Choroidal detachment

The use of latanoprost after trabeculectomy can cause choroidal detachment (31). 

Sodhi PK, Sachdev MS, Gupta A, Verma LK, Ratan SK. Choroidal detachment with topical latanoprost after glaucoma filtration surgery. Ann Pharmacother 2004 38 510-1. 

When a choroidal effusion (Figure 30-4) is detected without a wound leak, the patient can be treated with topical corticosteroids, such as 1% prednisolone acetate, one drop every 2 to 4 hours, with or without cycloplegia, such as homatropine 5% or atropine sulfate 1%, one drop two to four times daily. Routine topical antibiotics should be continued. When medical management fails to resolve the choroidal detachment (effusion) or if anterior synechiae form, consideration should be given to draining the fluid and re-forming the anterior chamber. 

Kerimoglu H, Zengin N, Ozturk B, Gunduz K. Unilateral chemosis, acute onset myopia and choroidal detachment following the use of tamsulosin. Acta Ophthalmol 2010 88(2) e20-l. 

Sensory systems A 30-year-old man developed bilateral transient myopia, secondary angle closure glaucoma, and choroidal detachment while taking mefenamic acid [32 ]. He was successfully managed by stopping the medication and symptomatic treatment. 

Vishwakarma P, Raman GV, Sathyan P. Mefenamic add-induced bilateral transient myopia, secondary angle closure glaucoma and choroidal detachment. Indian J Ophthalmol 2009 57(5) 398-400. 

A 75-year-old woman developed bilateral ocular irritation, swollen eyelids, and reduced visual acuity after using dorzolamide 2% eye-drops tds for 2 days, in addition to long-term latanoprost - - timolol Her best-corrected visual acuity deteriorated from 6/9 right and left, to 6/12 and 6/18 respectively. The eyelids were erythematous and there was bilateral conjunctival injection. The anterior chambers were deep and the intraocular pressure was 22 mmHg in both eyes, with no intraocular inflammation. Fundoscopy showed extensive bilateral choroidal detachment. Dorzolamide was withdrawn and the problem resolved within 2 weeks. 

Sensory systems Choroidal detachment has been attributed to dorzolamide [32 ],... 

Doherty MD, Wride NK, Birch MK, Figueiredo FC. Choroidal detachment in association with topical dorzolamide is hypotony always the cause Clin Experiment Ophthalmol 2009 37(7) 750-2. 

Davani S, Delbosc B, Royer B, Kantelip J-P. Choroidal detachment induced by dorzolamide 20 years after cataract surgery. Br J Ophthalmol 2002 86(12) 1457-8. 

Goldberg S, Gallily R, Bishara S, Blumenthal EZ. Dorzolamide-induced choroidal detachment in a surgically untreated eye. Am J Ophthalmol 2004 138(2) 285-6. 

Eyes Case-report studies have showed side effects of bilateral transient myopia and secondary ACG with choroidal detachment after use of oral methazolamide (100 mg) in a 51-year-old male with non-insulin-dependent diabetes mellitus (DM) used for refractory macular oedema after 10 days of treatment and a 70-year-old male with normoten-sive glaucoma after 1 day of treatment, which recovered with discontinuation of methazolamide [7],... 

A 48-year-old man presented with a 3-week history of painless loss of peripheral vision. Dilated fundus examination revealed an SRD and an SPED underlying the detached retina. Fluorescein angiography demonstrated uniform hyperfluorescence of the SPED with late leakage into the detached retina. Ultrasoxmd bio-microscopy showed bilateral annular choroidal detachments as well as scleral thickening. Further history revealed that the patient had recently started a combination medication for hypertension that included HCTZ. 

Kwon SJ, Park DH, Shin JP. Bilateral transient myopia, angle-closure glaucoma, and choroidal detachment induced by methazolamide. Jpn J Ophthalmol 2012 56(5) 515-7. 

All patients with anterior uveitis should undergo dilated funduscopy. Such examination should be attempted on the initial visit, although it may be difficult because of patient discomfort and/or posterior synechia. In such cases, ophthalmoscopy on the first follow-up visit may yield more useful information. Without adequate careful examination of the peripheral fundus and posterior pole, one cannot rule out the possibility of posterior involvement or masquerade syndromes. Masquerade syndromes are disorders that present as uveitis but do not have an inflammatory etiology. Such diseases either cause a secondary uveitis or are mistaken for a primary uveitis, because of the presence of white cells, red blood cells, pigment, or tumor cells. Examples of masquerade syndromes may include lymphoma, leukemia, retinoblastoma, malignant choroidal melanoma, retinal detachment, and intraocular foreign body. 

Inspection of the posterior pole may be hindered by vitreous debris however, it is vitally important to evaluate for CME, a primary cause of visual deficit. Another notable finding in the posterior pole is papillitis, which may occur in a variety of etiologies such as syphilis, herpetic infection, and sympathetic ophthalmia. Chronic long-term complications involving the fundus may include choroidal neovascularization, chorioretinal scarring, epiretinal membrane formation, neovascularization, and retinal detachment. 

The patient may report episodes of watering or tenderness. When reduced lOP is fc>imd by applanation tonometry, a careful examination of the woimd is necessary.This inspection is achieved by painting sodium fluorescein over the cataract incision to observe for Seidel s sign. Occasionally, the auxiliary incisions can leak, so they should also be examined. The clinician should note the appearance of the cornea, which often shows endothelial folds. After the instillation of sodium fluorescein, a waffled appearance of the cornea is generally apparent if the lOP is markedly reduced (Figure 30-3). In addition, the anterior chamber depth should be assessed as well as the presence of inflammation. The pupils should be dilated and a retinal examination should be performed to rule out serous or hemorrhagic choroidal separations or a retinal break or detachment. 

The interstitial space between RPE and photoreceptors contains a sticky inteiphotoreceptor matrix consisting of glycoproteins, proteoglycans, and hyaluronic acid that helps the retina adhere to the back of the eye. Retinal adhesion is also promoted by extrusion of water from the RPE to choroid. Basolateral Cl channels and apical Na/K/2C1 transporters are particularly important for water transport out of the RPE. Because photoreceptors are not physically bound to the RPE, the retina can detach from the RPE with a strong blow to the eye, fluid build-up behind the retina (rhegmatogenous... 

A heavier-than-water fluorinated silicone oil was used in the treatment of 30 selected cases of complicated retinal detachment due to proliferative vitreoretinopathy (n = 19), proliferative diabetic retinopathy with traction detachment (n = 2), giant retinal tears (n = 5), ruptured globe with retinal detachment (n = 2), massive choroidal effusion with retinal detachment (n = 1), and acute retinal necrosis with retinal detachment (n = 1) (13). Initial retinal reattachment was achieved in all cases. Complications included redetachment (n = l), cataract (n = 6), raised intraocular pressure (n = 4), hypotony (n = 4), keratopathy (n = 3), uveitis sjme-chia formation (n = 3), phthisis (n = 2), choroidal hemorrhage (n — 1), and vitreous hemorrhage n = 1). 

The use of intravitreal corticosteroids was first popularized by Machemer in 1979 (33) in an effort to halt cellular proliferation after retinal detachment surgery, and Graham (34), McCuen (35), Tano (36), and others have studied its use in both animal models and humans. In contrast to other corticosteroids with short half-lives following intravitreal injection, triamcinolone acetonide is an effective and well-tolerated (35,37) agent for intravitreal injection in conditions such as uveitis (38,39), macular edema secondary to ocular trauma or retinal vascular disease (40), proliferative diabetic retinopathy (41), intraocular proliferation such as proliferative vitreoretinopathy (42), and choroidal neovascularization from AMD (43,44). 

Figure 12 Histological section showing a microdialysis probe in a rabbit eye showing part of the dialysis membrane near the probe tip. The probe had been in the eye for 30 days. There is no inflammatory reaction and the structure of the overlying retina, retinal pigment epithelium, and choroid is normal. There is an artifactual retinal detachment that occurred during preparation of the section (hematoxylin and eosin x3584).

Robertson DM. Photodynamic therapy for choroidal hemangioma associated with serous retinal detachment. Arch Ophthalmol 2002 120 1155-1161. 

Figure 1 Schematic diagram of the eye in horizontal section indicating each ocular component, a, corneal epithelium b, keratocyte c, corneal endothelium d, aqueous humor e, conjunctiva /, sclera g, trabecular meshwork h, iris i, lens /, ciliary zonule and body k, vitreous /, retina m, interphotoreceptor matrix n, retinal pigment epithelium o, Bruch s membrane p, choroid q, optic nerve head r, lamina cribrosa extraocular muscles and tissues. The candidate glycosaminoglycans involved in the ocular components of each eye disease described in this chapter are as follows macular corneal dystrophy (b, c KS, CS/DS, HA), glaucoma (d HA g CS/DS, HS, HA q, r CS, HS, HA), cataract r. CS/DS, HS, HA), diabetic retinopathy (fc HA / HS), retinal detach-ment/proliferative vitreoretinopathy k, I, m, n CS/DS, HS, HA), myopia (f, p CS), thyroid eye disease (s CS, HA), pseudoexfoliation syndrome (c, d, g, h, i, j KS, CS/DS, HA). KS, keratan sulfate CS/DS, chondroitin sulfate/dermatan sulfate HS, heparan sulfate HA, hyaluronan.

The argon ion laser (488-514.5 nm) in the localized heating and thermal coagulation of the vascular choroid layer and adjacent retina, resulting in the anchoring of the retina in treatment of retinal detachment (Katoh and Peyman, 1988). 

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