Ab-externo drainage with continuous anterior chamber infusion for non-resolving exudative retinal detachment: a case rep
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CASE REPORT
Open Access
Ab-externo drainage with continuous anterior chamber infusion for non-resolving exudative retinal detachment: a case report Matthew P. Simunovic1,2,3* , Emily H. Shao1,2 and Perach Osaadon1,2
Abstract Background: Drainage of exudative retinal detachment may be necessary for either therapeutic or diagnostic purposes (or both). Here, we describe an external drainage technique for non-resolving vision-threatening exudative retinal detachment which combines the advantages of internal drainage (widefield viewing and intraocular pressure control using continuous anterior chamber infusion) with those of external drainage (drainage of sub-retinal fluid without vitrectomy). Case presentation: To illustrate this technique, we present a 13-year-old girl with macula-off exudative retinal detachment secondary to Vogt-Koyanagi-Harada syndrome, which was unresponsive to aggressive medical management. External drainage was undertaken using widefield viewing and chandelier illumination. Intraocular pressure was maintained with an anterior chamber infusion. Near-complete drainage of sub-retinal fluid was achieved, and retinal reattachment was maintained at 6 months postoperatively, with a corresponding improvement in visual acuity from 20/63 to 20/40. Conclusions: External drainage under chandelier-assisted viewing at the surgical microscope with anterior chamber infusion offers the ergonomic and optical advantages of the surgical microscope and widefield visualisation, continuous IOP control and drainage of sub-retinal fluid without the need for pars plana vitrectomy. Keywords: Exudative retinal detachment, Retinal detachment, Sub-retinal fluid drainage, Vogt-Koyanagi-Hara syndrome
Background Exudative retinal detachment is primarily managed medically; however, surgical drainage may be indicated in cases where less invasive procedures, such as systemic therapy, laser and peri−/intra-ocular medical approaches, fail. Surgical approaches can be divided into internal drainage — where fluid is aspirated via a retinotomy following trans-pars plana vitrectomy (TPPV) — and external drainage, where fluid is removed via a * Correspondence: [email protected] 1 Save Sight Institute, University of Sydney, 8 Macquarie Street, Sydney, NSW 2000, Australia 2 Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia Full list of author information is available at the end of the article
trans-chorioscleral route (with, or without peritomy) [1]. The external approach may be preferable to the internal approach in young, phakic patients for several reasons. First, the internal approach generally requires the creation of a posterior vitreous detachment, which in turn confers a risk of inducing iatrogenic breaks. Second, it risks the development of proliferative vitreoretinopathy (PVR). Third, it can rarely cause iatrogenic cataract through unwanted lens touch. However, it is argued that internal surgery provides a superior view of the posterior segment intra-operatively, carries a lower risk of subret
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