Role of choroidal drainage in therapeutic keratoplasty.
OBJECTIVE
To discuss the role of choroidal drainage in the management of positive vitreous pressure during therapeutic keratoplasty for patients with perforated corneal ulcers.


METHODS
Over a 2-year period, 8 of 36 (22%) consecutive patients with therapeutic grafts presented with a shallow anterior chamber during or immediately after surgery. These patients underwent choroidal drainage for formation of the anterior chamber. In 5 of them choroidal drainage was done intraoperatively when there was significant positive vitreous pressure and the anterior chamber could not be formed. Three patients had drainage within a week postoperatively for persistent shallow anterior chamber when ultrasonogram showed choroidal detachment.


RESULTS
Of the eight cases, seven drained fluid and the chamber could be reformed well. One was a dry tap and the chamber did not reform completely.


CONCLUSIONS
Choroidal detachment (CD) is a previously unpublished cause for positive vitreous pressure in therapeutic keratoplasty for perforated corneal ulcers. In these situations suprachoroidal drainage can be considered as an option for the reformation of the anterior chamber. We recommend that a preoperative B-scan ultrasound be included in the workup of all corneal perforations and that intraoperative drainage of the fluid is considered in cases with significant positive vitreous pressure and confirmed CD.
Maharajan
V Senthil
VS
Division of Ophthalmology and Visual Sciences, University of Nottingham, UK.
Dua
Harminder S
HS
Maharajan
Prema
P
Kuriakose
Thomas
T
Joseph
Annie
A
D000867:Anterior Chamber / Q000473:pathology; D015862:Choroid Diseases / Q000601:surgery*; D003320:Corneal Ulcer / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D005122:Exudates and Transudates; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000379:methods*; D011312:Pressure; D012422:Rupture, Spontaneous; D014822:Vitreous Body