but none of the eyes in the PSW group required this procedure (P=0.02). No intra- and postoperative issues were observed at the site of the scleral window in the PSW group. PSW creation during AGV surgery is a safe method to decrease the rate of choroidal effusion and choroidal drainage surgery.

Ocular Manifestations of the Sturge-Weber Syndrome.

Sturge–Weber syndrome (SWS) or encephalotrigeminal angiomatosis is a non-inherited congenital disorder characterized by neurologic, skin, and ocular abnormalities. A somatic activating mutation (R183Q) in the GNAQ gene during early embryogenesis has been recently recognized as the etiology of vascular abnormalities in SWS. Approximately, half of the patients with SWS manifest ocular involvement including glaucoma as the most common ocular abnormality followed by choroidal hemangioma (CH). The underlying pathophysiology of glaucoma in SWS has not been completely understood yet. Early onset glaucoma comprising 60% of SWS glaucoma have lower success rates after medical and surgical treatments compared with primary congenital glaucoma. Primary angle surgery is associated with modest success in the early onset SWS glaucoma while the success rate significantly decreases in late onset glaucoma. Filtration surgery is associated with a higher risk of intraoperative and postoperative choroidal effusion and suprachoroidal hemorrhage. CH is reported in 40–50% of SWS patients. The goal of treatment in patients with CH is to induce involution of the hemangioma, with reduction of subretinal and intraretinal fluid and minimal damage to the neurosensory retina. The decision for treating diffuse CHs highly depends on the patient's visual acuity, the need for glaucoma surgery, the presence of subretinal fluid (SRF), its chronicity, and the potential for visual recovery.

Chronic Kidney Disease as a Predictor of Postoperative Choroidal Effusions After Glaucoma Surgery.

Patients with chronic kidney disease (CKD) are at increased risk for choroidal effusion development following glaucoma surgery. Choroidal effusion is a postoperative complication of glaucoma surgery that results from a transudative fluid collection in the suprachoroidal space. Kidney disease alters bodily fluid dynamics through a variety of mechanisms. The relationship between CKD and choroidal effusion following glaucoma surgery has not previously been studied. The purpose of this study was to determine the relationship between CKD and choroidal effusion development after glaucoma surgery. This retrospective cohort study consisted of 86 eyes from 86 patients who received glaucoma filtering surgery or transscleral cyclophotocoagulation within the study timeframe. Forty-three patients had CKD, and 43 patients did not have kidney disease. The main outcome of this study was the development of choroidal effusion measured by the Pearson χ2 test and multivariate analysis using a binomial regression with a log link. Ten patients (23.3%) in the CKD group developed choroidal effusion, while 2 patients (4.7%) in the no-kidney disease group developed choroidal effusion (relative risk, 5.0; 95% confidence interval: 1.16-21.5; P=0.013). The association between CKD and choroidal effusion showed mixed results in the multivariate analysis, with some analyses showing a significant association and others showing no significant association. In both the univariate and multivariate analyses, CKD was found to be significantly associated with choroidal effusion after glaucoma surgery.

Perioperative Propranolol: A Useful Adjunct for Glaucoma Surgery in Sturge-Weber Syndrome

Ocular manifestations of Sturge-Weber syndrome (SWS) include choroidal hemangioma and glaucoma. Intraocular pressure (IOP) reduction in these patients commonly is associated with sight-threatening choroidal effusions. Oral propranolol is the standard of care for infantile cutaneous hemangioma, but its role in choroidal hemangioma largely is unexplored. We studied the role of perioperative oral propranolol during glaucoma surgery in SWS. Prospective, nonrandomized case series with historical controls. Fourteen eyes of 12 patients with SWS scheduled for glaucoma surgery were included, and the outcomes were compared with those of historical controls without propranolol use (15 eyes of 14 patients). Patients in the prospective cohort received oral propranolol 2 mg/kg of body weight daily in 2 divided doses 1 week before surgery and continued for 6 weeks after surgery. There was no modification (e.g., posterior sclerotomy) in the existing surgical technique. The historical control group was identified from records and SWS diagnosis validated by chart review. The incidence and extent of postoperative choroidal effusion, additional procedures required compared with the control group, and adverse effects of the drug in the prospective cohort. Average follow-up was 25.7±12.1 months (95% confidence interval, 19.3-32.1 months). The intraocular pressure reduced from 25.2±9.7 mmHg at presentation to 16.25±6.2 mmHg, 14.6±4.5 mmHg, 13.7±6.4 mmHg, and 16.5±8.0 mmHg at 1 week, 1 month, 3 months, and 1 year after surgery, respectively. In the perioperative propranolol group, no patient demonstrated sight-threatening choroidal effusion within the vascular arcades. In the 2 patients with bilateral disease, both eyes of each patient showed peripheral choroidal effusion, which settled with medical treatment. Surgery was a repeat procedure in 3 of the 4 eyes. There were no adverse effects of propranolol in any patient. In the control group, 5 of 12 eyes showed peripheral choroidal effusion after primary glaucoma surgery, whereas 5 of 6 eyes that underwent repeat surgery failed demonstrated sight-threatening choroidal effusion requiring surgical intervention. Oral propranolol seems to be an effective method to minimize the development of sight-threatening choroidal effusion after glaucoma surgery in SWS.

Influence of α2-adrenomimetics on incidence of choroidal effusion following laser trabeculoplasty in primary open angle glaucoma

To evaluate the influence of different topical hypotensive drugs on incidence of choroidal effusion (CE) following laser trabeculoplasty as the second stage of combined laser-surgical treatment plan in patients with primary open-angle glaucoma (POAG). The study included 60 patients with previously operated stage I and II POAG who has 'b-c' intraocular pressure (IOP) on maximum hypotensive therapy. Fistulizing subscleral removal of the outer wall of Schlemm's canal (a.k.a. subscleral sinusotomy) was the first stage of treatment plan. The second stage took place 14 days later in the form of laser trabeculoplasty. In order to reduce the risk of IOP spikes, all patients were prescribed specific hypotensive therapy 5 days prior to the procedure. The 1st group included 30 patients (30 eyes) who were asked to use Brimonidine-Purite (0.15%). The 2nd group included 30 patients (30 eyes) who used either nonselective β-blockers, or carbonic anhydrase inhibitors. IOP was measured on days 1, 5, 9, and 12 after stage 1, as well as after laser trabeculoplasty. Ophthalmic examination included ultrasound imaging and optical coherence tomography. After the combined laser-surgical treatment, the IOP reliably decreased in both groups. Choroidal effusion was observed in 7 cases in the 1st group and in 15 cases in the 2nd group. Change in IOP was less prominent in patients who had received instillations of α2-adrenomimetic (p<0.05). Patients who received Brimonidine-Purite 0.15% before laser trabeculoplasty had lower IOP drop than those on pre-surgical therapy with nonselective β-blockers or carbonic anhydrase inhibitors. Topical application of 0.15% Brimonidine-Purite 5 days prior to laser trabeculoplasty as the second stage of combined laser-surgical treatment resulted in statistically significant reduction of the incidence of postoperative choroidal effusion, likely due to α2-adrenomimetics inhibiting the secretory function of the ciliary Body to the lesser extent than drugs of other groups that were tested.

Effectiveness of scleral decompression procedures for preventing choroidal effusion in nanophthalmic eyes: A retrospective review

Purpose: The purpose of this study is to study role of prophylactic scleral decompression procedures in the prevention of choroidal effusion in nanophthalmos. Materials and Methods: Nanophthalmos was defined as eye with axial length (AL) ( +5.00 D) and scleral thickness (>1.7 mm). In a retrospective case series, we analyzed 21 eyes of 21 patients with nanophthalmos, who underwent cataract and/or glaucoma surgery with concurrent sclerotomy or sclerotomy with sclerectomy. Results: The mean age at the time of surgery was 51 ± 7 years. The mean AL was 17.18 ± 1.74 mm. Surgery-related complications were documented in 8 (38%) eyes. The prophylactic scleral decompression procedures did not offer protection against postoperative choroidal effusion (P = 0.6). On univariate logistic regression, preoperative intraocular pressure (P = 0.01) was significantly associated with postoperative complications. Conclusion: Prophylactic scleral decompression does not offer absolute protection against postoperative complications during cataract and/or glaucoma surgery in nanophthalmic eyes.

Choroidal effusions after glaucoma surgery.

A diverse range of surgical approaches are now used for glaucoma management. This review compares the reported rates of serous choroidal effusion and suprachoroidal hemorrhage after various glaucoma surgical procedures. As these complications can be visually devastating, we summarize the current literature on prevention strategies and management. Trabeculectomy remains one of the most effective and widely used glaucoma surgeries, but it is also associated with a significant rate of complications, including serous choroidal effusion and suprachoroidal hemorrhage. Alternative surgical techniques for glaucoma management are increasingly utilized due in part to their lower rate of associated complications. Prevention measures for serous choroidal effusion and suprachoroidal hemorrhage include the recognition of patient risk factors and careful selection of glaucoma surgical technique. Management options include observation, medications, office-based procedures, and surgical interventions directed at maximizing patient outcomes. Familiarity with reported rates of postoperative choroidal effusions, patient risk factors, and management strategies will aid in reducing the frequency of these complications and in improving patient care.

Ex-PRESS® Mini Glokom İmplant Cerrahisi Sonuçlarımız

Amaç: Glokomun cerrahi tedavisine yönelik Ex-PRESS® mini glokom implantı (Alcon, Fort Worth, TX) uygulamasının göz içi basıncı (GİB) düşüşü üzerine etkinliğinin ve güvenilirliğinin değerlendirilmesi. Gereç ve Yöntemler: 2011-2012 yıllarında kliniğimizde Ex-PRESS® tüp (P-50) implantasyonu cerrahisi uygulanan olgular retrospektif olarak incelendi. Cerrahi öncesi ve sonrası GİB değerleri, görme keskinlikleri, kullanılan antiglokomatöz tedavi sayıları ile cerrahiye sekonder olarak gelişen komplikasyonlar kaydedildi. Cerrahi başarı kriteri, son kontrolde GİB ölçümünün 6-21 mmHg (ilaçlı ya da ilaçsız) olması olarak belirlendi. Bulgular: Çalışmaya 32 olgunun 32 gözü dâhil edildi. Olguların yaş ortalaması 54,43±14,56 yıl (20-77 yıl), ortalama takip süresi 6,34±2,95 ay (3-16 ay) idi. Cerrahi öncesi ortalama GİB değerleri 30,71±4,72 mmHg iken, cerrahi sonrası 1. haftada 13,21±3,51 mmHg (p<0,001), 1. ayda 14,46±4,08 mmHg (p<0,001), 3. ayda 14,37±2,93 mmHg (p<0,001), 6. ayda 13,78±2,98 mmHg (p<0,001), ve son kontrolde 14,53±2,27 mmHg (p<0,001) idi. Son kontrolde olguların tamamında ölçülen GİB değerleri 21 mmHg ve altındaydı. Kullanılan antiglokomatöz tedavi etken madde sayısı medyan değeri cerrahi öncesi 4,0 (3,0-5,0) iken, son kontrolde olguların %81,3'ünde antiglokomatöz tedavinin tamamen bırakılmış olduğu gözlendi. Cerrahi sonrası 1 olguda gelişen koroid efüzyonu dışında takip süresince herhangi bir komplikasyon görülmedi. Sonuç: Ex-PRESS® mini glokom implant cerrahisi GİB'in düşürülmesinde etkili ve güvenilir bir tedavi yöntemi olarak kabul edilebilir. Aynı zamanda antiglokomatöz tedavi gereksiniminde belirgin bir azalma sağlayarak, hastaların tedaviye uyumunu ve yaşam kalitesini artırmaktadır.

Vision Loss and Recovery After Trabeculectomy

To assess the risk of long-term vision loss after trabeculectomy and to determine the course of long-term vision loss vs transient loss and recovery. The medical records of 301 eyes in 262 patients undergoing trabeculectomy between January 1999 and September 2003 were retrospectively reviewed. Postoperative vision loss was categorized as mild or moderate (decrease in Snellen visual acuity of 3-5 lines) vs severe (decrease of >5 lines). Postoperative vision loss was considered permanent if visual acuity did not have a return of 3 lines within a 6-month follow-up period. Permanent vision loss occurred in 24 of 301 eyes (8.0%): 13 (4.3%) had mild or moderate vision loss, and 11 (3.7%) had severe vision loss. Ten eyes (3.3%) with permanent mild or moderate vision loss and 6 eyes (2.0%) with permanent severe vision loss had no identifiable cause. Significant risk factors for permanent severe unexplained vision loss were preoperative split fixation on visual fields, preoperative number of quadrants with split fixation, and postoperative choroidal effusions with eventual resolution. Transient vision loss occurred in 170 of 301 eyes (56.5%): 79 (26.2%) had mild or moderate vision loss, with a mean time to recovery of 88 days (range, 6-720 days), and 91 (30.2%) had severe vision loss, with a mean time to recovery of 78 days (range, 6-720 days). Transient vision loss after trabeculectomy is common and may take up to 2 years for recovery. The risk of permanent vision loss is less common but significant. Two percent of our study population experienced permanent severe unexplained vision loss ("snuff-out"), and risk factors included preoperative split fixation on visual fields, preoperative number of quadrants with split fixation, and postoperative choroidal effusions with eventual resolution.

Assessing the need for posterior sclerotomy at the time of filtering surgery in patients with Sturge-Weber syndrome

Purpose Posterior sclerotomy has been recommended for prevention of intraoperative choroidal hemorrhages and choroidal effusions in patients with Sturge-Weber syndrome (SWS) or Klippel-Trenaunay-Weber (KTW) syndrome undergoing glaucoma filtering surgery. In this study, we evaluated this unproven clinical perception. Design A retrospective, noncomparative, case series. Participants Seventeen consecutive patients with SWS or KTW syndrome who underwent glaucoma filtering surgery without prophylactic posterior sclerotomy or other prophylactic measures between January 1973 and March 1997 at a university-based practice. Intervention Glaucoma filtering surgery without prophylactic posterior sclerotomy. Main outcome measures Incidence of intraoperative and postoperative choroidal effusion, choroidal detachment, or choroidal hemorrhage. Results No intraoperative choroidal effusion, choroidal detachment, or choroidal hemorrhage occurred in this series. After surgery, 6 patients had a transient choroidal effusion. Surgical drainage was not required in any of them. No suprachoroidal hemorrhages occurred after surgery. Conclusions We did not encounter significant intraoperative suprachoroidal hemorrhage, choroidal effusions, or a combination requiring therapeutic intervention in our series. This finding leads us to question the necessity for prophylactic posterior sclerotomy to prevent the occurrence of these complications in patients with SWS and KTW syndrome undergoing glaucoma filtering surgery.

Pars Plana Modified Baerveldt Implant Versus Neodymium:YAG Cyclophotocoagulation in the Management of Neovascular Glaucoma

To determine the relative effectiveness of neodymium:YAG cyclophotocoagulation (NCYC) and pars plana modified Baerveldt implant (PPBI) surgery on intraocular pressure (IOP) control in eyes with neovascular glaucoma (NVG). In this retrospective comparative group study, 30 patients with NVG treated with contact NCYC were compared with 18 patients who underwent PPBI. Patients groups were not statistically dissimilar with respect to the underlying disorder-causing angle and iris neovascularization, intraocular pressure, and patient's age. During a follow up of 6 months, an IOP control of > or = 6 and < or = 21 mm Hg was achieved in 23 eyes (76.6%) treated with NCYC compared with 17 eyes (94.4%) receiving PPBI (P = 0.13). Among eyes that had unsuccessful outcome in both groups, the proportions with persistently high IOP or hypotony were greater in the NCYC group than in the PPBI group. Based on our criteria, the cumulative proportion of failure in the NCYC group was 23.3% at 6 months as compared to 5.6% in the PPBI group. Seven eyes (23.3%) in the NCYC group lost light perception versus 1 eye (5.6%) in the PPBI group. The incidence of postoperative choroidal effusion (36%) was higher in the PPBI group. This study suggests that in the management of NVG, PPBI surgery more frequently controls IOP in a medically acceptable range with less hypotony and greater preservation of visual acuity than NCYC.

Glaucoma in Sturge-Weber syndrome

Background: In glaucoma associated with Sturge-Weber syndrome (SWS), medical treatment often fails to control intraocular pressure, thus requiring surgical intervention that may result in serious complications. Methods: Eighteen consecutive patients with SWS were reviewed retrospectively at the King Khaled Eye Specialist Hospital. An intraocular pressure less than 20 mm Hg, plus stable optic nerve cup-to-disc ratio and corneal diameter (or visual fields where appropriate), were parameters chosen to indicate that the glaucoma was being controlled. Results: Glaucoma was found in 15 of 18 patients (22 eyes). The mean follow-up time was 62 months (range, 12 to 148 months). Medical treatment alone was successful in 5 patients (7 eyes); the remainder required surgical intervention. The initial surgical procedures included cyclocryotherapy, YAG laser goniotomy, surgical goniotomy, and trabeculotomy or trabeculectomy. Eight eyes required subsequent surgery, 5 with Molteno or Ahmed implants. Early postoperative choroidal effusion and hemorrhage occurred in 4 eyes and resolved spontaneously. Hemorrhagic choroidal detachment with total retinal detachment developed in 2 patients 3 to 5 months after surgery. In 1 patient a recurrent serous choroidal detachment after suture lysis was associated with total optic atrophy. Conclusions: Glaucoma in SWS is common. Control of glaucoma was successfully achieved with medical treatment in 7 of 22 eyes of our 15 SWS-glaucoma patients, and we consider it the initial treatment of choice. Of the 15 eyes that required surgery, late postoperative complications resulted in loss of vision as a result of persistent postoperative hypotony in 3 eyes that underwent surgical procedures. (J AAPOS 1999;3:40-5)

Complications of Baerveldt glaucoma drainage implants.

To report the incidence and identify risk factors of postoperative complications after Baerveldt glaucoma drainage implantation. A retrospective review of the medical records of all patients at the Bascom Palmer Eye Institute, Miami, Fla, who underwent placement of a Baerveldt glaucoma drainage implant from October 1, 1992, through October 31, 1996, to determine demographic characteristics, preoperative and postoperative intraocular pressures, and complications. Variables were analyzed using the Student t test and Fisher exact test to determine the association between delayed postoperative suprachoroidal hemorrhage and various potential risk factors. A total of 107 eyes of 103 patients were identified. Suprachoroidal hemorrhage occurred in 4 eyes (4%), with onset ranging from 3 to 33 days after implantation. Two eyes (2%) had choroidal effusions requiring surgical drainage, and 20 eyes (19%) had low choroidal effusions requiring only close observation. Tube blockage was observed in 5 eyes (5%). Four eyes (4%) had aqueous misdirection, 2 eyes (2%) had corneal decompensation, and 1 eye (1%) each had endophthalmitis, tube migration, corneal ulcer, hyphema, and implant migration. Patients who were older (P=.04) or had postoperative choroidal effusions (P=.03), low intraocular pressure immediately after the tube opened (P=.03), hypertension (P= .08), or atherosclerosis (P=.09) were more likely to develop suprachoroidal hemorrhage. A lower incidence of serious postoperative complications was observed in Baerveldt implantations in this study when compared with a recent report. Risk factors for serious complications were similar to trabeculectomy.

Molteno Implantation for Glaucoma in Young Patients

Seventy patients younger than 21 years of age underwent Molteno implantation for nonneovascular glaucoma. Fifty-three (76%) patients had failed angle and/or conventional filtering surgery. Final intraocular pressure less than 22 mmHg (but over 5 mmHg) was achieved in 40 (62%) of the 65 patients with at least 6-month follow-up (range, 6 to 59 months; mean ± standard deviation, 22.7 ± 14.1 months); however, only 22 (34%) were controlled after the initial Molteno implantation procedure, and 54 (83%) patients underwent further glaucoma and/or nonglaucoma surgical procedures. The visual acuities remained within one line of their preoperative levels or improved in 25 (68%) of the 37 patients on whom Snellen acuities were available. The most frequent complications -included: tube-cornea touch (20%, transient in 3%), corneal edema (17%), retinal detachment (16%), tube block (10%), cataract (9%), chronic hypotony or phthisis (9%), pupillary or cyclitic membrane (9%), hyphema (7%), flat anterior chamber (6%), and large postoperative choroidal effusion (6%). Despite the high rates of subsequent surgical interventions and complications, Molteno implantation has been a useful approach for achieving intraocular pressure reduction in young patients with glaucoma.

Nanophthalmos with Uveal Effusion: Clinical and Embryologic Considerations

Three brothers were found to have nanophthalmos as evidenced by marked hyperopia, decreased global axial length, and shallow anterior chambers. The thickness of the lens, measured with A-scan ultrasound biometry in two cases, was much greater than normal. Choroidal thickening with shallow retinal detachments without breaks was found in those patients. Fluorescein angioscopy demonstrated leaks beneath the serous retinal detachments in one. The spontaneous presence of choroidal effusions and retinal detachments in nanophthalmic patients has been reported only rarely. The present findings emphasize that careful examination of the posterior segment should be done prior to anterior segment surgery in these patients to alert the surgeon to the possibility of serious intra- and post-operative choroidal effusions and retinal detachments. An attempt is made to explain some of the clinical findings in nanophthalmos by extrapolating from results obtained on experimental animals. It is postulated that the increased lens size in nanophthalmos may be due to the abnormal accumulation of a factor influencing lens fiber differentiation. The overall small size of the eye may be the result of the formation of a smaller than usual optic vesicle anlage.