Risk factors and management of choroidal effusions

Abstract

Purpose of reviewChoroidal effusions are recognized as a common early postoperative complication of glaucoma surgery, and although often benign, they may cause significant ocular morbidity. This article aims to summarize current research on the risk factors and management of choroidal effusions.Recent findingsGlaucoma drainage device (GDD) implantation and trabeculectomy are the most commonly performed surgeries for the management of moderate to severe glaucoma. Common postoperative complications of these procedures include hypotony and the development of choroidal effusions. Choroidal effusions have recently been associated with the oral administration of certain drugs, including select monoclonal antibody, antiseizure and bisphosphonate medications. Risk factors for effusion development include specific patient characteristics such as pseudoexfoliative glaucoma, older age and hypertension. Although choroidal effusions typically resolve with medical therapy alone, surgical intervention may be required. Various methods of surgical intervention, such as surgical drainage or GDD tube ligation, can be utilized to treat choroidal effusions when conservative management with medical treatment fails, but themselves carry alternative risks that must be considered.SummaryMinimizing the incidence and duration of hypotony following ophthalmic surgery and careful monitoring of patients starting certain oral medications are important in limiting the occurrence of choroidal effusions. Risk factors for choroidal effusions have been recently identified in the literature. A better understanding of these risk factors, as well as the outcomes of choroidal effusion management, can help to reduce the occurrence of effusions overall and minimize ocular morbidity.

Acute serous and hemorrhagic choroidal effusion associated with topical dorzolamide therapy

“…brolucizumab), and bisphosphonates. 5 Choroidal effusion is extremely rare after topical CAI administration. Goldberg et al described a case of choroidal effusion in a 76-year-old female with no prior ocular surgery within 12 hours after starting dorzolamide therapy.…”

Spontaneous resolution of long-standing choroidal effusion after glaucoma drainage implant surgery without significant visual deterioration : a case report

“…Indications for surgery included a flat anterior chamber with lens-cornea apposition, persistent corneal edema with a shallow anterior chamber, combined serous retinal and choroidal detachment, and a prolonged duration of effusion. Persistent choroidal effusion is associated with a risk of complications, such as reduction in best-corrected visual acuity (BCVA) or cataract formation [6]. Herein, we report a case of spontaneous resolution of long-standing severe choroidal effusion without significant visual deterioration after Ahmed glaucoma valve implantation.…”

“…It usually occurs in cases of significant postoperative hypotony. Reported rates of choroidal effusions range from 2.8 to 22.6% after trabeculectomy and from 9 to 35.1% after Ahmed glaucoma valve implantation [2][3][4][5][6]. With the widespread use of wide-field fundus photography, the rates from recent reports tend to be higher than those from previous studies because physicians can easily detect even small choroidal effusions in the peripheral retina [7].…”

A Brief Review of Historical and Current Trends in Trabeculectomy

“…Choroidal effusions are often self-limited, requiring only observation or medical therapy, including topical or oral steroids to reduce inflammation and topical cycloplegics to rotate the lens-iris diaphragm posteriorly. 204 In-office interventions including injecting cohesive viscoelastic agent to fill the anterior chamber and increase the IOP may be considered before surgical intervention. Surgical drainage may be required in patients with large persistent effusion or with high risk for the development of a suprachoroidal hemorrhage.…”

“…However, recent retrospective studies have highlighted that age, 201,202 profound drop in postoperative IOP, 201,203 exfoliative glaucoma, 202,203 and increased corneal thickness 203 are also risks for choroidal detachment. Choroidal effusions are often self-limited, requiring only observation or medical therapy, including topical or oral steroids to reduce inflammation and topical cycloplegics to rotate the lens-iris diaphragm posteriorly 204 . In-office interventions including injecting cohesive viscoelastic agent to fill the anterior chamber and increase the IOP may be considered before surgical intervention.…”