Is post-trabeculectomy serous choroidal detachment a risk factor for failure in the long term

Abstract

Background: To investigate the long-term effect of serous choroidal detachment on the success of trabeculectomy in glaucoma patients. Methods: In this case-control study, 17 patients who underwent trabeculectomy and developed choroidal detachment, and completed at least 3 years of follow-up were included. The controls were matched based on age, sex, preoperative intraocular pressure, and glaucoma type, and lack of choroidal detachment. Surgical success was defined based on two definitions of 5 < IOP < 16 and 20% reduction from the baseline and no need for further glaucoma surgery and all the same but 5 < IOP < 22. Results: The mean estimated duration of survival ±SD was 2.73 ± 0.35 years (CI 95% 2.1, 3.4), which was significantly shorter than 3.98 ± 0.38 years (CI 95% 3.3, 4.7) in the control group. (LogRank = 5.03 p = 0.02). Cumulative probability of success was 76.5%, 52.9%, 29.4%, 17.6%, and 11.8% in year 1, 2, 3, 4, and 5 in the case group, respectively. Corresponding values were 88.2%, 82.4%, 68.6%, 58.8%, and 47.1%. In the control group, respectively. At baseline, average IOP was 22.3 ± 2.7 and 23.8 ± 8.3 mmHg in the case and control groups, respectively ( p = 0.17). Mean IOP was significantly higher in the case group than in the control group in years 2, 3, 4, and 5. Conclusion: Serous choroidal detachment affects the long-term surgical success of trabeculectomy, especially in patients with advanced glaucoma when lower target pressure is required.

Clinical profile and long term outcomes of eyes with choroidal detachment following trabeculectomy

“…Yadgari et al . [ 5 ] in their case-control study of 17 patients who developed choroidal detachment post trabeculectomy found a slightly lower cumulative success probability of 76.5% at 1 year as compared to ours (79.3%). It is also worth noting that they used a limbal-based approach as compared to our fornix-based approach with a slightly lower concentration of mitomycin C.…”

“…[ 1 2 4 ] The high incidence of the same prompts for an increased need to focus on its prevention and treatment. [ 5 ] Early postoperative hypotony and choroidal detachment have been shown to cause anterior chamber inflammation and surgical failure following trabeculectomy. [ 6 ] Choroidal effusion has also been reported to lead to a permanent reduction in long-term visual acuity.…”

“…Evidence of choroidal detachments affecting the long-term success rates of trabeculectomy has been previously documented. [ 5 9 ] Although the literature mentions about risk factors for choroidal detachment, there remains a lacuna for its long-term outcomes. Thus, the purpose of this study was to report the long-term outcomes of choroidal detachments in eyes that have undergone trabeculectomy.…”

Management of Serous and Hemorrhagic Choroidal Detachments and Complications

“…32 In general, 29% to 32% of patients with choroidal detachments with RDs achieve 20/200 or better, but 7% to 33% have final visual acuities of NLP. 3,12,18,29,33,34,36 In the authors' study, 42.4% achieved 20/200 or better, but 12.1% were NLP at the last follow-up. The mean visual acuity decreased from a baseline of 0.88 ± 0.84 logMAR (approximate Snellen equivalent of 20/153) to 1.58 ± 0.97 logMAR (≈20/760) after developing choroidal detachments; unfortunately, the vision improved only slightly by the last follow-up (1.40 ± 1.0 logMAR, ≈20/500).…”

“…35 Others have suggested creating anterior sclerotomies with thicker flaps, using valved tubes, or ligating nonvalved tubes to help prevent initial postoperative hypotony until a fibrotic capsule has formed around the plate to prevent overfiltration. 34 ' Imaging Dynamic ultrasound can be used to help differentiate between hypoechoic serous effusions from hyperechoic dome-shaped SCHs, evaluate for centrally apposed choroidal detachments, detect the presence of concurrent RDs, and assess the stages of blood liquefication.…”