Prospective cohort study of risk factors for choroidal detachment after trabeculectomy.

PURPOSE: To investigate risk factors for choroidal detachment after trabeculectomy. METHODS: We prospectively evaluated 97 patients with open-angle glaucoma who underwent primary trabeculectomy to investigate risk factors for choroidal detachment after trabeculectomy. The primary outcome measure was risk factors for the occurrence and severity of choroidal detachment after trabeculectomy. Choroidal detachment severity was quantified as the number of fundus quadrants with choroidal detachment. RESULTS: Sixteen patients (16.5%) had choroidal detachment. Mean period between surgery and occurrence of choroidal detachment was 7.9 ± 5.7 days. Mean intraocular pressure (IOP) on the first day of choroidal detachment was 6.1 ± 3.0 mm Hg. Multivariable analyses revealed that the exfoliation glaucoma, greater ΔIOP between preoperative and lowest postoperative IOPs, and thicker cornea were associated with choroidal detachment (P = 0.022, P = 0.002, and P = 0.013, respectively). These factors were also associated with the severity of choroidal detachment (exfoliation glaucoma; P = 0.013, greater ΔIOP; P < 0.001, and thicker cornea; P = 0.006). CONCLUSIONS: Exfoliation glaucoma, more IOP reduction, and thicker cornea are associated with the occurrence and severity of choroidal detachment after trabeculectomy.

Risk Factors for Choroidal Detachment After Ahmed Valve Implantation in Glaucoma Patients.

PURPOSE: To assess the incidence and risk factors related to choroidal detachment after glaucoma drainage device (Ahmed valve) implantation. DESIGN: Retrospective case-control study. METHODS: A total of 188 eyes of 188 glaucoma patients were enrolled who underwent Ahmed valve implantation surgery. Patients were divided into 2 groups according to the presence or absence of choroidal detachment. The data were analyzed for factors associated with choroidal detachment. Separately, we divided eyes with choroidal detachment into 2 subgroups according to severity and conducted a subanalysis. In addition, we also analyzed the factors associated with chamber collapse. RESULTS: The incidence of choroidal detachment was 35.1% according to wide-field fundus photography and 16.9% according to 45-degree fundus photography. The current study showed that age, central corneal thickness, axial length, etiology of glaucoma, history of cataract or glaucoma, hypertension, diabetes, and severity of the visual field (MD) were different between the choroidal detachment and nonchoroidal detachment groups. A multivariate analysis showed significant differences in age (P = .035), etiology of glaucoma (pseudoexfoliation; PEX) (P = .028), lens status (pseudophakia) (P = .011), and hypertension (P = .011). The greater the intraocular pressure difference before and after surgery, the greater the size of the choroidal detachment. Chamber collapse risk was associated with only short axial length. CONCLUSION: The detection of choroidal detachment after Ahmed valve implantation can be increased according to the introduction of wide fundus photography. The risk of choroidal detachment is associated with the etiology of glaucoma (PEX), older age, pseudophakia (lens status), and hypertension.

Choroidal detachments: what do optometrists need to know?

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.