OSLI Retina

August 2019

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August 2019 ยท Vol. 50, No. 8 529 Laura L. Snyder, MD, and Shriji N. Patel, MD, very nicely and concisely demonstrate and dis- cuss the use of a guarded-needle technique to drain persistent serous choroidal detachments. Highlighted in the surgical video are several key features to the success of this proce- dure. First, they illustrate the ap- propriate type of patient who benefits from surgical inter- vention: one with a symptom- atic and persistent choroidal detachment despite medical management. They very el- egantly demonstrate the tech- nique to guard the needle to guard against over-penetration into the choroi- dal space, along with the need to attempt drain- age in the area of greatest choroidal detachment (which is typically temporal). Placing illumi- nation in the vitreous cavity while taking care to avoid iatrogenic injury to the elevated retina allows the surgeon to visualize the drainage in "real time" to monitor progress of the resolution of the choroidal detachment. Utilizing aspiration creates a "closed loop" system where the sur- geon always maintains control over the drainage process. Finally, the use of the guarded-needle technique reduces conjunctival manipulation, thus giving a better chance at preserving the fil- tering bleb. In summary, this video is a concise guide and reference to the important steps in performing guarded needle drainage of a serous choroidal detachment. It is a useful technique that is less invasive in many ways when compared to the traditional scleral cutdown procedure. I sincere- ly appreciate the authors mentioning our con- tributions to the development of this procedure. John W. Kitchens, MD Retina Associates of Kentucky Lexington, KY John W. Kitchens, MD External Choroidal Drainage Using Direct Visualization Laura L. Snyder, MD; Shriji N. Patel, MD ABSTRACT: A woman in her 60s with a functional glaucoma tube shunt presented after vitrectomy for epiretinal membrane peeling with symptomatic choroidal effu- sions not responsive to medical therapy. She underwent a mini- mally invasive, transconjunctival choroidal drainage procedure, which was directly visualized un- der a widefield viewing system to prevent intraocular hemorrhage or retinal penetration of the needle. This allowed for preservation of her conjunctiva, restoration of normal intraocular pressure by temporary blockage of her tube shunt with a viscoelastic, and res- olution of her choroidal effusions. A pseudophakic woman in her 60s with a his- tory of severe glaucoma in the left eye man- aged with a tube shunt presented 2 weeks after vitrectomy for epiretinal membrane peeling with symptomatic choroidal effusions that were not responsive to medical therapy. Her visual acuity was 20/50, and she complained of an enlarging shad- owed area in her peripheral vision. Her intraocular pressure (IOP) was 4 mm Hg by applanation. After extensive discussion, the patient elected to undergo drainage of the choroidal effusions. We performed this procedure under direct visualization using a technique that was described previously. 1 Our surgi- cal goals included normalizing IOP and draining the effusions while minimizing conjunctival disruption in the event that additional glaucoma surgery may be needed in the future. After the patient was placed under monitored an- esthesia care with a peribulbar block, a paracentesis Laura L. Snyder Shriji N. Patel The Cutting Edge Surgical video section with expert commentary

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