Choroidal detachment

Introduction to choroidal detachment Choroidal detachment refers to the increase or bleeding of the suprachoroidal fluid due to surgery, trauma, inflammation or intraocular tumors, resulting in choroidal bulging. The disease is characterized by a brown-black spherical bulge and a low intraocular pressure at the fundus. In most areas, only a small amount of fibrous connective tissue is loosely connected between the choroid and the sclera. There is a potential gap between the two, which is the suprachoroidal space. The pressure of the cavity is equal to or slightly less than the intraocular pressure. If this pressure relationship is destroyed, the fluid will accumulate in the suprachoroidal space called choroidal detachment. Due to the anatomical continuity of the ciliary body and choroid, choroidal detachment is often accompanied by detachment of the ciliary body. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: glaucoma

Choroidal detachment

(1) Causes of the disease

The factors that induce choroidal detachment are the most ocular trauma. The trauma can directly damage the choroidal vessels, ciliary artery and vortex vein, etc., which can cause suprachoroidal hemorrhage. The trauma is accompanied by a large amount of choroid and retinal hemorrhage, which indicates that the injury is serious. The prognosis is very poor, followed by internal eye surgery, in which anti-glaucoma surgery and vitreoretinal surgery are more, intraoperative, postoperative, extraocular pressure or high-intensity glaucoma patients with extraocular drainage surgery, intraoperative Or postoperative choroidal detachment or even hemorrhage is a common complication. Retinal detachment is extensive in scleral surgery, excessive condensation, electrocoagulation; external compression or cerclage is too tight, or position is backward; vitreous surgery is too long, Low perfusion pressure, large-area laser photocoagulation can induce choroidal detachment during or after surgery. In recent years, cataract surgery has been popularized by phacoemulsification, with small incision, short time, constant intraocular pressure during surgery, and cataract surgery. Or postoperative choroidal detachment is rare, but nuclear myopia in high myopia, especially in patients with grade IV or higher, in ultrasound It may still occur during the operation, and most of them are choroidal hemorrhage. In addition, in the suture suspension intraocular lens surgery, the ciliary long artery is damaged by the needle at 3 or 9 o'clock, and the suprachoroidal hemorrhage is also caused. Reported that in trauma, advanced age, high myopia, high intraocular pressure, diabetes, hypertension, arteriosclerosis and other cardiovascular diseases as well as multiple intraocular surgery, are the high risk of choroidal detachment or suprachoroidal hemorrhage Factors, preoperative attention should be paid to prevention, trauma or intraocular surgery after choroidal lesions can be divided into:

1 choroidal edema thickening.

2 suprachoroidal hematomas (suprachoroidal hematomas).

3 choroidal exudative detachment.

4 suprachoroidal hemorrhage.

5 desperragoroidal expulsive hemorrhage: the latter is the most dangerous, the most serious prognosis, other rare causes unrelated to surgery such as idiopathic choroidal leakage, true small eyeballs, excessive use of intraocular pressure drugs, after Scleritis, blood diseases, hypoproteinemia caused by extreme malnutrition, etc., can induce choroidal exudation and detachment.

(two) pathogenesis

The choroidal tissue blood flow accounts for 70% of the total blood volume of the eyeball. It is a highly vascularized tissue. On the other hand, there is a gap between the choroidal capillary endothelial cells, and the vascular permeability is high. The blood vessels are not terminally branched and have extensive traffic. Because of these factors, the suprachoroidal lesions are actually lesions originating from choroidal vessels, which can be roughly classified into three categories according to the damage process:

1. Direct damage to choroidal blood vessels such as severe eye trauma.

2. Common causes of indirect injury to choroidal vessels are:

1 A sudden drop in intraocular pressure: dilates the choroidal blood vessels, causing massive exudation or hemorrhage, as occurs after multiple intraocular surgery and rhegmatogenous retinal detachment.

2 choroidal blood reflux disorder: such as scleral surgery in the vortex vein compression or congenital scleral thickening, such as true small eyeball.

3 Inflammation: Intraocular inflammatory factor-mediated changes in vascular permeability caused by various traumas.

4 choroidal neovascular hemorrhage.

3. Changes in blood composition such as plasma hypoallergenic osmotic pressure caused by hypoproteinemia.

The liquid accumulated in the suprachoroidal space may be exudate, leakage, blood or all of them. It is customary to use effusion or leakage as the main exudate or leakage. The upper choroidal hemorrhage.

According to the cause, it can be divided into idiopathic choroidal detachment, ciliary choroidal detachment and secondary choroidal ciliary detachment after operation.

Choroidal detachment prevention

Choroidal detachment occurs mainly after glaucoma filtration surgery, and is related to various factors such as preoperative high intraocular pressure, diabetes, hypertension, arteriosclerosis, etc., to minimize preoperative intraocular pressure, to avoid and reduce intraocular pressure drop during surgery. At the time of the formation of the anterior chamber, the external removable scleral flap suture, postoperative application of corticosteroids and ciliary muscle paralysis to avoid mental stress, is an effective measure to prevent choroidal detachment after glaucoma filtration surgery.

Choroidal detachment complications Complications glaucoma

Corneal blood staining, secondary glaucoma, and proliferative glass reflect retinal lesions (PVR).

Choroidal detachment symptoms common symptoms eye pain sclera yellow staining high intraocular pressure uveitis

Explosive suprachoroidal hemorrhage occurs during intraocular surgery. Sudden and large amount of bleeding can force the eye, including the iris, lens, vitreous, uveal and even the retina to escape from the open wound. The bleeding is suddenly due to intraocular pressure. Increased or because the clot directly stimulates the ciliary nerve, the patient is often accompanied by severe eye pain. After the emergency closure of the incision is stopped, a large amount of blood in the superior choroid can penetrate into the subretinal or vitreous, or break through the attachment of the scleral process. Entering the anterior chamber, producing high intraocular pressure and causing corneal blood staining, the blood in the anterior chamber or the suprachoroidal space can be drained by the aqueous humor to the surface of the sclera, so that the sclera is yellow-stained, if no further treatment, intraocular blood Mechanization leads to retinal, ciliary body detachment, and finally the eyeball shrinks. This is the most serious consequence. The disease is mild, and the choroidal detachment can be gradually absorbed and disappeared. The typical manifestation of choroidal detachment is the appearance of one or several surface smoothings at the fundus. Spherical or lobulated solid brown bulge, the size of the detachment can be different from the height, because it is a vortex vein in the equatorial region. Separately, the choroidal detachment here is mostly hemispherical or lobulated, and the anterior equator is a flat flat bulge. When the bulge is very high, the choroidal ridges on both sides can contact each other (kissing choroidls) and affect the observation of the back of the eye.

Choroidal detachment examination

1. Scleral transillumination can distinguish the suprachoroidal cavity from exudate or blood.

2. The role of B-ultrasound in the diagnosis of choroidal detachment is particularly prominent. It can not only clearly identify the site of detachment, but also distinguish the exudative detachment or hemorrhagic detachment according to the low density or high density of the suprachoroidal space. It can also show the presence or absence of intraocular occupancy and retinal detachment.

3. Fundus fluorescein angiography (FFA) examination helps identify choroidal melanoma and choroidal detachment.

4. ICG can identify retinal pigment epithelial hemorrhage and choroidal detachment.

5. Imaging examination UBM, CT and MRI are helpful in the diagnosis and differential diagnosis of choroidal detachment.

Need to pay attention to the identification of the disease: retinal detachment, retinal cleft palate and scleral bulge caused by extra-scleral compression, post-traumatic low intraocular pressure cases need to do a corner or ultrasound biomicroscopy to exclude ciliary body corner leakage (cyclodialysis Cleft).

Diagnosis and diagnosis of choroidal detachment

diagnosis

Diagnosis can usually be made based on medical history and fundus.

Differential diagnosis

1. Bulbous retinal detachment is a multiple posterior pole serous retinal pigment epithelial detachment, also associated with non-porous retinal detachment, also known as multiple posterior pigment epitheliopathy (multifocal posterior pigment epitheliopathy) , MPPE), its prodromal period is often repetitive, central serous chorioretinopathy, sudden onset, round yellow-white pigment epithelial detachment in the posterior pole, followed by non-porous retinal detachment, much like uveal leakage However, the latter often has choroidal detachment in the peripheral part, which can be distinguished according to fundus fluorescein angiography and the presence or absence of eutrophic disease.

2. In some cases of posterior scleritis, annular ciliary choroidal detachment and exudative retinal detachment may occur, and subretinal fluid also moves with body position, but posterior scleritis often has eye pain, eye movement pain, red eyes, and severe There are diplopia, eye movement disorders, and even eyeballs. Patients with rheumatoid arthritis may also be associated with anterior scleritis. Ultrasound examination may reveal posterior choroidal detachment, scleral thickening, and post-balloon edema. Hormone therapy is effective.

3. Porous retinal detachment with choroidal detachment This is due to low intraocular pressure or vitreous to subretinal stimulation caused by ciliary choroidal detachment, often accompanied by uveitis, eye pain conjunctival hyperemia, very low intraocular pressure.

4. Harada disease has oozing plaque on the fundus, accompanied by retinal detachment, but the detachment does not move with the body position, there is obvious inflammation in the anterior and posterior segments, corticosteroid treatment is effective, inflammation subsides, retinal detachment is reset.

5. Choroidal tumors can be distinguished according to ultrasound, fluorescein angiography, and normal or high intraocular pressure.

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