Draining fluid can counter large choroidal detachments

Issue: May 25, 2014

BOSTON — When dealing with large choroidal detachments, draining the choroidal fluid is a simple, low-risk way to stabilize the eye, a speaker here said.

“Drainage of choroidal fluid will definitely re-establish the anatomy of the eye,” Marlene R. Moster, MD, told attendees at Glaucoma Day preceding the American Society of Cataract and Refractive Surgery annual meeting. “It will preserve the bleb as aqueous formation will resume almost immediately to restore good vision, all with the minimal trauma of a 3-mm incision.”

Marlene R. Moster

A dilated exam is key in diagnosing choroidal effusions, she said. Surgeons should look for mounds of fluid under the choroid, use ultrasound, double-check the diagnosis, rule out "kissing" choroidals and retinal detachment, and make sure there is no suprachoroidal hemorrhage.

Once the diagnosis is confirmed, generally the patient should be dilated with atropine and given a shield to wear at night, while also being told absolutely no eye rubbing, according to Moster.

“If the situation doesn’t reverse in 2 to 4 weeks and the bleb is shrinking, it’s time to consider draining the choroidals to re-establish the anatomy. If the anatomy isn’t restored, the trabeculectomy may fail,” Moster said.

“As far as surgical options, if the choroidal detachment is significant and the chamber is shallow, or even if the chamber is formed and the bleb is shrinking, we recommend draining the choroidals,” she said.

If the choroidals are kissing with the potential of vitreoretinal traction, the surgeon should defer to a retina colleague. A retina specialist should also be deferred to if there is a massive suprachoroidal hemorrhage with breakthrough into the vitreous cavity through the retina; however, if there is a moderate suprachoroidal hemorrhage, surgeons can wait, usually 10 days, until the blood liquefies and then perform the choroidal drainage, Moster said.

Disclosure: Moster has no relevant disclosures.