Postoperative Choroidal Detachment Research Articles

Impact of postoperative choroidal detachment on trabeculectomy outcomes: a four-year comparative study

BackgroundThe aim of this study was to compare trabeculectomy outcomes in patients with and without post-operative serous choroidal detachment (CD) and establish an association between CD and trabeculectomy outcomes.MethodsIn this 4-year retrospective cohort study, medical records of glaucoma patients older than 18 who underwent primary trabeculectomy with Mitomycin-C between 2012 and 2020 were reviewed. Phakic eyes without history of any other intraocular surgery and with at least one year of follow-up were included in the study. Postoperative CD was defined as clinically visible CD developed within the first postoperative week. Cases were categorized into with and without CD and trabeculectomy outcomes were compared. Comparison was carried out using postoperative intraocular pressure (IOP), glaucoma medications and surgery success. Two levels of success were defined regardless of glaucoma medications; criteria A) 5 < IOP < 19 mmHg and criteria B) 5 < IOP < 16 mmHg. In addition to the defined IOP ranges, IOP reduction less than 20% from baseline and further glaucoma surgery were also counted as surgery failures.ResultsTotal of 183 patients including 153 without CD (mean age 58.73 ± 11.40 years, mean IOP 23.7 ± 6.63 mmHg) and 30 with CD (59.00 ± 12.59 years, mean IOP 22.2 ± 3.83 mmHg) entered the study. Post-trabeculectomy mean IOPs were significantly higher in the CD group at all follow-up visits at year 1 through 4 (14.70, and 14.82 mmHg vs. 11.03, and 12.59 mmHg; p-value < 0.05). Similarly mean number of glaucoma medications was higher in the CD group at all follow-up visits (p-value > 0.001). Based on success criteria A, cumulative probability of success for patients with CD wasn’t significantly different compared to those without CD at years 1 through 4 (80.0%, and 69.6% vs. 88.2%, and 74.1% respectively; p-value > 0.05, log-rank). However, based on success criteria B, patients with CD had significantly lower cumulative probability of success at years 1 through 4 (50.0% and 8.9% vs. 79.7% and 59.8%, p-value < 0.001).ConclusionWe established that early post-trabeculectomy serous choroidal detachment is associated with adverse surgery outcomes. Lower rate of surgery success and higher mean postoperative IOP and glaucoma medications were observed in patients with post-trabeculectomy choroidal detachment and this was more pronounced in patients who required more stringent IOP control (success definition 5 < IOP < 16 mmHg).

A clinical case of choroidal detachment as choroidal effusion in a child with Sturge-Weber-Crabbe syndrome

Choroidal effusion syndrome is a rare idiopathic condition that occurs predominantly in middle-aged man with hyperopia and is characterized by ciliochoroidal detachment (CD), followed by exudative retinal detachment. To present a clinical case of postoperative choroidal detachment in a child with SturgeWeberCrabbe syndrome after microinvasive non-penetrating glaucoma surgery.&#x0D; RESULTS: This article presents the clinical case of postoperative choroidal detachment in a child with SturgeWeberCrabbe syndrome after microinvasive non-penetrating glaucoma surgery. Against the background of the existing anomalies in the development of an optic disc after antiglaucomatous intervention for decompensated glaucoma, after the normalization of IOP, the patient developed choroid detachment with exudative retinal detachment the next day of operation. After conservative therapy involving bed rest and double instillation of mydriatics for 1 month, the situation was completely resolved and his vision was restored to 1.0.&#x0D; DISCUSSION: The atypicality of our clinical case of CD lies in the overly pronounced exudative component. In addition to the classic CD vesicles, we observed high exudative retinal detachment as well as high retinoschisis, which is extremely atypical for classical CD. Considering the characteristics of congenital syndrome, it is necessary to accurately differentiate atypical CCA from the rare choroidal effusion syndrome, which also includes CCA with retinal detachment, but does not present with retinoschisis. Against the background of conservative therapy with bed rest and two instillations of mydriatics for 1 month, the situation was completely resolved, and the patients vision was restored to 1.0. In the treatment of such patients, it is always necessary to consider their individual anatomical features as well as to understand the detailed pathogenesis of the complications that arise before rushing to repeat surgery.

Early changes in photopic negative response in eyes with glaucoma with and without choroidal detachment after filtration surgery

Background/aimsTo evaluate the electroretinographic (ERG) changes in the early postoperative period following glaucoma filtration surgery, and its relationship with choroidal detachment (CD).MethodsThis retrospective observational single-centre study included 57 consecutive patients...

Outcomes of a novel bubble ultra-wide field viewing system for vitreoretinal surgery.

To report the clinical outcomes and evaluate the efficacy of a novel bubble ultra-wide field viewing system for vitreoretinal surgery. Prospective, noncomparative, interventional case series. One hundred and fifty-one eyes of 146 consecutive patients with proliferative diabetic retinopathy (PDR), vitreous haemorrhage originating from retinal vein occlusion (VH-RVO), epiretinal membrane (EM), macular hole (MH) or retinal detachment (RD) who underwent vitreoretinal surgery using the bubble ultra-wide field viewing system were included. A standard phacoemulsification was performed on each patient. Core humour and mid-peripheral vitreous humour were removed using a planoconcave lens. A suitably sized bubble was infused to attach to the posterior capsule or the anterior chamber depending on the integrity of the posterior capsule. The planoconcave lens and the air bubble formed the wide-angle viewing system, through which peripheral vitrectomy was performed. Range of applications, field of view, model validation and complications were recorded. The new ultra-wide field viewing system was successfully applied in all eyes, including 34 with PDR, 28 VH-RVO, 28 EM, 25 MH and 36 RD. Peripheral vitrectomy, local or panretinal laser photocoagulation, and removal of the peripheral proliferative membrane were successfully performed while viewing through this system. Maximum peripheral retinal area observable during the procedure was positively correlated with pupil diameter. Model analysis results showed that when the pupil diameter was 6 mm, the maximum field of view was approximately 128.1- 148.0 degrees with this system. Of 142 eyes, the main intraoperative complication was iatrogenic retinal breaks (IRBs) in 8 eyes (5.3%) and posterior capsule injury by vitreous cutter during bubble removal in 6 eyes (4.2%). The postsurgery mean best-corrected visual acuity (BCVA) (0.48 ± 0.39 logMAR) was significantly improved compared with the preoperative mean BCVA (1.60 ± 1.08 logMAR, p < 0.001). No incidents of postoperative choroidal detachment, secondary glaucoma or endophthalmitis were recorded. For patients with lens excision or absence, vitreoretinal surgery can be successfully performed using the novel viewing system described here. The system is a safe, convenient and economical ultra-wide field viewing system with a wide range of applications.

Trabeculectomy with Mitomycin-C in Post-Traumatic Angle Recession Glaucoma in Phakic Eyes With no Prior Intraocular Intervention

ABSTRACT Purpose : To evaluate the outcomes of primary trabeculectomy with mitomycin-C (trab MMC) in phakic eyes with post-traumatic angle recession glaucoma with no prior intraocular surgeries. Methods : We included 32 phakic eyes of 32 patients who underwent trab MMC between January-2002 and December-2017. Complete success was IOP between 6 and 21 mm Hg without anti-glaucoma medications (AGM) and failure was when IOP >21 mm Hg with AGM or need for additional intervention for IOP control or loss of light perception. Results : Thirty-two eyes of 32 subjects with a mean age (± standard deviation) of 30.6 ± 12.6 years were included. The majority were male (97.6%) and the major cause of blunt trauma were sports injury in 28/32 eyes (88%) and 24/32 eyes (75%) had >180-degree angle recession. The Median (interquartile range) follow-up duration was 1.3 years (0.3,3.5). There was significant IOP reduction at 1-year postoperatively (34 (28,40) to 13 (12,16) mm Hg; p < .001). The median postoperative AGM at 1-year was significantly less (4 (3,4) to 0; p < .001) with stable Log MAR visual acuity (p = .24). The complete survival of trab MMC was 88% at 1 year and was 77% from 2 to 5 years. Complications were intraoperative vitreous prolapse needing limited vitrectomy in two eyes and postoperative choroidal detachment in two eyes that resolved with conservative management. The contralateral eyes of three patients (9.7%) developed elevated IOP during the follow-up period. Conclusion : Trabeculectomy with mitomycin-C in phakic eyes with traumatic angle recession glaucoma showed good safety and efficacy in the medium-term follow-up. The contralateral fellow eye needs monitoring for glaucoma in these patients.

Syndrome de Radius-Maumenee : une cause rare de glaucome

Radius-Maumenee syndrome is a rare cause of severe secondary open-angle glaucoma. The ocular hypertension is due to episcleral venous hypertension. This syndrome consists of open angle glaucoma and episcleral venous dilatation without orbital or systemic abnormalities. It is diagnosis of exclusion after ruling out carotid-cavernous fistula, thyroid orbitopathy and an invasive orbital process that might explain the elevated episcleral venous pressure. Treatment begins with glaucoma eyedrops and, in case of failure, filtering surgery. Uveal effusion syndrome and postoperative choroidal detachment are frequent complications of filtering surgery in patients with this syndrome. We present the case report of a 59-year-old woman with Radius-Maumenee syndrome.

Determinants of Corneal Endothelial Cell Loss After Trabeculectomy With Mitomycin C.

To investigate factors associated with decreased corneal endothelial cell density (ECD) after trabeculectomy with mitomycin C (MMC). Retrospective review of consecutive glaucoma cases who underwent trabeculectomy with MMC. The types of glaucoma included were primary open-angle glaucoma, exfoliation glaucoma (XFG), neovascular glaucoma, and uveitic glaucoma (UG). The postoperative ECD changes compared with the preoperative ECD and risk factors for ECD decrease were analyzed using mixed-effects models. In total, 162 eyes of 136 patients were included in this study. Postoperative ECD measurements were performed 3.7±1.8 times (mean±SD) during a median follow-up period of 34 months. The mean intraocular pressure decreased from 25.3±9.6 to 9.2±2.3 mm Hg postoperatively. The marginal mean (SE) ECD decrease at 24 months was 9.3% (1.3%) in all cases. The marginal mean ECD decrease at 24 months was 18.2% (3.1%) and 20.6% (4.7%) in eyes with XFG and UG, respectively, which was significantly greater than 4.8% (1.8%) in eyes with primary open-angle glaucoma (P<0.001, each), after accounting for the variability in the number and timepoint of ECD measurements. Multivariate mixed-effects model analyses showed that type of glaucoma (XFG and UG) and older age were significantly associated with larger ECD decrease, and preoperative factors (oral carbonic anhydrase inhibitor and vitrectomy) and postoperative choroidal detachment were significantly associated with a declining trend of ECD over time. The type of glaucoma (XFG, UG) and older age were risk factors for larger ECD decrease after trabeculectomy with MMC.

Reasons and treatment of intraoperative and postoperative choroidal detachment after minimally invasive vitrectomy

Reasons and treatment of intraoperative and postoperative choroidal detachment after minimally invasive vitrectomy

Medium-term Outcomes of Unsutured Scleral Flap Trabeculectomies.

To examine the clinical characteristics and medium-term outcomes of unsutured scleral flap trabeculectomies. A retrospective review of 45 patients who underwent 50 unsutured scleral flap trabeculectomies by a single ophthalmic surgeon. Information pertaining to each patient's demographic details, preoperative assessment, surgical procedure, and 2 years of postoperative management were obtained. The average age of patients was 72.4±12.5 (range, 30 to 97) years. The diagnosis was primary open-angle glaucoma in 38 (76.0%) cases. The average preoperative, 1 year postoperative and 2-year postoperative intraocular pressure (with number of topical antiglaucoma medications) were 20.8 (2.5), 13.2 (0.4), and 12.6 mm Hg (0.7), respectively. The procedure performed was a trabeculectomy alone in 32 (64.0%) cases, and combined trabeculectomy and phacoemulsification in 18 (36.0%) cases. Four were performed with mitomycin C. Three procedures (6%) had intraoperative complications (2 iris prolapses, 1 subconjunctival hemorrhage). Seven procedures were complicated by a postoperative choroidal detachment, which were managed conservatively and resolved spontaneously over time. There was 1 case (2%) of postoperative hypotony, which failed to resolve (intraocular pressure of <6 mm Hg for >3 months). The majority of unsutured scleral flap trabeculectomies had an acceptable risk profile and resulted in a decrease in the intraocular pressure at 2 years postoperatively.

Multiple methods of surgical treatment combined with primary IOL implantation on traumatic lens subluxation/dislocation in patients with secondary glaucoma.

To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma, and discuss the multiple treating methods of operation combined with primary intraocular lens (IOL) implantation. Non-comparative retrospective observational case series. 30 cases (30 eyes) of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi'an No.4 Hospital from 2007 to 2011. According to the different situations of lens subluxation/dislocation, various surgical procedures were performed such as crystalline lens phacoemulsification, crystalline lens phacoemulsification combined anterior vitrectomy, intracapsular cataract extraction combined anterior vitrectomy, lensectomy combined anterior vitrectomy though peripheral transparent cornea incision, pars plana lensectomy combined pars plana vitrectomy, and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy. And whether to implement trabeculectomy depended on the different situations of secondary glaucoma. The posterior chamber intraocular lenses (PC-IOLs) were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present. visual acuity, intraocular pressure, the situation of intraocular lens and complications after the operations. The follow-up time was 11-36mo (21.4±7.13). Postoperative visual acuity of all eyes were improved; 28 cases maintained IOP below 21 mm Hg; 2 cases had slightly IOL subluxation, 4 cases had slightly tilted lens optical area; 1 case had postoperative choroidal detachment; 4 cases had postoperative corneal edema more than 1wk, but eventually recovered transparent; 2 cases had mild postoperative vitreous hemorrhage, and absorbed 4wk later. There was no postoperative retinal detachment, IOL dislocation, and endophthalmitis. To take early treatment of traumatic lens subluxation/dislocation in patients with secondary glaucoma by individual surgical plan based on the different eye conditions would be safe and effective, which can effectively control the intraocular pressure and restore some vision.

Large choroidal melanoma diagnosed after cataract surgery

A dense cataract prevents detailed fundus examination which may lead to delayed diagnosis of undiscovered intraocular pathology before cataract surgery. We report two cases where large choroidal melanomas were diagnosed after cataract surgery and/or Nd:Yag laser capsulotomy. In the first case, a dense cataract prevented proper examination of the fundus of an 84-year-old female. A brownish choroidal lesion was seen after cataract surgery and diagnosed as postoperative choroidal detachment. As this lesion persisted over months, the patient was sent to our hospital for evaluation where a diagnosis of choroidal melanoma with extrascleral growth was made and an enucleation with implantation of a dermis-fat graft was performed without complication 10days later. In the second case, a 58-year-old female patient had Nd:Yag laser treatment 2years after cataract surgery had been performed. During fundus examination 1day after treatment, the ophthalmologist noticed a choroidal lesion which he suspected to be a reaction to the laser treatment and referred the patient to our hospital where a diagnosis of a mushroom-shaped choroidal melanoma with serous retinal detachment was made. These cases show that preoperative evaluation of the posterior segment prior to cataract surgery or other therapeutic interventions is essential in order to identify any pathology. In case of a dense cataract, additional imaging such as ultrasound sonography is recommended in order to exclude intraocular lesions and to visualize the optic disc in suspected glaucoma.

The ahmed shunt versus the baerveldt shunt for refractory glaucoma: A single-surgeon comparison of outcome

Purpose To compare the surgical outcome of Baerveldt and Ahmed shunt implants in the treatment of refractory glaucoma. Design Retrospective, nonrandomized, comparative trial. Methods and participants Medical records of 118 consecutive patients who underwent glaucoma shunt implantation (70 Baerveldt, 48 Ahmed) by a single surgeon were reviewed. Main outcome measures The primary outcome measure was surgical success (6 mmHg ≤ intraocular pressure [IOP] ≤ 21 mmHg without additional glaucoma surgery or devastating complication) at 12 months after surgery. Secondary outcome measures included mean IOP and number of medications used at the following postoperative visits: day 1, 1 week, 1 month, 3 months, 6 months, and every 6 months thereafter. Additional outcome measures evaluated include visual acuities, prevalence and timing of postoperative choroidal detachment, and clinical bleb encapsulation. Results Survival curve analysis showed success rates of 82.9% of the Ahmed group and 72.9% of the Baerveldt group at 12 months after surgery ( P = 0.257). Patients in the Ahmed group exhibited lower IOPs at 1 day ( P < 0.001) and 1 week ( P < 0.001) after surgery and were taking fewer glaucoma medications at 1 week ( P < 0.001) and 1 month ( P < 0.001) after surgery. A higher proportion of Ahmed patients experienced clinical bleb encapsulation than did the Baerveldt patients (60.4% vs. 27.1%; P < 0.001). Moreover, the first observation of postoperative bleb encapsulation was sooner after surgery for the Ahmed patients (50.0 ± 43.8 days) than for the Baerveldt patients (69.8 ± 22.6 days; P = 0.001). Conclusions The Ahmed shunt implant exhibited better control of IOP in the early postoperative period (1 day and 1 week) with patients requiring fewer glaucoma medications at 1 week and 1 month after surgery. There was both a higher prevalence and earlier onset of bleb encapsulation observed with the Ahmed shunt implant.

Complications Associated With Vortex Vein Damage in Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment

Purpose: To further understand postoperative complications after vortex vein damage during scleral buckling surgery. Methods: The records of 34 patients (34 eyes) with vortex vein damage during scleral buckling surgery for rhegmatogenous retinal detachment were reviewed and compared with the records of 410 eyes undergoing similar surgery without vortex vein damage. Results: Postoperative complications were noted in 16 eyes (47%) of the damaged vortex vein group. The incidence of choroidal detachment, vitreous opacities, intraocular pressure elevation, and vitreous hemorrhage were 27%, 18%, 9%, and 6%, respectively, with a higher incidence than in the group without vortex vein damage. Other complications included development of epiretinal membrane (9%), subretinal hemorrhage (3%), and anterior segment ischemia (3%). Serous choroidal detachment occurred in the early postoperative days and subsided within 3 weeks. Vitreous opacification became marked in the later periods and continued for 2 months or longer. The incidence of postoperative choroidal detachment in the vortex vein damage group was related to the patient’s age ( P = .002) and the cutting of the vortex veins ( P = .048), but was not related to preoperative conditions of retinal detachment or the number of vortex veins damaged. All the eyes except one achieved retinal reattachment after initial surgery. Conclusions: Choroidal detachment and vitreous opacity are common after scleral buckling surgery with vortex vein damage. Although intervention of the vortex veins during scleral buckling surgery is acceptable when performing otherwise difficult to achieve ample scleral indentation, it should be minimized to avoid increased incidence of postoperative complications.

Risk factors for proliferative vitreoretinopathy.

Proliferative vitreoretinopathy (PVR) is one of the major causes of failure in retinal detachment surgery. To prevent PVR, it is necessary to determine factors predisposing its development. In primary PVR, large retinal tears, long duration of retinal detachment, vitreous hemorrhages, aphakia and choroidal detachment were demonstrated as clinical risk factors for PVR. In postoperative PVR, it was revealed that large breaks, pre- and postoperative choroidal detachment, minor intra- or postoperative hemorrhages, signs of uveitis, extensive retinal detachment, vitrectomy, cryopexy, air injection and preoperative PVR were risk factors for PVR by multivariate analysis. Almost all risk factors for PVR are associated with intravitreal dispersion of retinal pigment epithelial (RPE) cells or breakdown of the blood-ocular barrier which are prerequisite to development of PVR.

Spontaneous Dislocation of a Foldable Lens Following Phacotrabeculectomy and Implant Insertion: a Case Report

Spontaneous postoperative dislocation of a foldable implant into the anterior chamber has not previously been recorded. Such a case of spontaneous implant (Chiron 32-C10XX) dislocation in the early postoperative period is described following a phacotrabeculectomy procedure along with its successful surgical management. Possible mechanisms of spontaneous implant dislocation in this case were the development of a large post-operative choroidal detachment and the presence of a large capsulorrhexis.

CLINICAL RISK FACTORS FOR PROLIFERATIVE VITREORETINOPATHY AFTER RETINAL DETACHMENT SURGERY

To identify the clinical risk factors for the development of severe proliferative vitreoretinopathy (PVR) after retinal detachment surgery. A retrospective study of 1020 patients with either no PVR or with PVR of grade C1 or less at initial examination was conducted. After surgery, severe PVR was defined as grade C2 or worse. The data relating to 94 variables were evaluated by univariate analysis and stepwise logistic regression. Severe PVR developed after surgery in 107 patients (10.5%). Ten significant predictive variables were identified: minor intra- or postoperative hemorrhage, grade A preoperative PVR, preoperative choroidal detachment, giant tears, air tamponade, detachment involving more than 2 quadrants, cumulative break area larger than 3 optic disks, postoperative choroidal detachment, signs of uveitis at initial examination, and grade B preoperative PVR. The results indicate that in addition to the size of breaks, extent of detachment, and presence of preoperative inflammation or low-grade PVR, iatrogenic problems also are important factors in the pathogenesis of severe PVR after surgery for retinal detachment.

Sturge-Weber Syndrome: Management of Glaucoma With Combined Trabeculotomy-Trabeculectomy

ABSTRACT We reviewed the records of 16 patients (19 eyes) with Sturge-Weber syndrome (SWS). Scleral pigmentation was present in 12 (63.2%) of these eyes; nevus of Ota in two (10.6%). Combined trabeculotomy-trabeculectomy was performed in 18 eyes. After a mean follow up of 42 months (range, 1 to 8 years), intraocular pressure was controlled (=≤ 22 mm Hg) in 11 eyes (61.1%), and visual acuity was better than 6/60 in eight. Intraoperative hyphema occurred in four eyes (22.2%); vitreous loss in three (16.7%). Postoperative choroidal detachment occurred in three eyes (16.7%); vitreous hemorrhage in one (5.6%). In all of the cases of repeat surgery (three eyes), postoperative subconjunctival injections of 5-fluorouracil resulted in a diffuse filtering bleb. We conclude that combined trabeculotomy-trabeculectomy is a promising treatment for patients with SWS with glaucoma.

Tears of the Retinal Pigment Epithelium: Occurrence in Association With Choroidal Effusion

Two patients developed large tears of the retinal pigment epithelium associated with choroidal effusion. One tear occurred after combined cataract/filtration surgery complicated by postoperative choroidal detachment; the second developed in a patient with idiopathic uveal effusion syndrome. Weakness of the junctions of the pigment epithelial cells secondary to the accumulation of fluid in the subretinal or suprachoroidal space may result in tearing of the retinal pigment epithelium as it is stretched.

Management of Rhegmatogenous Retinal Detachment with Macula Detached: Steroids, Choroidal Detachment, and Acuity

One hundred thirty-four consecutive eyes with rhegmatogenous retinal detachment involving the macula were evaluated with reference to the effectiveness of systemic steroids in preventing choroidal detachment after scleral buckling surgery and in facilitating both anatomic and functional success. The occurrence of postoperative choroidal detachment was inversely related to the routine intravenous administration of steroids under antibiotic coverage beginning in the recovery room (P = 0.014). Eyes so treated were free of both clinically significant infection and extrusion. The infrequent but worrisome complication of angle closure sufficient to require choroidal tap did not occur among treated eyes. Routine steroid use may have been associated with increased preservation of acuity at the level of 20/200 or better (P = 0.043).

Multilobed uveal melanoma masquerading as postoperative choroidal detachment.

A case of multilobed malignant melanoma with a haemorrhagic retinal detachment which mimicked a postoperative choroidal detachment is described. Because the lesion showed no resolution six weeks after cataract surgery a tumour evaluation was undertaken. The diagnosis was established with a positive radioactive phosphorus uptake (32P) test and biopsy of the intraocular mass. A suggested approach to the diagnosis in such difficult cases is proposed.