Ciliochoroidal detachment

Abstract

Ciliochoroidal detachments occur under a variety of pathological circumstances and are most commonly noted following intraocular surgery where hypotony is combined with postoperative inflammation. Although the condition is easily recognized, the pathophysiologic mechanisms involved are not well understood. In this review, the pathophysiologic mechanisms are summarized, with special emphasis on fluid dynamics within the suprachoroidal space. The clinical features, etiology and treatment of ciliochoroidal detachments are also reviewed.

Surgical effects of combined trabeculotomy and sinusotomy compared to trabeculotomy alone

“…However, the filtration bleb subsequently disappeared in many cases during, the followup period, and filtration blebs after the combined procedure were very flat and localized in comparison to those after standard trabeculectomy In addition, because the inner wall of Schlemm's canal remains even after the combined procedures, this surgical modality is different from classic filtration operations such as Scheie or Elliot procedures. Also, none of the common complications after filtration surgery such as prolonged hypotony, a shallow anterior chamber and choroidal detachment were found in any patient of this study (Sugar 1970;Cain & Sinskey 1981;Brubaker & Pederson 1983;Lobue et al 1985). Thus, although the presence of filtering effects cannot be neglected, especially in the early postoperative period, these effects are very different from those of standard filtration surgery such as trabeculectomy.…”

Light microscopy of uveoscleral drainage routes after gelatine injections into the suprachoroidal space

“…Under normal circumstances, drainage from the suprachoroidal space is sufficient to prevent fluid accumulation. However, several pathological conditions can interrupt this balance, resulting in large, multi-lobed choroidal detachments, often combined with ocular hypotony (Pederson et al 1979;Brubaker & Pederson 1983). Further knowledge of the fluid dynamics in the suprachoroidal space is therefore fundamental to the understanding of both choroidal detachments and intraocular pressure regulation.…”

Bee sting-induced ciliochoroidal detachment

“…Traumatic ciliochoroidal detachments typically occur in the setting of penetrating ocular injuries, where the inflammation is combined with hypotony. 8 In our case, bee sting-induced type 1 hypersensitivity response and ocular inflammation accounted for the ciliochoroidal detachment. As well, the presence of cyclodialysis cleft must be excluded, which was absent in our case.…”

“…Sudden release of highly concentrated biogenic amines, such as histamine in the venom produce vasodilatation and increase in capillary permeability and the immunologic reaction to high molecular weight enzymes in the venom-induced type 1 hypersensitivity response mediated by immunoglobulin E. 2,4,7 Ciliochoroidal detachment or effusion refers to an abnormal accumulation of serous fluid in the outer layer of the ciliary body and choroid, resulting from altered choroidal fluid dynamics. 8 Ocular inflammation increases capillary protein permeability, allowing greater leakage of protein into the extravascular space. This effectively reduces the colloid osmotic absorptive force across capillary walls, favouring extravascular fluid retention.…”