What causes choroidal and retinal detachment from Sturge-Weber syndrome (SWS) glaucoma surgery and how are they treated?

Updated: Dec 26, 2018
  • Author: Masanori Takeoka, MD; Chief Editor: George I Jallo, MD  more...
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Answer

During surgery, when the eye is opened and the IOP falls, rapid transudation of fluid from the intravascular to the extravascular space results. The extravasation of fluid can be massive enough to instantly cause choroidal detachment and, later, serous retinal detachment. Although the mechanism is probably similar to that for the more commonly seen benign postoperative choroidal detachment, the degree and the speed of fluid extravasation during surgery make this entity more serious.

This intraoperative event can mimic an expulsive suprachoroidal hemorrhage because of rapid fluid accumulation after the commencement of surgery. It differs, however, because, if the suprachoroidal space is evacuated, clear, copious amounts of yellow fluid are found and the eye can be decompressed transiently.

It seems that once the intraoperative effusion is treated with immediate drainage, the postoperative prognosis becomes excellent despite the persistence of some degree of choroidal and serous retinal detachment. Smaller, postoperative serous choroidal detachment is another possible complication in SWS.

Serous retinal detachment often occurs in association with choroidal effusion and hypotony. A choroidal effusion may temporarily interfere with the metabolic transport systems of the retinal pigment epithelium. These serous retinal detachments usually resolve spontaneously as the IOP normalizes.


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