A New Approach to Managing Ciliary Body and Choroidal Detachment After Trabeculectomy Surgery
Abstract
Choroidal detachment (CD) is defined as the abnormal presence of fluid or blood in the space above the choroidal detachment, which is the area between the ciliary body and the sclera, and it has two forms: serous and hemorrhagic. Serous choroidal detachment is one of the recurrent complications of glaucoma surgery. The causes of choroidal detachment, especially in the context of glaucoma surgery, involve various factors, including the disruption of the normal fluid dynamics within the eye, as well as surgical factors; traumatic surgical maneuvers inside the eye and the use of anti-scarring agents during glaucoma surgery can be responsible.
We utilized a specific type of glaucoma surgery (inverted pericardial graft in minimally invasive glaucoma surgery). This study was conducted at the Eye Department of Tishreen University Hospital in Lattakia during 2022, and the sample included 10 patients aged between 20 and 78 years. The standard surgical procedure was performed with a male-to-female ratio of 50/50. The mean intraocular pressure in the sample before surgery was 32.05 mmHg, and we reduced the intraocular pressure to a mean of 18 ± 2 mmHg preoperatively using diuretics. The following factors were evaluated: intraocular pressure after surgery (with a mean of seven readings using the Goldman applanation tonometer recorded for 7 consecutive days after the sclerostomy was cut). We used B-scan ultrasound and clinical diagnosis to detect choroidal detachment.
Among the ten patients, we identified 4 patients (40%) who suffered from choroidal detachment. The average time between sclerostomy and choroidal detachment was 2 ± 1 days. The intraocular pressure at the time of choroidal detachment was significantly low. Patients with choroidal detachment were treated with serum (saline and mixed solution). Steroids were administered from the first day, and post-surgery all patients received subconjunctival injections of gentamicin and dexamethasone immediately. All patients showed improvement within 7 days.
Sodium plays an important role in the production of aqueous humor, as it stimulates the ciliary body through its secretion of aqueous humor, which is initially suppressed by anti-glaucoma medications before surgery. Additionally, glucose plays a supportive role in rejuvenating the ciliary body as it serves as a vital fuel for it.
In conclusion, serum helps in the treatment of choroidal detachment, reduces the required treatment duration, and, in addition, can aid in better recovery. We suggest conducting future studies on the administration of mixed serum during surgery and its immediate effects in preventing choroidal detachment following sclerostomy.
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