Concurrent ciliary body detachment in patients presenting with serous choroidal detachment following glaucoma surgery.

PURPOSE: To examine the rate of ciliary body detachment in patients with choroidal detachment following glaucoma surgery and its effect on the clinical course, management, and prognosis. METHODS: A prospective observational case-series study. Patients with choroidal detachment following glaucoma surgery in 2018-2019 were included. All underwent complete ophthalmological examination and ultrasound biomicroscopy for evaluation of the presence and extent of ciliary body detachment. Follow-up examinations including ultrasound biomicroscopy scans were performed at 1 week, 1 month, 3 months, and 6 months. RESULTS: Eight patients (8 eyes) were enrolled, 4 male and 4 female, of mean age 72 years (range 60-83). Five patients underwent trabeculectomy with mitomycin C (0.02%), which was combined with phacoemulsification cataract extraction in one; two underwent Ahmed glaucoma valve implantations, and one underwent ab-interno Xen45 gel stent implantation with mitomycin C (0.02%). The mean intraocular pressure was 26.0 ± 7.65 mmHg preoperatively, dropping to 6.9 ± 2.64 mmHg on first postoperative day one. Mean time from surgery to diagnosis of choroidal detachment was 11.6 ± 5.73 days. Ciliary body detachment was identified by ultrasound biomicroscopy in all patients, ranging between one and four quadrants. All patients were treated with topical steroids and cycloplegics; three (37.5%) received oral steroids. No surgical intervention for the choroidal or ciliary body detachments was indicated. CONCLUSIONS: In this real-world prospective study, concurrent ciliary body detachment was identified in all patients who presented with choroidal detachment following glaucoma surgery. This observation may deepen our understanding of the mechanism underlying the hypotony that is often seen after glaucoma surgery.

Coexisting bilateral ciliochoroidal effusion syndrome and an isolated cytotoxic corpus callosum lesion in dengue fever.

Dengue fever is a major health concern in India. There are various reports in the literature regarding the ocular manifestations of this febrile illness. We are reporting a rare case of a woman in her late 30s who developed coexisting bilateral ciliochoroidal effusion syndrome with an isolated cytotoxic corpus callosum lesion associated with dengue febrile illness. To the best of our knowledge, this is the first case of its kind. It opens the avenues for neurological and radioimaging attention for such cases with bilateral ciliochoroidal effusion syndrome.

Spontaneous resolution of long-standing choroidal effusion after glaucoma drainage implant surgery without significant visual deterioration : a case report.

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.

Efficacy of Pneumatic Retinopexy Preceding Pars Plana Vitrectomy in Managing Combined Retinal and Choroidal Detachment: A Retrospective Study of 64 Patients.

BACKGROUND Combined retinal and choroidal detachment (RD-CD) poses significant challenges in ophthalmic treatment, often requiring surgical intervention for optimal outcomes. The selection of the appropriate surgical procedure is crucial for ensuring visual restoration and overall eye health. This study delves into the therapeutic benefits and outcomes of two distinct surgical approaches for RD-CD: pneumatic retinopexy (PR) followed by pars plana vitrectomy (PPV) and PPV alone, in an attempt to guide optimal clinical decision-making. MATERIAL AND METHODS We retrospectively analyzed data from 64 consecutive patients diagnosed with RD-CD. They were categorized into two groups: Group A consisted of 34 patients (34 eyes) who underwent PR as an initial treatment and subsequently received PPV, while Group B, serving as a control, comprised 30 patients (30 eyes) treated solely with PPV. RESULTS The application of PR in Group A notably accelerated intraocular pressure (IOP) increase (P.

Risk factors and management of choroidal effusions.

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.

Ab-externo intraluminal stent for prolonged hypotony and choroidal detachment after Preserflo implantation.

PURPOSE: To describe a case of prolonged hypotony and choroidal detachment following insertion of a Preserflo™ MicroShunt in a patient with primary open-angle glaucoma (POAG). CASE REPORT: An 84-year-old Caucasian man with medically uncontrolled POAG developed refractory hypotony and choroidal detachment following a mitomycin C augmented Preserflo MicroShunt (PMS) insertion. Initial medical treatment with Dexamethasone 2 mg/mL and Atropine 1% for the hypotony (4 mmHg) and choroidal detachment was unsuccessful, BCVA decreased from the preoperative 20/28 to 20/60. After 90 days, surgery revision was carried out by inserting a 10-0 nylon monofilament suture through the distal end of the PMS reaching the opposite end of the tube. The free end of the nylon suture was exposed from the conjunctiva in the inferotemporal quadrant close to the fornix to ensure access to the occlusive stent. After one month intraocular pressure (IOP) was 7 mmHg, the choroidal detachment was completely regressed, and best corrected visual acuity (BCVA) increased to 20/28, at that time the exposed part of the stent was trimmed. 6 months after the revision surgery IOP was 14 mmHg, BCVA was 20/25, and the nylon stent was retained side to side inside the PMS lumen. CONCLUSION: The management of hypotony and choroidal detachment after a glaucoma drainage device (GDD) implantation is still unstandardized. The ab externo insertion of a nylon suture grants multiple advantages over the other techniques when performed on a PMS tube.

Appositional Choroidal Detachment Following XEN45 Gel Stent Requiring Surgical Drainage.

An 82-year-old man with severe primary open-angle glaucoma on maximal medical therapy underwent an ab externo closed conjunctival Xen45 device insertion with mitomycin C. The surgery was uncomplicated, with a first postoperative day intraocular pressure of 4 mm Hg and visual acuity of 20/40 OD. Ten days later, the patient presented with an intraocular pressure of 5 mm Hg and a visual acuity of counting fingers at 5 feet. Examination showed Seidel negative bleb, shallow anterior chamber, and large nonappositional choroidal detachments. Medical therapy with steroids and cycloplegia was initiated. One week later, the serous choroidal detachments became appositional, and Xen explantation and surgical drainage of the choroidal detachment was performed. Postoperatively, the vision improved to 20/60. Significant choroidal detachments can occur after XEN45 implantation requiring surgical intervention.

Choroidal Detachment following an Intravitreal Injection in a Patient with Vogt-Koyanagi- Harada Disease.

Purpose: To report a unique case of choroidal detachment following an intravitreal injection in a patient with Vogt-Koyanagi-Harada (VKH) disease.Methods: A 33-year-old male, a known case of chronic VKH disease for 9 years developed an inflammatory choroidal neovascular membrane (CNVM) in the right eye. Following an intravitreal ranibizumab injection, he reported loss of vision 2 days later. Clinical examination revealed hypotony with annular serous choroidal detachment.Results: Following an intensive systemic corticosteroid therapy, there was a complete resolution of choroidal detachment and restoration of visual acuity at 1 week of follow up. The subretinal fluid and cystic spaces due toCNVM also resolved completely.Conclusion: This is the first report of a patient with VKH disease developing choroidal detachment following an uncomplicated intravitreal injection of ranibizumab for an inflammatory CNVM.

Pembrolizumab-related Bilateral Ocular Hypotony, Uveitis, Cataracts, Exudative Retinal, and Choroidal Detachments: An Unusual Success Story.

Here, we report the presentation and management of a rare case of sight-threatening bilateral panuveitis with secondary chronic hypotony, subcapsular cataracts, exudative retinal detachments, and choroidal detachments, following initiation of pembrolizumab immunotherapy for metastatic melanoma. An 82-year-old white woman presented with painful, blurry vision 3 days after initiation of pembrolizumab immunotherapy. She had developed a marked panuveitis causing secondary hypotony. The fundal view was entirely limited by acutely dense cataracts and small, uveitic pupils unresponsive to topical dilation. Urgent cataract surgery with intravitreal dexamethasone implant (Ozurdex) was completed successfully and allowed a fundal examination. This revealed bilateral, symmetrical, inferior exudative retinal detachments, and choroidal detachments secondary to chronic hypotony. After 3 months of observation and cessation of oral steroids, the panuveitis remains quiescent, hypotony persists, and the choroidal and retinal detachments are showing progressive self-resolution. The current best-corrected visual acuity is 6/24 OU. She remains under close monitoring. The immune checkpoint inhibitor, pembrolizumab, has been reported to cause sight-threatening adverse effects. We report a rare case of profound bilateral complications treated successfully with oral and intravitreal steroids. To the authors' knowledge, this has not previously been reported in the literature. Ophthalmologists and oncologists should be aware of the ocular effects of pembrolizumab and be able to identify various complications early. Here, cataract surgery with a steroid implant has been an effective sight-saving intervention. The promising visual outcome makes this an unusual success story.

Persistent Hypotony and Annular Ciliochoroidal Detachment After Microhook Ab Interno Trabeculotomy.

PRéCIS:: Creation of a cyclodialysis cleft can be a mechanism of ciliochoroidal detachment (CCD) and associated persistent hypotony after microhook ab interno trabeculotomy (µLOT). AIMS: To report persistent hypotony after µLOT, a minimally invasive glaucoma surgery (MIGS). SUBJECTS AND METHODS: This observational case series included 4 consecutive cases (3 men, 1 woman; mean age, 48.8±15.1 y) of persistent hypotony that developed after µLOT between May 2015 and March 2018. The patients' data and surgical results were obtained from the medical charts. RESULTS: All patients had open-angle glaucoma (2 juvenile, 1 primary, and 1 pigmentary) and were myopic (axial lengths, >24 mm). Two patients had undergone previous refractive surgery. µLOT alone was performed in 2 cases and combined with cataract surgery in 2 cases. In all cases, hypotony below 5 mm Hg was recorded 1 day postoperatively and sustained. In all cases, ultrasound biomicroscopy showed an annular CCD; communication between the anterior chamber and suprachoroidal space was detected in 3 of 4 cases. The hypotony resolved in 3 of the 4 cases from 2 to 8 months postoperatively, that is, spontaneously in 2 cases (cases 1 and 4) and after sulfur hexafluoride gas injection into the anterior chamber in 1 case (case 2). CCD resolution accompanied remarkedly high intraocular pressure, which required filtration surgeries. The incidence of persistent hypotony was 0.7% (4/547 eyes). CONCLUSIONS: After MIGS, persistent hypotony because of CCD rarely occurs. Increased uveoscleral outflow because of LOT or creation of a cyclodialysis cleft by traction of the pectinate ligament can be a mechanism of CCD development. Young age and myopia can be risks for cyclodialysis cleft formation and hypotony maculopathy after MIGS.

A Case of Delayed-onset Hemorrhagic Choroidal Detachment After PreserFlo Microshunt Implantation in a Glaucoma Patient Under Anticoagulant Therapy.

PURPOSE: To describe a case of delayed-onset hemorrhagic choroidal detachment (HCD) in a patient affected by primary open-angle glaucoma (POAG) undergone PreserFlo Microshunt implantation. CASE REPORT DESCRIPTION: A 76-year-old patient with POAG, under treatment with Dabigatran (a novel oral anticoagulant), underwent an uncomplicated PreserFlo Microshunt implantation in the left eye. In the first postoperative day, intraocular pressure (IOP) was 6 mm Hg, conjunctival bleb was diffuse, anterior chamber (AC) deep, and device correctly positioned. Twelve days after surgery, the patient had emergency access complaining severe ocular pain and sudden vision loss. Ophthalmological evaluation revealed shallow AC and an IOP of 50 mm Hg. The fundus examination revealed almost kissing HCD. OUTCOME: Immediate topical treatment with atropine, aqueous humor suppressants, and corticosteroids was started. Because of high IOP, ocular pain, and the presence of almost kissing HCD, surgical drainage of suprachoroidal hemorrhage and removal of PreserFlo Microshunt were performed. An improvement of the clinical condition was observed in the following postoperative days, with partial resolution of the HCD and a decrease of the IOP. On the third postoperative day, there was a worsening of the HCD, with a reduction of the AC depth and IOP elevation. HCD was drained through the previously performed sclerotomies, associated with pars-plana vitrectomy and silicone-oil tamponade. HCD completely resolved during the following 6 weeks, with IOP reduction and partial improvement of visual acuity. CONCLUSION: Great attention must be taken in patients with glaucoma under treatment with a novel oral anticoagulant, also when planning PreserFlo Microshunt implantation.

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.

Chronic chorioretinal detachment under normal intraocular pressure in eye with uveitic glaucoma after trabeculectomy: A case report.

RATIONALE: Choroidal detachment is a major postoperative complication of trabeculectomy. Postoperative choroidal detachment occurs with low intraocular pressure (IOP), and is naturally resolved by elevation of IOP. We report a case of chronic chorioretinal detachment (CRD) in the eye with uveitic glaucoma after trabeculectomy which persisted with normal IOP resistant for medication and required surgery. PATIENT CONCERNS: A 63-year-old man was referred to our department with uncontrolled uveitic glaucoma in his right eye. At first presentation, IOP was 62 mm Hg in the right eye with opened angle, and active ocular inflammation was presented by moderate cell infiltration to the anterior chamber. DIAGNOSIS: Uveitic glaucoma. INTERVENTIONS: Trabeculectomy with mitomycin-C combined with phacoemulsification were performed without any surgical trouble. Postoperative inflammation in the anterior segment was mild, and IOP decreased to the middle-teen. OUTCOMES: At 19 days after surgery, the depth of the anterior chamber changed to shallow and CRD occurred in the inferior quadrant area. This complication could not be resolved by additional systemic corticosteroid medication and scleral fenestration. Although IOP was maintained in middle-teen range, suture fixation of the sclera flap and additional scleral fenestration were necessary to resolve CRD at 191 days after primary surgery. LESSONS: In uveitic eye with uncontrolled ocular hypertension, severe CRD after trabeculectomy is able to occur even with normal IOP, which requires surgical procedure in addition to the medical treatment.

Overfiltering Bleb en Route to Annular Ciliochoroidal Effusion.

Annular ciliochoroidal effusion is a rare condition that can complicate trabeculectomy. We report a case of ciliochoroidal effusion mimicking aqueous misdirection after combined glaucoma and cataract surgery. A 75-year-old male with pseudoexfoliation, chronic angle-closure glaucoma, and advanced optic disc damage developed ciliochoroidal effusion after a combined trabeculectomy and phacoemulsification with intraocular lens implantation. The patient presented with overfiltering bleb, hypotony, and a uniformly shallow anterior chamber that mimicked aqueous misdirection in the clinical picture. Reformation of anterior chamber followed by revision of the bleb was performed. Ultrasound biomicroscopy confirmed the diagnosis. Atropine and steroid eye drops improved the condition. Ciliochoroidal effusion should be ruled out in hypotony with shallow anterior chamber post glaucoma surgery.

Transient choroidal detachment after ultrasonic circular cyclocoagulation.

Two patients with refractory glaucoma followed in our ophthalmology department registered progression on left eyes (OS) despite best practice. Best corrected visual acuity (BCVA) was 9/10 and 8/10 and intraocular pressure (IOP) was above 20 mm Hg while under maximal hypotensive therapy. The procedure was performed under retrobulbar anaesthesia with second-generation EyeOp1probes. In follow-up, OS were hypotonic with registered IOP ≤5 mm Hg and revealed a 3/10 BCVA. The funduscopy showed one temporal and superior and another nasal and temporal choroidal detachments. The patients started oral steroids and interrupted all ocular hypotensive medication. After therapy, patients returned with normal rising OS IOPs and with totally reapplied choroids, accompanied by normalised BCVA. These two cases are proof of the possibility of transient choroidal detachment after a ultrasonic circular cyclocoagulation. While a very rare major vision-threatening complication, every ophthalmologist should remind it when sudden BCVA reductions occur after this procedure.