|Year : 1983 | Volume
| Issue : 7 | Page : 1010-1012
Nascent choroidal detachment
Rajvardhan Azad, HK Tewari, PK Khosla
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Azad R, Tewari H K, Khosla P K. Nascent choroidal detachment. Indian J Ophthalmol 1983;31, Suppl S1:1010-2
Choroidal detachment following lens extraction can occur either immediately' or after some days of surgery (intermediate) or delayed. There have been tremendous advances in the field of methodology of cataract extraction but literature is scanty regarding occurrence, progression and nature of chroidal detachment.
The basic aim of this study was to record the incidence nature and progression of chroidal detachment in the immediate postoperative period following lens extraction as it is practised now-a-days.
| Material and methods|| |
100 patients who underwent uneventful intracapsular lens extraction at the Dr. Rajendra Prasad Centre for Ophthalmic Sciences form the basis of this study. Various paramenters as age, sex, technique of lens extraction including number and type of sutures applied were recorded. Normal saline was injected into the anterior chamber on operation table to reform the anterior chamber immediately after completion of surgery and indirect ophthalmoscopy was performed to see the presence of chroidal detachment. Speical attention was given to record site, size, nature and progression or disappearance of choroidal detachment on 1st, 3rd and 5th postoperative days.
| Observations|| |
[Table - 1] shows that average age in groups without and with choroidal detachment was nearly same as the total group.
Fundus was visible in only 75 cases. Out of 100 cases it could not be seen in 25 cases where the media was hazy on account of either pigment dispersal (16 cases) or corneal haze (5 cases) or others (4 cases). 20 cases out of 75 showed immediate choroidal detachment (26.66%), 14 had flat or shallow and rest 6 cases had globular type of choroidal detachment. All showed lifting up of the ora, never extending beyond equator and neverinvolving more than one quadrant. Majority of these detachments were seen in inferotemporal quadrant [Table - 2]. Choroidal detachment was seen in 4 cases on 1 st postoperative day, in 1 case on 3rd postoperative day and non on 5th postoperative day.
Continuous sutures were applied for wound closure in 30 patients and only 5 cases (16.6%) had choroidal detachment while in the group of 45 where interrupted sutures were applied, 15 cases (33.33%) showed choroidal detachment. Analysis of type of lens extraction revealed that 7 cases (28%) out of 27 who underwent lens extraction by Modified Smith Indian technique developed choroidal detachment while 13 cases (27%) out of 48 showed choroidal detachment where cryo extraction was done [Table - 3].
| Discussion|| |
Choroidal detachment was clinically diagnosed first by capseuling in 1870. O'Brien' found that it was present in 93% of cases where fundus was visible just after lens extraction either by intracapsular or extra capsular methods. He could see fundus only in 90 cases (64.98%) out of 140 consecutive cases but we could visualise fundus in 75% of cases probably due to better surgical techniques and reformation of anterior chamber by normal saline. Pigment dispersal and corneal haze due to either endothelial or epithelial damage, in otherwise uncomplicated lens extraction were a major sources of annoyance. We could see choroidal detachment in only 20 cases (26.66%) inspite of use of indirect ophthalmoscopy which is in sharp contrast to O'Brien. Venco and Giardiani supported O'Brien's observations indicating 80% incidence, however, Jaffe and Kirsch and Singer have indicated that incidence is much lower than reported earlier. Kirsch and Singer 4sub , however, report retinal infoldings in 84% which they claim is different from true choroidal detachment but the points of difference mentioned as disappearance of infoldings after injection of saline and normal filing of vessels over socalled infolded retina neither proven or disprove the diagnosis of choroidal detachment.
Choroidal detachments were either shallow or globular in nature, always anterior to equator and involving not more than one quadrant. Annular choroidal detachment was not seen in any of our cases. There was no progression of choroidal detachment but it regressed as we observed it only in 20% patients on 1st postoperative day and none on 5th postoperative day. Higher incidence (33.3%) of choroidal detachment was seen with interrupted suturing technique through it did occur (16.6%) even with continuous suturing technique. Eye undergoes immediate hypotony when cataract extraction is done which is indepencent of the suturing technique by virtue of sealing anterior chamber reforms it and may thus be factor in different incidences in various methods of suturing. We did not find any significant correlation between types of lens extraction and choroidal detachment from our series i.e. 28.07% with Modified Smith India and 27.0% with cryoextraction indicating that the technique per se effects the pathogenetic factors causing immediate choroidal detachment similarly.
The technique of lens extraction in recent days is definitely less traumatic. Replacement of knife section by Keratome Section or blade breaker achieves slow decompression of globe. Atraumatic needles and fine monofilament sutures cause minimal trauma to eye while handling ocular structures. The factor of magnification further helps in precise approximation of wound. The lesser incidence of choroidal detachment from O'Brien's series may be due to use of better surgical techniques thereby providing lesser trauma, watertight closure of wound, and formation of the anterior chamber. It is possible that the incidence of choroidal detachment might have been close to 100% in the past but it has lowered definitely due to watertight closure of wound. There is a distinct possibility that resolution of choroidal detachment in the postoperative period maybe attributed to formation of anterior chamber.
| Summary|| |
Nascent choroidal detachment which occurs immediately after lens extraction has the following characteristics
1. Occurs immediately after surgery and is not related to leaking wound. 80% disappear on 1st postoperative day and no choroidal detachment remains by 5th postoperative day.
2. Appears as a gently curved dark bulge (balloonous or annular) always anterior to the equator.
3. More in inferior quadrant (classical postoperative choroidal detachments occur in nasal or temporal halves), more frequently multiple.
4. Prognosis is good and does not bother either the surgeon or the patient.
| References|| |
O'Brien: 1936, Arch. Ophthalmol. 16: 655
Venco and giardini, 1973, Ann. Ottal: 449 quoted by Duke Elder Henry Kimpton London Vol. IX Page 939: 1977
Jaffe Norman S., 1981, 3rd ed. C.V. Mosby & Co. page 297 Cataract Surgery and its complications.
Kirsch R.I and Singer JA.,1973,Arc .Ophthalmol. 90:460-464.
[Table - 1], [Table - 2], [Table - 3]