Transconjunctival Drainage of Serous and Hemorrhagic Choroidal Detachment

Rezende, Flávio; Kickinger, M. C.; Li, Gisèle; Prado, R. F.; Régis, Luiz Gustavo Tonelli

doi:10.1097/iae.0b013e31821c4087

Cited by 31 publications

(35 citation statements)

References 24 publications

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“…In the past, many surgeons have described the use of vitrectomy instruments for SB, including chandelier lighting and wide-angle viewing systems on surgical microscopes [12,13]. Similarly, the development of new techniques to drain choroidal detachments, using trocars placed in the suprachoroidal space, have allowed surgeons to be more familiarized with this region of the posterior segment [14,15]. SCB uses techniques that are more familiar to vitrectomytrained surgeons, but many are still reticent to try it.…”

Section: Discussionmentioning

confidence: 99%

Hemorrhagic complications associated with suprachoroidal buckling

et al. 2020

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Background: Multiple surgical techniques exist for the repair of rhegmatogenous retinal detachments (RRD). Suprachoroidal buckling (SCB), consisting of injecting viscoelastic material in the suprachoroidal space to allow chorioretinal apposition, has been recently described in the repair of RRD. The aim of this study is to report the complications of SCB and to propose measures to decrease their incidence during the learning curve. Methods:A total of 26 eyes of 26 patients who underwent a SCB procedure for the management of RRD secondary to a single or multiple retinal breaks were enrolled. Patients were operated between January 2014 and March 2017 at two academic institutions. Patient and retinal detachment characteristics were obtained from the charts. Surgical videos were reviewed for every case and intraoperative complications were recorded. Complications observed postoperatively were obtained from the charts.Results: Sixteen eyes (62%) underwent SCB alone, 5 eyes (19%) underwent additional gas tamponade and 5 eyes (19%) had combined pars plana vitrectomy. The most common complication was hemorrhage (6 cases, 23%). There were no cases of ischemic choroidal changes or hyperpigmentation at the edge of the dome. All six complications occurred in phakic patients who had inferior RRD with retinal breaks in the inferior quadrants. Isolated subretinal hemorrhage occurred in 4 patients and isolated suprachoroidal hemorrhage in 1 patient, and those did not affect final visual outcome. Extensive combined subretinal and suprachoroidal hemorrhage occurred in one case, and was complicated by phthisis bulbi. Re-detachment occurred in 4/6 (67%) of patients, and 5/6 (83%) of patients required a secondary procedure. Three out of 6 patients (50%) had at least 2 lines of visual acuity improvement.Conclusion: SCB performed for RRD can be associated with hemorrhagic complications. The hemorrhages are usually self-limited but may occasionally result in severe visual compromise when involving the suprachoroidal space. Specific surgical measures need to be undertaken in order to decrease the likelihood of complications and further studies are needed to assess the safety and efficacy of this technique.

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Section: Discussionmentioning

confidence: 99%

Hemorrhagic complications associated with suprachoroidal buckling

et al. 2020

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“…More recently, Rezende et al8 evaluated transconjunctival drainage of serous and hemorrhagic choroidal detachment using 20- or 25-gauge transconjunctival trocar/cannula systems. They inserted the transconjunctival trocar/cannula systems into the suprachoroidal space 7.0 mm from the limbus, and reported that vitrectomy may not be necessary when the choroidal detachments are drained in this manner.…”

Section: Discussionmentioning

confidence: 99%

Abrupt spontaneous suprachoroidal hemorrhage post-23-gauge vitrectomy during peritoneal dialysis

Kim¹,

Lee²,

Lee³

2013

OPTH

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Herein, we report a case of abrupt suprachoroidal hemorrhage (SCH) that developed during peritoneal dialysis in a patient with proliferative diabetic retinopathy. A 53-year-old female patient visited our clinic with blurred vision due to vitreous hemorrhage and proliferative diabetic retinopathy. Her medical history included diabetes, hypertension, chronic renal failure, and she had received scheduled peritoneal dialysis. No anticoagulant agents were used. We performed combined phacoemulsification with intraocular lens implantation and vitrectomy without any complications. Two hours later, the retina was stable and the intraocular pressure (IOP) was 11 mmHg. Four hours later, while receiving peritoneal dialysis, she abruptly developed ocular pain. Examination of her eye revealed an IOP of 38 mmHg and a SCH in the entire peripheral retina and posterior pole. At 12 hours after surgery (on the same day), the SCH was found to be further aggravated, and because a “kissing retina” was imminent, silicone oil was injected. An attempted fluid–air exchange failed because there was not enough space to fill with silicone oil due to aggravation of the SCH. Sclerotomies were performed to remove the SCH, and to create space for the silicone oil injection. Two months after surgery, the silicone oil was removed and her visual acuity was found to have improved to 20/40, but the patient died of pontine hemorrhage 1 month later. SCH can occur in vitrectomized eyes due to an increase in abdominal pressure during peritoneal dialysis, because chronic renal failure patients with diabetes and hypertension have structural vulnerabilities and vascular weaknesses due to arterial sclerosis in response to the increased blood pressure.

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“…7 Rezende et al 8 described the transconjunctival drainage of haemorrhagic choroidal detachments angulation. After entering the cutting tip, only the cannula progresses, thus avoiding iatrogenic retinal damage.…”

Section: Drainage Of Extensive Suprachoroidal Haemorrhagesmentioning

confidence: 99%

Microincision Vitrectomy Trocars – Redefining Surgical Practices Through a New Range of Applications

Marques¹,

Azenha²,

Figueira³

2015

European Ophthalmic Review

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Transconjunctival microincision vitrectomy surgery (MIVS) has grown increasingly popular among vitreoretinal surgeons over the last few years. Technical advances have led to the development of cutting-edge vitrectomy systems and instruments that significantly contributed to the success of MIVS. Trocar evolution has added extra safeness and effectiveness to the technique. In the hands of an experienced surgeon, microincision vitrectomy trocars offer a new range of applications that can redefine surgical practices and facilitate otherwise complex surgical techniques.

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Transconjunctival Drainage of Serous and Hemorrhagic Choroidal Detachment

Abstract: Transconjunctival drainage of serous and hemorrhagic choroidal detachments seems to be a feasible and simple surgical option with minimal scleral and conjunctival damage. Pars plana vitrectomy may not be necessary when draining choroidal detachments in this manner.

Cited by 31 publications

References 24 publications

Hemorrhagic complications associated with suprachoroidal buckling

Hemorrhagic complications associated with suprachoroidal buckling

Abrupt spontaneous suprachoroidal hemorrhage post-23-gauge vitrectomy during peritoneal dialysis

Microincision Vitrectomy Trocars – Redefining Surgical Practices Through a New Range of Applications

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