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PubMed1995

Choroidal effusion as a mechanism for transient myopia induced by hydrochlorothiazide and triamterene.

PURPOSE: We treated a case of transient myopia in a patient being treated with hydrochlorothiazide and triamterene for tinnitus. METHODS: The patient underwent gonioscopic, ophthalmoscopic, and echographic examinations. RESULTS: Examination showed anterior chamber flattening and echography disclosed bilateral 360-degree shallow choroidal detachments. CONCLUSION: All of the patient's symptoms and signs resolved after the cessation of drug therapy.

Adult↗
PubMed2006

[Choroidal effusion syndrome after embolization of an indirect cavernous sinus fistula via the superior ophthalmic vein].

Embolization of a cavernous sinus fistula (SCF) via the superior ophthalmic vein (SOV) was reported to be an almost uncomplicated procedure, even after ligature of the vein at the end of the procedure. We report about a complication of this therapy. A 58-year-old female had a successful embolization of a right indirect cavernous sinus fistula via the SOV. At the end of the operation the SOV was ligated because of the danger of bleeding. Directly after surgery she experienced general worsening of the right eye with signs of venous congestion and marked effusion syndrome. The patient underwent total heparinization to achieve an opening of venous collaterals. Under local therapy with atropine 1% eye drops a decrease of the intraocular pressure was observed. The effusion syndrome was completely resolved within 1 month. If embolization of a cavernous sinus fistula is performed via the SOV, the ligature of the vein at the end of the procedure leads to thrombosis, which can reduce the venous stream from the eye and orbit. A secondary effusion syndrome with ocular hypertension because of a ciliolenticular block situation is possible and requires appropriate therapy. It is not possible to assess the capacity and time of opening of the venous collateral system before surgery. Therefore a transient outflow disturbance should be considered.

Carotid-Cavernous Sinus Fistula↗
PubMed2003

Assessing the need for posterior sclerotomy at the time of filtering surgery in patients with Sturge-Weber syndrome.

PURPOSE: Posterior sclerotomy has been recommended for prevention of intraoperative choroidal hemorrhages and choroidal effusions in patients with Sturge-Weber syndrome (SWS) or Klippel-Trenaunay-Weber (KTW) syndrome undergoing glaucoma filtering surgery. In this study, we evaluated this unproven clinical perception. DESIGN: A retrospective, noncomparative, case series. PARTICIPANTS: Seventeen consecutive patients with SWS or KTW syndrome who underwent glaucoma filtering surgery without prophylactic posterior sclerotomy or other prophylactic measures between January 1973 and March 1997 at a university-based practice. INTERVENTION: Glaucoma filtering surgery without prophylactic posterior sclerotomy. MAIN OUTCOME MEASURES: Incidence of intraoperative and postoperative choroidal effusion, choroidal detachment, or choroidal hemorrhage. RESULTS: No intraoperative choroidal effusion, choroidal detachment, or choroidal hemorrhage occurred in this series. After surgery, 6 patients had a transient choroidal effusion. Surgical drainage was not required in any of them. No suprachoroidal hemorrhages occurred after surgery. CONCLUSIONS: We did not encounter significant intraoperative suprachoroidal hemorrhage, choroidal effusions, or a combination requiring therapeutic intervention in our series. This finding leads us to question the necessity for prophylactic posterior sclerotomy to prevent the occurrence of these complications in patients with SWS and KTW syndrome undergoing glaucoma filtering surgery.

Choroid Diseases↗
PubMed1981

Uveal effusion syndrome.

Cilio-choroidal effusion is a non-specific reaction seen in numerous clinical conditions. It is important to recognize this condition and distinguish it from a solid tumour. Some eyes with this condition have been mistaken for ring melanoma and have been enucleated. In some instances cilio-choroidal effusion is caused by specific conditions and in others it is associated with systemic diseases such as the Vogt-Koyanagi-Harada and the uveal effusion syndromes. In many cases the cause is not apparent and there are no associated or systemic features. This paper reviews the clinical and histopathological features of cilio-choroidal effusion in general, and the uveal effusion syndrome in particular.

Aged↗
PubMed1994

Krupin disk implantation for complicated glaucomas.

BACKGROUND: The Krupin Eye Valve with Disk (Krupin disk) is a glaucoma shunt that incorporates a slit valve intended to minimize early postoperative hypotony. METHODS: The medical records of all patients who have undergone Krupin disk implantation at the Doheny Eye Institute between July 1990 and December 1992 (25 eyes of 25 patients) were reviewed. RESULTS: Intraocular pressure (IOP) was reduced from a mean of 36.1 +/- 11.5 mmHg to 15.3 +/- 7.5 mmHg at follow-up intervals of 4 to 19 months (mean, 13.2 months). On the first postoperative day, IOPs ranged from 0 to 40 mmHg. In two eyes (8%), the IOP was less than 6 mmHg, and in five eyes (20%) the IOP was more than 21 mmHg. Serous choroidal effusion and/or choroidal hemorrhage occurred in seven patients (28%). Six- and 12-month life-table success rates (6 < or = IOP < or = 21 mmHg) were 84% and 66%, respectively. CONCLUSION: The Krupin disk lowers IOP in most patients; however, the presence of a slit valve does not eliminate either early postoperative hypotony with its attendant complications or early IOP spikes.

Adolescent↗
PubMed1997

Cavernous-dural fistula with secondary angle-closure glaucoma.

PURPOSE: To report a rare case of angle-closure glaucoma, secondary to the rapid development of a choroidal effusion, in a patient with a long-standing cavernous-dural shunt. METHODS: Case report. Investigations included computed tomographic scan, magnetic resonance imaging, and carotid angiography. RESULTS: The development of the choroidal effusion occurred because of partial thrombosis of the ipsilateral superior ophthalmic vein and cavernous sinus. Drainage of the choroidal effusion resolved the angle-closure glaucoma. CONCLUSIONS: The combination of worsening signs and evidence of thrombosis indicates impending resolution of a cavernous-dural shunt. However, if a choroidal effusion causes angle-closure glaucoma, prompt surgical drainage should be considered to prevent permanent peripheral anterior synechiae formation, with the expectation that the effusion will not recur.

Aged↗
PubMed1998

Complications of Baerveldt glaucoma drainage implants.

OBJECTIVES: To report the incidence and identify risk factors of postoperative complications after Baerveldt glaucoma drainage implantation. METHODS: A retrospective review of the medical records of all patients at the Bascom Palmer Eye Institute, Miami, Fla, who underwent placement of a Baerveldt glaucoma drainage implant from October 1, 1992, through October 31, 1996, to determine demographic characteristics, preoperative and postoperative intraocular pressures, and complications. Variables were analyzed using the Student t test and Fisher exact test to determine the association between delayed postoperative suprachoroidal hemorrhage and various potential risk factors. RESULTS: A total of 107 eyes of 103 patients were identified. Suprachoroidal hemorrhage occurred in 4 eyes (4%), with onset ranging from 3 to 33 days after implantation. Two eyes (2%) had choroidal effusions requiring surgical drainage, and 20 eyes (19%) had low choroidal effusions requiring only close observation. Tube blockage was observed in 5 eyes (5%). Four eyes (4%) had aqueous misdirection, 2 eyes (2%) had corneal decompensation, and 1 eye (1%) each had endophthalmitis, tube migration, corneal ulcer, hyphema, and implant migration. Patients who were older (P=.04) or had postoperative choroidal effusions (P=.03), low intraocular pressure immediately after the tube opened (P=.03), hypertension (P= .08), or atherosclerosis (P=.09) were more likely to develop suprachoroidal hemorrhage. CONCLUSIONS: A lower incidence of serious postoperative complications was observed in Baerveldt implantations in this study when compared with a recent report. Risk factors for serious complications were similar to trabeculectomy.

Adolescent↗
PubMed1992

Glaucoma filtering surgery with postoperative 5-fluorouracil in patients with intraocular inflammatory disease.

Twenty-one eyes of 18 patients with uncontrolled glaucoma and intraocular inflammatory disease had glaucoma filtering surgery with postoperative subconjunctival 5-fluorouracil (5-FU). Follow-up for eyes in which intraocular pressure was controlled ranged from 6 to 53 months (mean, 34 months; median, 35 months). Fifteen of 21 eyes (71%) had controlled intraocular pressure (21 mmHg or less). Control was achieved in 9 of 10 (90%) phakic eyes and in 6 of 11 (55%) aphakic or pseudophakic eyes with or without glaucoma medication. Four of six filter failures had a second filtering procedure with 5-FU, and of these four procedures, three were successful. Cataract progression occurred in 9 of 10 phakic eyes, leading to cataract surgery in 7 eyes. Other complications included corneal epithelial defects in 13 eyes, bleb leaks in 3 eyes, choroidal effusions in 13 eyes, 1 choroidal hemorrhage, 1 serous retinal detachment and macular retinal pigment epithelial disturbance associated with hypotony and choroidal effusion. Filtering surgery with postoperative subconjunctival 5-FU can successfully control intraocular pressure in eyes with ocular inflammatory disease.

Adolescent↗
PubMed1990

Serous retinal detachment following glaucoma filtering surgery.

We report the occurrence of serous retinal detachment in association with choroidal effusion and hypotony in six eyes that had undergone glaucoma filtering surgery. Hypotony with choroidal effusion was documented in five patients before the onset of serous retinal detachment. While one patient underwent vitrectomy, treatment was conservative in the other patients. Serous retinal detachment and choroidal effusions resolved spontaneously as the intraocular pressure normalized. Although one patient regained preoperative visual acuity, all other patients lost at least one line of Snellen acuity.

Adolescent↗
PubMed2003

Risk factors for hypotony maculopathy.

PURPOSE: To determine the risk factors for hypotony maculopathy. DESIGN: Retrospective case control study. PARTICIPANTS: Two hundred twenty-eight eyes of 228 patients with hypotony from one medical center. METHODS: Chart review of patients with hypotony from January 1988 to April 2001. Hypotony was defined as intraocular pressure of 5 mmHg or less. Cases of hypotony maculopathy had retinal or choroidal folds or both within the arcades. Controls had hypotony alone. Risk factors were evaluated using multiple logistic regression analysis. MAIN OUTCOME MEASURES: Risk factors for hypotony maculopathy, including age, gender, race, refractive error, systemic illness, intraocular pressure, primary filtering surgery, use of antifibrotic agents, and presence of choroidal effusion. RESULTS: Eighty-one case eyes with hypotony maculopathy and 147 control eyes with hypotony alone were identified. The mean age of patients with hypotony maculopathy was 50.5 years +/- 18.7 compared with 70.6 years +/- 12.7 for the control patients (P < 0.001). More patients with hypotony maculopathy were male, 54.3% (44 of 81), than controls, 33.6% (49 of 147) (P = 0.004). The refractive error was -3.02 +/- 3.67 diopters (D) for phakic eyes with hypotony maculopathy (n = 31), whereas the phakic control eyes' (n = 30) refractive error was -0.61 D +/- 2.00 (P = 0.003). Choroidal effusion was found in 21% (17 of 81) of the case eyes at diagnosis and 52.4% (77 of 147) of the control eyes (P < 0.001). Race distribution and use of antifibrotics was similar for both groups. In multivariate analyses, young age, male gender, no history of diabetes, and absence of choroidal effusion predicted the development of hypotony maculopathy; in phakic eyes myopia was also a risk factor for hypotony maculopathy. CONCLUSIONS: Young age, male gender, and myopia are significant risk factors for hypotony maculopathy. A history of diabetes and the presence of choroidal effusion are associated with a decreased risk for hypotony maculopathy.

Age Factors↗
PubMed1981

Choroidal detachment. Clinical manifestation, therapy and mechanism of formation.

One hundred and twelve eyes of 103 patients were analyzed during a 9 1/2-year period after surgical drainage of a choroidal (ciliochoroidal) detachment (CD). Choroidal detachment in five groups of postoperative patients was studied. CD after surgery for cataract, for cataract and glaucoma, and for glaucoma alone had different time courses, but in all of these, there were similar amounts of protein (67% of plasma protein concentration) in the suprachoroidal fluid (SCF). In marked contrast was a group of patients with intraoperative choroidal effusions and very little protein (18% of plasma concentration) in the SCF. Identified also was a chronic recurrent form of CD that usually persisted for more than three months. Three distinct mechanisms by which choroidal effusion is formed were recognized, (1) one with evidence for the effusion occurring through an intact isoporous membrane (groups 1-3); (2) a second in which hemorrhagic SCF appeared acutely or subacutely (groups 1 and 2) through a disrupted isoporous membrane; and (3) a third form, an intraoperative choroidal effusion in patients with elevated episcleral venous pressure. Increased filtration rate of serum through an intact choriocapillary membrane caused molecular sieving of serum proteins. Inflammation, infection, cataract formation, and corneal edema were uncommonly encountered. Indications for surgery and recommended surgical technique are outlined in detail.

Biological Transport↗
PubMed1986

Magnetic resonance imaging and computed tomography of choroidal detachment.

The magnetic resonance imaging (MRI) and computed tomography (CT) findings in 9 patients with hemorrhagic choroidal detachment, serous choroidal detachment and/or ocular hypotony, choroidal effusion and 6 patients with exudative retinal detachment are described. Subacute hemorrhagic choroidal detachment appeared as moderately hyperintense image in T1 weighted MR scans and as hypointense in T2 weighted scans. Chronic hemorrhagic choroidal detachment was seen as hyperintense image in T1 and T2 weighted scans. Serous choroidal detachment and choroidal effusion appeared as moderately hyperintense image in T1 and T2 weighted scans. The exudative retinal detachment characteristically appeared on MR scans as a dependent hyperintense object in T1 and T2 weighted scans.

Choroid Diseases↗
PubMed1993

Trabeculectomy and Molteno implantation for glaucomas associated with uveitis.

PURPOSE: This study compares the outcomes of trabeculectomy and Molteno implantation in the treatment of glaucomas associated with uveitis. METHODS: Forty-five patients with uveitis, who had undergone filtering surgery for glaucomas associated with uveitis, were reviewed retrospectively. Successful outcome was defined as final intraocular pressure (IOP) of 6 to 21 mmHg, with a minimum follow-up of 6 months without visually devastating complications or loss of light perception. RESULTS: One- and two-year life-table success rates, respectively, were 81% and 73% with trabeculectomy (16 patients); 53% and 31% with combined trabeculectomy and first-stage (reserve) Molteno implantation (19 patients); and 79% and 79% with one-stage Molteno implantation (10 patients). In 11 patients who underwent second-stage Molteno implantation after trabeculectomy failure, 1- and 2-year life-table success rates were 79% and 79%, respectively. Complications included surgically treated choroidal effusions (1/45; 2%), choroidal hemorrhages (3/45; 7%), and chronic hypotony (3/45; 7%). Follow-up in all groups ranged from 5 to 70 months (mean +/- standard deviation, 28 +/- 17 months). CONCLUSIONS: Trabeculectomy provides surprisingly good results in glaucomas associated with uveitis (modulation of wound healing with antimetabolites probably would afford an even higher success rate). However, when significant, immediate postoperative and/or moderate chronic postoperative inflammation is likely, aqueous drainage devices appear more likely to control IOP.

Adult↗
PubMed2000

Two-staged Baerveldt glaucoma implant for childhood glaucoma associated with Sturge-Weber syndrome.

PURPOSE: To report the outcome and complications of 10 eyes of 9 children with Sturge-Weber syndrome (SWS) who underwent two-stage insertion of a Baerveldt glaucoma implant (BGI) for glaucoma. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: The authors reviewed the medical records of children under the age of 14 years with SWS who underwent two-stage BGI for glaucoma at two tertiary care referral centers. MAIN OUTCOME MEASURES: Intraoperative and postoperative complications, intraocular pressure (IOP), number of glaucoma medications, visual acuity, and further surgical intervention. RESULTS: Ten eyes of nine patients were included in the study. Ages of the nine patients at time of first stage BGI ranged between 6 weeks and 13 years. With average follow-up of 35 months (range, 10-50), all eyes had adequate IOP control (< or = 21 mmHg) without the need for additional glaucoma surgery. Intraocular pressure was reduced from a mean (+/- standard deviation) of 24.8 +/- 6.2 mmHg preoperatively to 16.9 +/- 2.3 mmHg at last follow-up visit (P = 0.001). The number of medications used for control of glaucoma was reduced from a mean (+/- standard deviation) of 1.8 +/- 1.0 preoperatively to 1.1 +/- 1.4 at last follow-up visit (P = 0.2). One eye had serous choroidal effusions with overlying serous retinal detachment that resolved spontaneously after 7 days with no permanent visual loss, and one eye had low choroidal effusion that lasted 4 days. There were no intraoperative or postoperative suprachoroidal hemorrhages. At last follow-up, visual acuity had improved by one or more lines in all patients in whom vision was measurable. CONCLUSIONS: Two-stage BGI surgery appears to be a safe and effective treatment for refractory glaucoma in children with SWS.

Adolescent↗