Drainage of Choroidal Effusions

Abstract

The suprachoroidal space is a potential space between the choroid and sclera in which fluid can accumulate resulting in a choroidal effusion. The most common type is serous, thought to be due to a decrease in intraocular pressure that creates a pressure differential across the choroidal capillary membrane with inflammation augmenting this process. Choroidal effusions may be asymptomatic, or may present with decreased vision. They appear as bullous detachments separated into quadrants. Funduscopy and ultrasonography can assist in diagnosis. Persistent large choroidal effusions can result in complications from a flat anterior chamber and can develop into the potentially devastating hemorrhagic type. Suprachoroidal effusions are usually self-limited and resolve with supportive treatment. Cycloplegia relaxes an anteriorly rotated ciliary body to deepen a shallow anterior chamber. Inflammation is treated with corticosteroids and the source of hypotony is identified and corrected. Surgical drainage is undertaken urgently for effusions with a flat anterior chamber and electively for effusions causing a significant reduction in vision. A circumferential conjunctival incision is placed approximately 4 mm from the limbus in the desired inferior quadrant. A radially directed sclerotomy is created approximately 4–7 mm posterior to the limbus. Xanthochromic fluid should flow from the incision with flattening of the effusions as the anterior chamber is reinflated through a corneal paracentesis site. Surgical drainage of choroidal effusions is an acceptable treatment option with good outcomes when indicated.