Choroidal Hemorrhage Drainage Through 23-Gauge Vitrectomy Cannulas

Transconjunctival Drainage of Serous and Hemorrhagic Choroidal Detachment

“…The present choroidal drainage technique differs in concept from the recently published 23-gauge drainage technique, 22 as it does not require concomitant pars plana vitrectomy. The eye is pressurized anteroposteriorly by an anterior chamber infusion ( Figure 4, top left).…”

“…The eye is pressurized anteroposteriorly by an anterior chamber infusion ( Figure 4, top left). In our technique, instead of placing the drainage sclerotomies at the pars plana ( Figure 4, top middle), as described by Rossi et al, 22 we chose to place them further posteriorly (7.0 mm from limbus), guided by ultrasonography, to achieve a more complete drainage anteroposteriorly without the need for pars plana vitrectomy and use perfluorocarbons/silicone oil to push fluid/hemorrhage posteroanteriorly. In this manner, we assure that the pars plana is reattached and only need to then perform pars plana incisions in cases that have other concomitant comorbidities that require vitrectomy.…”

“…5,22,24 These vitrectomies are performed in large part because many authors suggest that concomitant vitrectomy may reduce the development of subsequent retinal detachment, giant retinal tear, and proliferative vitreoretinopathy. Our study suggests that pars plana vitrectomy is not required during choroidal drainage unless a pathology that demands the vitrectomy (i.e., rhegmatogenous retinal detachment or incarceration) coexists, as the cohort of patients did quite well without vitrectomy.…”

“…If the cannulas are placed at the pars plana region, depending on the angle of entry, they may go directly into the vitreous cavity and you may have no drainage (dry tap) or fluid vitreous or balanced salt solution may exit through the cannulas (false drainage) (Figure 4, top right). In addition, our technique uses 25-gauge cannulas for serous choroidal and 20-gauge cannulas for hemorrhagic choroidal detachment drainage instead of 23 gauge described by Rossi et al 22 Although a recent retrospective series 23 with 2 years of follow-up has shown that serous choroidal detachment appears not to influence trabeculectomy success in lowering IOP, eyes that developed choroidal detachments had a greater decrease in visual acuity and required almost 6 months before recuperating preoperative visual acuity in comparison with 1 month in eyes without choroidal detachments. Preservation of vision in the operated eye during the postoperative period is critical in monocular patients.…”

“…We believe that 1-step 23-gauge systems with soft cannulas may work just as well as the 25-gauge system for serous drainage, but for hemorrhagic drainage, we still prefer the 20-gauge trocar/cannula system. 22 For safety reasons, because of the length of the trocar blades, we included patients only with choroidal detachment of at least 7.0 mm in height. To confirm the choroidal detachment height, intraoperative B-scan ultrasonography may be used to select the quadrants to be drained.…”