Choroidal Detachment Follow-up

Updated: Feb 10, 2017
  • Author: Carlo E Traverso, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Follow-up

Further Outpatient Care

Monitor visual acuity, AC depth, IOP, and extension of the detachment.

After managing the underlying cause, a postoperative totally flat AC with corneal-lenticular touch should be managed surgically. A flat chamber with contact of the corneal endothelium with the lens or pseudophakos can lead to rapid corneal endothelial failure and decompensation, extensive anterior and posterior synechiae, and acceleration of cataract changes in phakic patients. It can also trigger aqueous misdirection.

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Inpatient & Outpatient Medications

Prescribe topical steroids and cycloplegics. Oral steroids may be indicated.

Consider topical IOP-lowering agents, oral carbonic anhydrase inhibitors, and systemic osmotics in patients with significant IOP elevation.

Avoid anticoagulants or aspirin with suprachoroidal hemorrhage. [24]

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Deterrence/Prevention

In open globe surgery, particularly glaucoma surgery, hypotony must be avoided by careful suturing techniques.

During surgery, take care not to suddenly decompress the globe; use a paracentesis tract to slowly deflate it.

Preoperative osmotics or carbonic anhydrase inhibitors can be used to decrease the IOP to a safe level before surgery.

Whether or not to discontinue aspirin or anticoagulants in preparation for glaucoma surgery is not yet clear.

During the postoperative period of any intraocular surgery, but especially after glaucoma surgery, increased venous pressure in the choroidal plexus may trigger choroidal hemorrhages. This risk can be increased in subjects under oral anticlotting treatment. Patients should be warned to avoid any effort likely to elicit a Valsalva effect, like lifting heavy objects, straining at stools, severe coughing.

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Complications

Serous choroidal detachment or suprachoroidal hemorrhage can result in phthisis, retinal detachment, cataract formation, or intractable secondary glaucoma. [25]

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Prognosis

The prognosis is guarded. In general, a correlation exists between the severity and extension of the detachment and the prognosis.

Preexisting eye conditions (eg, advanced glaucoma) influence the final functional outcome.

Even with treatment, loss of functional vision can occur in 10-80% of patients. [6]

In general, the prognosis for patients with choroidal hemorrhages is definitely worse than for those with serous choroidal detachments, especially when choroidal hemorrhages are intraoperative, where severe functional damage is frequent.

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Patient Education

During the postoperative period of any intraocular surgery, but especially after glaucoma surgery, increased venous pressure in the choroidal plexus may trigger choroidal hemorrhages. This risk can be increased in subjects under oral anticlotting treatment. Patients should be warned to avoid any effort likely to elicit a Valsalva effect, like lifting heavy objects, straining at stools, severe coughing.

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