Trocar-based surgical technique for drainage of suprachoroidal hemorrhages

Authors

  • David RP Almeida, MD, MBA, PhD, FRCSC, DABO Erie Retinal Surgery & Erie Retina Research, Erie, Pennsylvania, USA
  • Eric K. Chin, MD Retina Consultants of Southern California, Redlands, California, USA; Loma Linda University Medical Center; Veterans Affair Hospital, Loma Linda, CA

DOI:

https://doi.org/10.58931/cect.2023.2226

Abstract

Suprachoroidal hemorrhage (SCH) most commonly occurs during or following intraocular surgery or in the setting of trauma. SCH requires early recognition and appropriate monitoring to prevent severe vision loss. Fortunately, some cases of SCH are self-limited and can resolve spontaneously with careful observation. However, in cases of large, progressive or appositional SCH, surgical drainage is often necessary to prevent further complications such as retinal detachment; angle-closure glaucoma; retinal incarceration; or expulsion of intraocular contents, all of which can be associated with permanent vision loss and a guarded prognosis.

The traditional approach to SCH drainage involves external drainage via a 2.0 mm to 3.0 mm sclerotomy window or tunnel at the apex of the choroidal detachment. In some cases, a cyclodialysis spatula can be introduced into the suprachoroidal space to expedite outflow. Problematically, this technique can often result in post-operative leakage and hypotony, endophthalmitis, retinal incarceration, and the need for subsequent pars plana vitrectomy (PPV). Although transconjunctival trocar-cannula drainage techniques have been previously described in the literature, there is often ambiguity and ambivalence regarding vitreous substitutes (e.g., air vs gas, vs silicone oil tamponade) following drainage of choroidal hemorrhage. Here, we discuss and present a case demonstrating external trans-conjunctival drainage of SCH utilizing vitreoretinal trocar-cannulas on a patient with SCH following glaucoma surgery. Additionally, we discuss the efficacy and safety advantages of this surgical approach compared to those of previous drainage methods.

Author Biographies

David RP Almeida, MD, MBA, PhD, FRCSC, DABO, Erie Retinal Surgery & Erie Retina Research, Erie, Pennsylvania, USA

Dr. David RP Almeida is a Board-Certified Ophthalmologist and Vitreoretinal Surgeon. He completed an Honors Bachelor of Science (University of Toronto, Canada), PhD in Pharmaceutical Drug Research (University of Szeged, Hungary), MBA in healthcare management (The George Washington University, USA), medical school (Queen’s University, Canada), ophthalmology residency (Queen’s University, Canada) and a vitreoretinal disease and surgery fellowship (University of Iowa, USA). Dr. Almeida is part of Erie Retinal Surgery, a retina-only practice in Pennsylvania, and is the Director of Clinical Research at Erie Retina Research. He has over 200 peer-reviewed publications and over 150 national and international conference and keynote presentations, demonstrating a longstanding commitment to research.

Eric K. Chin, MD, Retina Consultants of Southern California, Redlands, California, USA; Loma Linda University Medical Center; Veterans Affair Hospital, Loma Linda, CA

Dr. Eric K. Chin is a Board Certified ophthalmologist and a native of Northern California. He graduated from the University of California Berkeley with a bachelor’s degree in Bioengineering. He received his medical degree from the Chicago Medical School. He completed his ophthalmology residency at the University of California Davis, and his surgical vitreoretinal fellowship at the University of Iowa. During his residency and fellowship, he was awarded several accolades for his teaching and research in imaging and novel treatments for various retinal diseases. Dr. Chin is trained in all aspects of vitreoretinal medicine and surgery, as well as uveitis and ocular tumors. He serves as Clinical Faculty at Loma Linda University and the Loma Linda Veterans Affairs Hospital where he teaches residents as well as gives lectures. He has numerous publications in major ophthalmic journals and textbooks. He is a member of many professional societies and a reviewer for several peer-reviewed ophthalmology journals.

References

Rezende FA, Kickinger MC, Li G, Prado RF, Regis LG. Transconjunctival drainage of serous and hemorrhagic choroidal detachment. Retina. 2012 Feb 1;32(2):242-9. DOI: https://doi.org/10.1097/IAE.0b013e31821c4087

Tarantola RM, Folk JC, Shah SS, Boldt HC, Abràmoff MD, Russell SR, Mahajan VB. Intraoperative choroidal detachment during 23-gauge vitrectomy. Retina. 2011 May 1;31(5):893-901. DOI: https://doi.org/10.1097/IAE.0b013e3181f4429b

Ali BYFS, Kurup SK, Garg SJ. Dealing with hemorrhagic choroidal detachments. Retina Today. 2018:21-24.

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Published

2023-05-17

How to Cite

1.
Almeida D, Chin EK. Trocar-based surgical technique for drainage of suprachoroidal hemorrhages. Can Eye Care Today [Internet]. 2023 May 17 [cited 2024 Jul. 24];2(2):11–13. Available from: https://canadianeyecaretoday.com/article/view/2-2-almeida_et_al

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Articles