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Editors Selection IGR 13-1

Surgical Treatment: Transconjunctival drainage of choroidal detachment

Comment by Brian Francis on:

47644 Transconjunctival drainage of serous and hemorrhagic choroidal detachment, Rezende FA; Kickinger MC; Li G et al., Retina (Philadelphia, Pa.), 2011;

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The standard treatment for post-operative serous and hemorrhagic choroidal detachment is medical treatment and observation. However, if the resolution is prolonged, there is central retinal touch or retinal or vitreous incarceration, or severe anterior chamber shallowing, then surgical drainage is warranted. The usual approach is to open the conjunctiva and create a scleral incision or window to allow drainage of the fluid as the anterior chamber is expanded with saline. However, in eyes with multiple prior surgeries and significant pathology, a minimally invasive technique may be preferred. Rezende et al. (2141) describe a technique for drainage of serous and hemorrhagic choroidal detachments with 25- and 20-gauge transconjunctival trocar systems, respectively. They included eyes with choroidal hemorrhage occurring intraoperatively, but excluded those with late hemorrhage or due to trauma. Eyes with serous choroidal detachment for greater than three months duration or appositional if less than three months were also included. Ultrasound was used to document resolution of fluid, which was the primary outcome measure. Secondary outcomes were visual acuity and intraocular pressure at one week, one, three, and six months after surgery.

The surgical procedure utilizes a 25-gauge anterior chamber maintainer and a transconjunctival beveled incision 7.0 mm posterior to the limbus in one or two quadrants. Following drainage of fluid, the cannulas are removed without suturing and the overlying conjunctiva cauterized. Two patients had hemorrhagic, and four had serous choroidal detachments. All patients had resolution of the choroidal detachment and improved visual acuity.

This small case series prospectively analyzed the results of a new technique of drainage of choroidal hemorrhage or serous detachment. The technique utilizes small incision retinal vitrectomy trocar/ cannula systems in order to drain the fluid without a conjunctival dissection or scleral suturing. It is unclear why post-operative hemorrhagic choroidal detachments were not included, as these can occur following glaucoma surgery with hypotony. Of note, only eyes with a choroidal detachment of at least seven mm were included in order to avoid damaging the retina or choroid with the sharp trocar. The technique described seems to be a relatively safe and effective method to treat choroidal fluid without the need for extensive dissection and the risk of conjunctival scarring.

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