Abstract
Purpose
To examine the rate of ciliary body detachment in patients with choroidal detachment following glaucoma surgery and its effect on the clinical course, management, and prognosis.
Methods
A prospective observational case-series study. Patients with choroidal detachment following glaucoma surgery in 2018–2019 were included. All underwent complete ophthalmological examination and ultrasound biomicroscopy for evaluation of the presence and extent of ciliary body detachment. Follow-up examinations including ultrasound biomicroscopy scans were performed at 1 week, 1 month, 3 months, and 6 months.
Results
Eight patients (8 eyes) were enrolled, 4 male and 4 female, of mean age 72 years (range 60–83). Five patients underwent trabeculectomy with mitomycin C (0.02%), which was combined with phacoemulsification cataract extraction in one; two underwent Ahmed glaucoma valve implantations, and one underwent ab-interno Xen45 gel stent implantation with mitomycin C (0.02%). The mean intraocular pressure was 26.0 ± 7.65 mmHg preoperatively, drop** to 6.9 ± 2.64 mmHg on first postoperative day one. Mean time from surgery to diagnosis of choroidal detachment was 11.6 ± 5.73 days. Ciliary body detachment was identified by ultrasound biomicroscopy in all patients, ranging between one and four quadrants. All patients were treated with topical steroids and cycloplegics; three (37.5%) received oral steroids. No surgical intervention for the choroidal or ciliary body detachments was indicated.
Conclusions
In this real-world prospective study, concurrent ciliary body detachment was identified in all patients who presented with choroidal detachment following glaucoma surgery. This observation may deepen our understanding of the mechanism underlying the hypotony that is often seen after glaucoma surgery.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Introduction
The choroid is attached to the sclera in the normal eye. It may be displaced by serous fluid or blood accumulating inside the potential space between the uvea and sclera, leading to choroidal detachment [1]. Serous choroidal detachments are typically associated with low intraocular pressure (IOP) or ocular hypotony, and most commonly occur after eye surgery. Inflammation, trauma, malignancy, and certain medications can also cause serous choroidal detachment [2,3,4,5,6,19, 20]. Our finding of concurrent ciliary body detachment in all cases of choroidal detachment sheds more light on the pathophysiology of the disease and the vicious cycle that transpires after choroidal detachment occurs. As the ciliary processes are the main site of aqueous humor production [13], ciliary body detachment may have an added detrimental effect on aqueous production and may thereby play an important role in postoperative hypotony.
A large persistent choroidal effusion may have immediate and long-lasting vision-threatening sequelae, particularly when it is associated with hypotony, maculopathy, or serous retinal detachment [2, 17]. However, most serous choroidal effusions follow a benign course as they may be asymptomatic and resolve spontaneously without treatment when the IOP gradually increases postoperatively [21]. If treatment is warranted, topical steroids are usually prescribed in an effort to increase IOP and reduce inflammation. Long-acting topical cycloplegics may be given to deepen the anterior chamber and prevent anterior synechiae and corneal endothelial cell loss [22]. When topical treatment is not sufficient, systemic steroids may be used [21, 23]. Surgical intervention is indicated when the choroidal detachment is longstanding or causes complications that can lead to loss of vision [24]. In our cohort, treatment was left to the treating physician’s discretion. All patients received topical steroids and cycloplegic agents, and some elected to add systemic steroids. Most maintained their visual acuity following resolution of the ciliary body detachment, even when it was longstanding. In the two patients who lost two or more Snellen lines of BCVA, a mature cataract and status post endophthalmitis were the presumed causes.
The major limitations of this study are the small number of patients examined and the heterogeneity of glaucoma types. Moreover, the various types of glaucoma surgeries performed in our cohort could have had different implications for the occurrence of ciliary body detachment. The strengths of the study are the prospective design and the long duration of follow-up.
To conclude, in this real-world prospective study, we found concurrent ciliary body detachment in all patients who presented with choroidal detachment following glaucoma surgery. This observation may deepen our understanding of the postoperative mechanism underlying hypotony. We found that all detachments resolved with no need for surgical intervention. Larger prospective studies are warranted.
Data Availability
No datasets were generated or analysed during the current study.
References
American Academy of Ophthalmology. Basic and Clinical Science Course. Section 12: Retina and Vitreous 2019–2020. San Francisco, CA: USA, p 379
Bellows AR, Chylack LT Jr, Hutchinson BT (1981) Choroidal detachment. Clinical manifestation, therapy and mechanism of formation. Ophthalmology 88:1107–1115
Arnalich-Montiel F, Ruiz-Casas D, Munoz-Negrete F, Rebolleda G (2015) Inadvertent cyclodialysis cleft and annular ciliochoroidal detachment after hyperopic phakic intraocular lens implantation and prophylactic surgical iridectomy. J Cataract Refract Surg 41:2319–2322. https://doi.org/10.1016/j.jcrs.2015.09.010
Brubaker RF, Pederson JE (1983) Ciliochoroidal detachment. Surv Ophthalmol 27:281–289. https://doi.org/10.1016/0039-6257(83)90228-x
Tarantola RM, Folk JC, Shah SS, Boldt HC, Abràmoff MD, Russell SR, Mahajan VB (2011) Intraoperative choroidal detachment during 23-gauge vitrectomy. Retina 31:893–901. https://doi.org/10.1097/IAE.0b013e3181f4429b
Yamane S, Inoue M, Arakawa A, Kadonosono K (2012) Early postoperative hypotony and ciliochoroidal detachment after microincision vitrectomy surgery. Am J Ophthalmol 153:1099-1103.e1. https://doi.org/10.1016/j.ajo.2011.11.001
Yang JG, Yao GM, Li SP, **ao-Huawang RBC (2011) Surgical treatment for 42 patients with traumatic annular ciliochoroidal detachment. Int J Ophthalmol 4:81–84. https://doi.org/10.3980/j.issn.2222-3959.2011.01.19
Elagouz M, Stanescu-Segall D, Jackson TL (2010) Uveal effusion syndrome. Surv Ophthalmol 55:134–145. https://doi.org/10.1016/j.survophthal.2009.05.003
Alibet Y, Levytska G, Umanets N, Pasyechnikova N, Henrich PB (2017) Ciliary body thickness changes after preoperative anti-inflammatory treatment in rhegmatogenous retinal detachment complicated by choroidal detachment. Graefes Arch Clin Exp Ophthalmol 255:1503–1508. https://doi.org/10.1007/s00417-017-3673-2
Martínez-Belló C, Capeáns C, Sánchez-Salorio M (1999) Ultrasound biomicroscopy in the diagnosis of supraciliochoroidal fluid after trabeculectomy. Am J Ophthalmol 128:372–375. https://doi.org/10.1016/s0002-9394(99)00118-x
Wada S, Kohno T, Yanagihara N, Hirabayashi M, Tabuchi H, Shiraki K, Miki T (2002) Ultrasound biomicroscopic study of ciliary body changes in the post-treatment phase of Vogt-Koyanagi-Harada disease. Br J Ophthalmol 86:1374–1379. https://doi.org/10.1136/bjo.86.12.1374
Yuki T, Kimura Y, Nanbu S, Kishi S, Shimizu K (1997) Ciliary body and choroidal detachment after laser photocoagulation for diabetic retinopathy. A high-frequency ultrasound study. Ophthalmology 104:1259–1264. https://doi.org/10.1016/s0161-6420(97)30149-3
American Academy of Ophthalmology. Basic and clinical science course. Section 10: Glaucoma. San Francisco: 2019–2020. p 13–16
Jampel HD, Musch DC, Gillespie BW, Lichter PR, Wright MM, Guire KE, Collaborative Initial Glaucoma Treatment Study Group (2005) Perioperative complications of trabeculectomy in the collaborative initial glaucoma treatment study (CIGTS). Am J Ophthalmol 140:16–22. https://doi.org/10.1016/j.ajo.2005.02.013
Haga A, Inatani M, Shobayashi K, Kojima S, Inoue T, Tanihara H (2013) Risk factors for choroidal detachment after trabeculectomy with mitomycin C. Clin Ophthalmol 7:1417–1421. https://doi.org/10.2147/OPTH.S46375
Iwasaki K, Kakimoto H, Arimura S, Takamura Y, Inatani M (2020) Prospective cohort study of risk factors for choroidal detachment after trabeculectomy. Int Ophthalmol 40:1077–1083. https://doi.org/10.1007/s10792-019-01267-6
Wang Q, Thau A, Levin AV, Lee D (2019) Ocular hypotony: a comprehensive review. Surv Ophthalmol 64:619–638. https://doi.org/10.1016/j.survophthal.2019.04.006
Mietz H (1996) The toxicology of mitomycin C on the ciliary body. Curr Opin Ophthalmol 7:72–79
** Y, Weihua P, Mei R, Jia Q (2011) Supraciliochoroidal fluid incidence at the early stage after trabeculectomy: study with anterior segment optical coherence tomography. Curr Eye Res 36:818–823. https://doi.org/10.3109/02713683.2011.593724
Fernández-Vigo JI, Kudsieh B, Shi H, De-Pablo-Gómez-de-Liaño L, Fernández-Vigo JÁ, García-Feijóo J (2022) Diagnostic imaging of the ciliary body: technologies, outcomes, and future perspectives. Eur J Ophthalmol 32:75–88. https://doi.org/10.1177/11206721211031409
Schrieber C, Liu Y (2015) Choroidal effusions after glaucoma surgery. Curr Opin Ophthalmol 26:134–142. https://doi.org/10.1097/ICU.0000000000000131
de Barros DS, Navarro JB, Mantravadi AV, Siam GA, Gheith ME, Tittler EH, Baez KA, Martinez SM, Spaeth GL (2009) The early flat anterior chamber after trabeculectomy: a randomized, prospective study of 3 methods of management. J Glaucoma 18:13–20. https://doi.org/10.1097/IJG.0b013e31816f7647
Ku WC, Lin YH, Chuang LH, Yang KJ (2005) Choroidal detachment after filtering surgery. Chang Gung Med J 28:151–158
WuDunn D, Ryser D, Cantor LB (2005) Surgical drainage of choroidal effusions following glaucoma surgery. J Glaucoma 14:103–108. https://doi.org/10.1097/01.ijg.0000146370.28625.fc
Funding
Open access funding provided by Tel Aviv University. The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by A.G, O.G.O, D.B. and A,H. The first draft of the manuscript was written by A.G, E.B, I.B and A.Z and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
Ethical approval
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Rabin Medical Center.
Consent to participate
Informed consent was obtained from all individual participants included in the study.
Consent to publish
The authors affirm that human research participants provided informed consent for publication of the images in Fig. 1a and b.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Barayev, E., Gal-Or, O., Gershoni, A. et al. Concurrent ciliary body detachment in patients presenting with serous choroidal detachment following glaucoma surgery. Int Ophthalmol 44, 283 (2024). https://doi.org/10.1007/s10792-024-03219-1
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s10792-024-03219-1