Efficacy of Combined Vitreous Surgery and Choroidal Suture Fixation on Choroidal Avulsion

Jin Ma， Yuhua Tong， Zhaomeng Shen，Panpan Ye

Eye Center， the Second Affiliated Hospital， Zhejiang University， Hangzhou 310009， China

Patients and methods

Patients'information

Surgical procedure

Figure 1 Operation diagram：．choroidal avulsion was sutured via sclera，．and choroidal reattachment was achieved．

Results

Postoperative retinal and choroidal reduction status

Before suture：after heavy water was injected，nasal choroidal reattachment was achieved，but ciliary body，choroidal avulsion in two quadrants were still rigid， and no reattachment was noted．

Figure 2 Surgery procedure：．choroidal avulsion suture fixation in temporalquadrant；．choroidalavulsion suture fixation in superior temporal quadrant

Figure 3 Comparison on retinal and choroidal reattachment 1-month postoperatively and during the final follow up．The complete reattachment rate of retina and choroid declined as time proceeded， and partially presented a trend of aggravated detachment．No significant difference was noted regarding the complete reattachment rate of choroid between 1-month postoperatively and the final follow up （Fourfold table chi-square test， P＞0．05）．The complete retinal reattachment rate during final follow up was significantly lower compared with that 1-month postoperatively， with statistical significance （Fourfold table chi-square test，P＜0．05）（Abbr．WCA-complete choroidal reattachment； PCA-partial choroidal reattachment； WRA-complete retinal reattachment； PRA-partial retinal reattachment）．

Postoperative intraocular pressure distribution

Visual acuity evaluation at 1 week postoperatively

Figure 4 Changes in IOP before and after operation．Significant differences were noted before and after surgery regarding IOP level using multiple comparison （P＜0．05）．LSD test and ANOVA showed that IOP increased postoperatively．Evident IOP variations were observed as time proceeded．Note：1 represents prior to operation，2 represents 1 day after operation， 3 represents 1-month postoperatively， 4 represents the late stage of follow up．

Figure 5 A supplementary case report．A．B-mode ultrasound examination preoperatively．The patient had steel penetrating injury， causing eye rupture in more than two quadrants， had a suture history 5 days prior to surgery．Before surgery： 5．6 mmHg IOP；B-mode ultrasound showed full choroidal avulsion，and straight and stretched band echo was observed toward anterior segment．B．The surgery was performed 4 days after injury．B-mode ultrasound revealed normal eye wall and full choroidal reattachment．C．Fundus image 3-month after operation．

Discussion