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Sung MS, Lee JH, Ji YS, Park SW. Spontaneous resolution of long-standing choroidal effusion after glaucoma drainage implant surgery without significant visual deterioration : a case report. BMC Ophthalmol 2023; 23:465. [PMID: 37974114 PMCID: PMC10655377 DOI: 10.1186/s12886-023-03213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Choroidal effusion is a common complication of glaucoma surgery. Although most cases of choroidal effusions resolve spontaneously with observation or medical management alone as intraocular pressure normalizes, surgical drainage might be needed in severe or persistent cases. Herein, we report a case of spontaneous resolution of long-standing severe choroidal effusion after Ahmed glaucoma valve implantation. CASE PRESENTATION An 85-year-old man with uncontrolled primary open-angle glaucoma and medical history of chronic kidney disease underwent uneventful Ahmed glaucoma valve implantation. On postoperative day 8, transient hypotony occurred, and large 360° peripheral choroidal detachments developed. Although the intraocular pressure increased to normal levels on postoperative day 15, choroidal effusion did not resolve. Fundus examination over 8 months showed that the large choroidal effusion persisted despite a well-controlled intraocular pressure. Laboratory test performed at preoperatively and follow-up period revealed persistently elevated potassium and creatinine levels. On postoperative 9 months, the lesion resolved spontaneously without any surgical intervention. We found that the patient's creatinine level was normalized, pre-existing hyperkalemia was corrected, and accordingly his general condition was improved. CONCLUSIONS Considering the underlying medical condition may be helpful in patients with persistent choroidal effusion of an unclear etiology following glaucoma filtering surgery.
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Affiliation(s)
- Mi Sun Sung
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, 61469, Gwangju, South Korea
| | - Jong Hoon Lee
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, 61469, Gwangju, South Korea
| | - Yong-Sok Ji
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, 61469, Gwangju, South Korea
| | - Sang Woo Park
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, 61469, Gwangju, South Korea.
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Ying S, Coulon SJ, Lidder AK, Labowsky M, Cheng CP, Vinod K, Sidoti PA, Panarelli JF. Choroidal Effusions after Glaucoma Drainage Implant Surgery: Risk Factors and Surgical Management. Ophthalmol Glaucoma 2023; 6:530-540. [PMID: 36925067 DOI: 10.1016/j.ogla.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To report the incidence of patients who developed choroidal effusions after glaucoma drainage implant (GDI) surgery and determine risk factors for and outcomes of surgical intervention. DESIGN Retrospective case series. SUBJECTS Medical records of 605 patients who underwent GDI surgery from January 1, 2017 to June 7, 2021 at New York University Langone Health and New York Eye and Ear Infirmary of Mount Sinai were reviewed. METHODS Preoperative, intraoperative, and postoperative clinical data were obtained. Multivariate logistic regression evaluated the factors associated with the need for surgical intervention. Patient records were analyzed for effusion resolution, intraocular pressure (IOP), visual acuity (VA), and complications across treatment modalities. MAIN OUTCOME MEASURES Incidence of choroidal effusion development and need for surgical intervention. RESULTS Choroidal effusions developed in 110 (18%) patients (110 eyes). Surgical intervention to drain the effusion or ligate the implant tube was performed in 19 (17%) patients. The average time to surgical intervention was 47.6 days. Among patients who developed postoperative effusions, risk factors for requiring surgical intervention included history of selective laser trabeculoplasty (SLT) (P = 0.004; odds ratio [OR], 14.4), prior GDI surgery (P = 0.04; OR 8.7), 350-mm2 Baerveldt glaucoma implant placement (P = 0.05; OR, 4.8), and anterior chamber shallowing (AC; P < 0.001; OR, 25.1) in the presence of effusions. The subgroup that required multiple surgeries for effusion resolution had a significantly lower mean IOP at the most recent follow-up compared with those who received medical management only (P < 0.001). A higher percentage of patients who required surgical intervention lost VA at the most recent follow-up compared with patients whose effusions resolved with conservative management (i.e., medical management, AC viscoelastic injection). CONCLUSIONS Choroidal effusions after GDI surgery resolved with conservative management in most patients. A history of SLT or GDI placement, implantation of a BGI-350, and the presence of a shallow chamber were risk factors for surgical intervention. Although interventions, such as surgical drainage are at times necessary, a better understanding of their impacts can help guide postoperative decisions. The risks and benefits of these procedures must be carefully considered in these high-risk eyes. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Stephanie Ying
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sara J Coulon
- Department of Ophthalmology, New York University Langone Health, New York, New York
| | - Alcina K Lidder
- Department of Ophthalmology, New York University Langone Health, New York, New York
| | - Mary Labowsky
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Christopher P Cheng
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kateki Vinod
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Paul A Sidoti
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Joseph F Panarelli
- Department of Ophthalmology, New York University Langone Health, New York, New York.
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Risk factors and management of choroidal effusions. Curr Opin Ophthalmol 2023; 34:162-167. [PMID: 36730733 DOI: 10.1097/icu.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Choroidal 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 FINDINGS Glaucoma 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. SUMMARY Minimizing 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.
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Yadlapalli N, Fan J, Sridhar J. Techniques to Repair Choroidal Detachments. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Zhang WW, Jiang F, Xie ZG. A Modified Trocar and Cannula System With Lateral Micropores for 1-Step Drainage of Suprachoroidal Fluid During Primary Vitrectomy. JAMA Ophthalmol 2022; 140:900-901. [PMID: 35862041 DOI: 10.1001/jamaophthalmol.2022.2597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Wen-Wen Zhang
- Department of Ophthalmology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Feng Jiang
- Department of Ophthalmology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Zheng-Gao Xie
- Department of Ophthalmology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
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Yeung SC, Mason RH, Minaker SA, AlAli A, Kertes PJ, Yan P. A Stepwise Approach to the Surgical Management of Hemorrhagic Choroidal Detachments. JOURNAL OF VITREORETINAL DISEASES 2022; 6:111-115. [PMID: 37008660 PMCID: PMC9976014 DOI: 10.1177/2474126421992024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: This work describes a stepwise surgical approach to draining choroidal detachments and 2 cases for which this approach was used. Methods: The first step involves insertion of an anterior chamber maintainer and a nonvalved 23- or 25-gauge trocar cannula at the highest peak of hemorrhagic choroidal detachment (as determined using B-scan ultrasonography), 6 to 8 mm from and angled 20° to 30° toward the limbus. The second step involves removal of the trocar to expose the sclerotomy. Alternatively, the second step can be insertion of a second trocar. The third step involves the creation of a small focal peritomy around the preexisting sclerotomy and enlargement of the preexisting sclerotomy into a radial sclerotomy. Progression between steps only occurs if prior steps did not provide adequate drainage. Results: Two cases of appositional hemorrhagic choroidal detachments in hypotonic eyes were successfully resolved by this stepwise approach. In case 1, a choroidal detachment developed after a corneal ulcer perforation. The hemorrhagic choroidal detachment in case 1 was resolved with steps 1 and 2, and an unnecessary scleral cutdown was avoided. In case 2, a choroidal detachment developed after a trabeculectomy. The detachment in case 2 required progression to step 3, extension of the trocar insertion site into a radial sclerotomy. Conclusions: This stepwise approach should be considered to reduce excessive manipulation of the globe and conjunctiva in hemorrhagic and serous choroidal detachments that warrant surgical intervention.
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Affiliation(s)
- Shanna C. Yeung
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ryan H. Mason
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, ON, Canada
- Kensington Vision and Research Center, Toronto, ON, Canada
| | - Samuel A. Minaker
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, ON, Canada
- Kensington Vision and Research Center, Toronto, ON, Canada
| | - Alaa AlAli
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, ON, Canada
- Kensington Vision and Research Center, Toronto, ON, Canada
| | - Peter J. Kertes
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, ON, Canada
- Kensington Vision and Research Center, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Peng Yan
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, ON, Canada
- Kensington Vision and Research Center, Toronto, ON, Canada
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Hattenbach LO, Bopp S, Strobel M, Chronopoulos A. Surgical Management of Choroidal Diseases. Klin Monbl Augenheilkd 2021; 238:980-987. [PMID: 34416789 DOI: 10.1055/a-1554-5496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Accumulation of serous fluid in the suprachoroidal space, known as uveal effusion, and choroidal or suprachoroidal haemorrhage (SCH) following rupture of ciliary blood vessels are considered rare, but serious, events with extremely poor functional prognosis. As a result, uveal effusion, and expulsive suprachoroidal haemorrhage in particular, continue to be considered as more or less fatal complications. However, clinical experience demonstrates that both clinical entities can be managed by conservative as well as surgical strategies, depending on their severity and localisation, with sometimes surprisingly favourable visual outcome. In addition to prognostic factors, timely recognition and prompt, if possible preventive, acute care, as well as carefully considered timing of adequate surgical measures taking advantage of the specific characteristics of the choroidal tissue, are crucial to treatment success. Along with technical advances in the field of vitreoretinal surgery, numerous variants of therapeutic approaches to the treatment of choroidal effusion and suprachoroidal haemorrhage have been proposed to date. This review presents some of the most important surgical techniques and strategies in the field.
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Affiliation(s)
| | - Silvia Bopp
- Bergman Clinics, Augenklinik Universitätsallee, Bremen, Deutschland
| | - Marc Strobel
- Augenklinik, Klinikum der Stadt Ludwigshafen gGmbH Deutschland
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Safuri S, Bar-David L, Barak Y. Minimally Invasive Technique for Choroidal Fluid Drainage. Clin Ophthalmol 2020; 14:1955-1958. [PMID: 32753838 PMCID: PMC7358090 DOI: 10.2147/opth.s253989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/02/2020] [Indexed: 11/27/2022] Open
Abstract
Background This study describes a simple technique for the treatment of kissing choroidal detachment. In contrast to the commonly used technique, this technique is minimally invasive, fast, sutureless, and does not require access to the vitreous space. Methods A maintainer is inserted into the anterior chamber. A 25G trocar is inserted at the pars plana into the suprachoroidal space. Drainage is evident by the clear yellowish fluid freely emerging through the trocar, accompanied with deepening of the anterior chamber and an increase in the red reflex. Results Follow-up ultrasound 1 week after the surgery demonstrated resolution of the choroidal detachment. Net surgery time is about 10 minutes. No complications were noted. Discussion This is the first report of the technique performed in phakic eye, with video description of the steps and real-time clues for successful drainage even with reduced posterior segment visibility due to lens opacities.
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Affiliation(s)
- Shadi Safuri
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Laura Bar-David
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Yoreh Barak
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
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Areephanthu CJ, Todd AM, Valluri S, Groppel P, Cantor L. Case Report of a 67-Year-Old Man with Zonisamide-Induced Ciliochoroidal Effusion Syndrome. Ophthalmol Glaucoma 2020; 3:308-310. [PMID: 33008566 DOI: 10.1016/j.ogla.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 06/11/2023]
Affiliation(s)
| | - Amelia Maureen Todd
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Shailaja Valluri
- Roudebush Veterans' Administration Medical Center, Indianapolis, Indiana
| | - Piper Groppel
- Roudebush Veterans' Administration Medical Center, Indianapolis, Indiana
| | - Louis Cantor
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
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Diep MQ, Madigan MC. Choroidal detachments: what do optometrists need to know? Clin Exp Optom 2018; 102:116-125. [PMID: 29971817 DOI: 10.1111/cxo.12807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 06/01/2018] [Accepted: 06/03/2018] [Indexed: 11/30/2022] Open
Abstract
Choroidal detachments occur when there is an accumulation of fluid or blood in the suprachoroidal space, a potential space situated between the choroid and the sclera. They are an uncommon ocular pathology. The most common cause of choroidal detachment is secondary to trabeculectomy; however, there are other causes such as trauma and inflammation. Clinically, choroidal detachments may vary in presentation from asymptomatic, to very poor vision, severe ocular pain, vomiting and nausea. Ocular findings associated with choroidal detachments include serous retinal detachment, secondary angle closure, and a very shallow anterior chamber. Optometrists, as primary eye care providers, need to be aware of the clinical signs and symptoms associated with choroidal detachments and ensure that appropriate and timely management, with a referral to an ophthalmologist, is instigated for optimal visual outcomes. In this review, the pathophysiology, detection, and associated risk factors for choroidal detachments are discussed, and evidence-based management recommendations in an optometric context are provided. The characteristics and management of uveal effusion syndrome are also reviewed, as this can cause idiopathic exudative choroidal detachments distinct from classical choroidal detachment.
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Affiliation(s)
- Martin Q Diep
- School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Michele C Madigan
- School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia.,Save Sight Institute, Discipline of Clinical Ophthalmology, The University of Sydney, Sydney, New South Wales, Australia
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Baswati P, Samiksha C, Subodh S, Abhishek D. Revision of dysfunctional filtering bleb by conjunctival advancement with bleb preservation: A simple choice for massive choroidals with hypotony following trabeculectomy. Saudi J Ophthalmol 2013; 27:287-90. [PMID: 24371426 DOI: 10.1016/j.sjopt.2013.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 07/01/2013] [Indexed: 10/26/2022] Open
Abstract
A 65-year-old diabetic and hypertensive male presented with a sudden diminution of vision after sustaining a trivial fingernail injury to his only good-seeing (right) eye. The patient underwent phacotrabeculectomy with posterior chamber intraocular lens (PCIOL) implantation 22 years previously. In his right eye visual acuity at presentation was counting fingers at 1.5 m with an accurate projection of light. Intraocular pressure (IOP) was 4 mmHg. The anterior chamber was uniformly shallow with a peripheral iridocorneal touch. Angle details could not be visualized. The bleb was avascular, thin and cystic with a positive forced Seidel test. Fundus examination showed 360° choroidal detachments. B-scan ultrasound revealed massive choroidals. Revision of dysfunctional filtering bleb by conjunctival advancement with bleb preservation and anterior chamber reformation with healon was performed. Postoperatively, the first day visual acuity improved to 6/36, the anterior chamber was deep, bleb was well covered with conjunctiva, the IOP was 10 mmHg and fundus examination revealed resolving choroidals. At the final follow up at 4 months, the patient did not require medication and visual acuity was 6/12, the bleb was functioning well with an IOP of 14 mmHg. Examination of the fundus revealed a cup-to-disc ratio of 0.5 with moderate non-proliferative diabetic retinopathy changes. The patient has been advised to maintain a strict glycemic control and return for routine follow up after 3 months.
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Affiliation(s)
| | | | - Sinha Subodh
- Venu Eye Institute & Research Center, New Delhi, India
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Faingold D, Kasner OP. Expanded indications for transconjunctival trabeculectomy flap suturing: postoperative choroidal effusion and dysesthesia. Can J Ophthalmol 2012; 47:291-5. [PMID: 22687310 DOI: 10.1016/j.jcjo.2012.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 03/09/2012] [Accepted: 03/22/2012] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the efficacy of transconjunctival trabeculectomy flap suturing (TTFS) in improving choroidal effusions and bleb dysesthesia resulting from overfiltration after trabeculectomy. DESIGN Retrospective review. PARTICIPANTS The study involved 15 eyes of 15 patients. METHODS Patients underwent TTFS for choroidal effusions and bleb dysesthesia following trabeculectomy using mitomycin C. The scleral flap was sutured through the conjunctiva as an outpatient clinic procedure. RESULTS There were 11 patients who had choroidal effusions and 4 patients were identified with dysesthesia. The average duration of choroidal effusion prior to TTFS was 2.1 ± 2.3 months and 3 ± 2 months in the dysesthesia group. At the final follow-up (25 ± 17 months) the mean intraocular pressure improved from 4.1 ± 2.1 mm Hg before suturing to 8.1 ± 3.6 mm Hg (p < 0.007) for the patients with choroidal effusion and from 4.2 ± 0.6 mm Hg to 8. 7 ± 3.5 mm Hg (p = 0.05) for the patients with dysesthesia. In both groups, resolution of the signs and symptoms was achieved in all cases. The mean time to resolution of choroidal effusions was 5.5 ± 8.6 weeks and the mean time to resolution of dysesthesia was 2 ± 0.8 weeks. None of the patients had serious complications such as failure of the trabeculectomy or visual loss. CONCLUSIONS Transconjunctival suturing of the trabeculectomy scleral flap is a simple and effective surgical method for the treatment of cases of choroidal effusions or dysesthesia resulting from trabeculectomy.
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Affiliation(s)
- Dana Faingold
- Henry C. Witelson Ocular Pathology Laboratory, McGill University, Montreal, Que
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Vijaya L, Manish P, Ronnie G, Shantha B. Management of complications in glaucoma surgery. Indian J Ophthalmol 2011; 59 Suppl:S131-40. [PMID: 21150025 PMCID: PMC3038515 DOI: 10.4103/0301-4738.73689] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Surgical option for glaucoma is considered when other modalities are not working out to keep the intraocular pressure under control. Since the surgical procedures for glaucoma disrupt the integrity of the globe, they are known to produce various complications. Some of those complications can be vision-threatening. To minimize the morbidity, it is very important that one should know how to prevent them, recognize them and treat them. The objective of this article is to provide insight into some of those complications that will help the ophthalmologists in treating glaucoma patients in their clinical practice.
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Affiliation(s)
- Lingam Vijaya
- Smt Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, 18 College Road, Chennai 600006, India.
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The early flat anterior chamber after trabeculectomy: a randomized, prospective study of 3 methods of management. J Glaucoma 2009; 18:13-20. [PMID: 19142129 DOI: 10.1097/ijg.0b013e31816f7647] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate prospectively 3 different approaches to the management of a flat anterior chamber (FAC) because of overfiltration in the early postoperative period after trabeculectomy. MATERIALS AND METHODS Thirty-six eyes diagnosed with a FAC with total iridocorneal touch, but no lenticular touch (grade II) because of overfiltration in the first 14 days after trabeculectomy were randomized prospectively into 3 groups: group 1--anterior chamber reformation with viscoelastic substance; group 2--anterior chamber reformation with balanced salt solution and concurrent drainage of choroidal effusion; and group 3--pharmacologic therapy with atropine, phenylephrine, and in select cases oral acetazolamide. Outcome measures were visual acuity, amount of intraocular pressure (IOP) reduction, and achievement of predetermined target IOP. RESULTS Treatment group 2 had a greater number of eyes with acuity decline of two or more lines relative to group 3 (P=0.04). Group 1 had more eyes with acuity decline of two or more lines relative to group 3, but this was not significant (P>0.05). CONCLUSIONS For grade II FACs because of overfiltration in the early postoperative period after trabeculectomy, reformation of the anterior chamber with drainage of choroidal effusion may be associated with greater long-term trabeculectomy success, but is associated with greater visual acuity loss relative to medicinal therapy alone. Reformation with viscoelastic resulted in a trend toward lowest final IOP in comparison to medicinal therapy alone.
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Gedde SJ, Herndon LW, Brandt JD, Budenz DL, Feuer WJ, Schiffman JC. Surgical complications in the Tube Versus Trabeculectomy Study during the first year of follow-up. Am J Ophthalmol 2007; 143:23-31. [PMID: 17054896 DOI: 10.1016/j.ajo.2006.07.022] [Citation(s) in RCA: 213] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2006] [Revised: 07/19/2006] [Accepted: 07/25/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE To describe the intraoperative and postoperative complications encountered during the first year of follow-up in the Tube Versus Trabeculectomy (TVT) Study. DESIGN Multicenter randomized clinical trial. METHODS SETTING Seventeen clinical centers. STUDY POPULATION Two hundred twelve patients aged 18 to 85 years who had undergone previous trabeculectomy and/or cataract extraction with intraocular lens implantation and uncontrolled glaucoma with intraocular pressure > or =18 mm Hg and < or =40 mm Hg on maximum tolerated medical therapy. INTERVENTIONS A 350-mm(2) Baerveldt glaucoma implant or trabeculectomy with mitomycin C (MMC). MAIN OUTCOME MEASURES Surgical complications, reoperation for complications, visual acuity, and cataract progression. RESULTS Intraoperative complications occurred in seven patients (7%) in the tube group and 10 patients (10%) in the trabeculectomy group (P = .59). Postoperative complications developed in 36 patients (34%) in the tube group and 60 patients (57%) in the trabeculectomy group during the first year of follow-up (P = .001). Surgical complications were associated with reoperation and/or loss of > or =2 lines of Snellen visual acuity in 18 patients (17%) in the tube group and 28 patients (27%) in the trabeculectomy group (P = .12). CONCLUSIONS There were a large number of surgical complications during the first year of follow-up in the study, but most were self-limited. The incidence of postoperative complications was higher after trabeculectomy with MMC than nonvalved tube shunt surgery. Serious complications resulting in reoperation and/or vision loss occurred with similar frequency with both surgical procedures.
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Affiliation(s)
- Steven J Gedde
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 900 NW 17th Street, Miami, FL 33136, USA.
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