A Stepwise Approach to the Surgical Management of Hemorrhagic Choroidal Detachments

Shanna C Yeung; Ryan H Mason; Samuel A Minaker; Alaa AlAli; Peter J Kertes; Peng Yan

doi:10.1177/2474126421992024

A Stepwise Approach to the Surgical Management of Hemorrhagic Choroidal Detachments

J Vitreoretin Dis. 2021 Mar 2;6(2):111-115. doi: 10.1177/2474126421992024. eCollection 2022 Mar-Apr.

Authors

Shanna C Yeung¹, Ryan H Mason^{2

3}, Samuel A Minaker^{2

3}, Alaa AlAli^{2

3}, Peter J Kertes^{2

3

4}, Peng Yan^{2

3}

Affiliations

¹ Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
² Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, ON, Canada.
³ Kensington Vision and Research Center, Toronto, ON, Canada.
⁴ Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

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.

Keywords: choroidal effusion; hemorrhagic choroidal detachment; sclerotomy; surgical technique; transconjunctival; trocar.