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Narcisa Ianopol, Dante J. Pieramici, Stephen Couvillon, Melvin Rabena; Modified Minimally Invasive Technique For Transconjunctival Drainage Of Suprachoroidal Fluids. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3796.
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A modified minimally invasive surgical technique is proposed, for safe and efficient external drainage of serous and hemorrhagic fluid in the suprachoroidal space.
Three patients with suprachoroidal hemorrhage and two patients with choroidal effusion syndrome of different etiology underwent surgery including the proposed technique for external drainage of suprachoroidal fluid associated or not with other procedures. The steps of the new surgical technique were demonstrated on a patient with suprachoroidal hemorrhage. Continuous infusion line was placed in the anterior chamber. By using the ALCON new generation couple trocar - vitrectomy valved cannula, a transconjunctival sclerotomy is performed 3 to 10 mm posteriorly from the limbus, in the location of the highest choroidal elevation revealed by preoperative ultrasonography. The trocar was removed and the cannula left in place, to maintain the sclerotomy opening and to serve as a route for controlled suprachoroidal fluid evacuation. With the infusion on, the suprachoroidal fluids egression was passively promoted by passing through the cannula a small gauge hypodermic needle connected to a tuberculin syringe with its plunger removed. The efficacy, safety and feasibility of each surgical step were analysed on the presented cases and compared with the other published procedures. The disadvantages of the conventional methods as well as the advantages of the new technique are discussed.
The proposed technique was safe, minimally traumatizing for the eye, feasible and efficient in transconjunctival controlled drainage of suprachoroidal fluid, allowing a good restoration of the ocular anatomy and a significant visual acuity recovery in all five cases. This procedure also permitted controlled collection of fluids for quantitative analysis and pathologic evaluation. No complication was noted in any patient, intraoperatively or postoperatively with 6 -15 months follow-up.
Our modified small gauge surgical technique is an elegant method for safe and efficient transconjunctival drainage of suprachoroidal fluids. Technical adjustments of the system components are necessary to improve the safety and feasibility of the procedure.
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