Published online Dec 6, 2018. doi: 10.12998/wjcc.v6.i15.1059
Peer-review started: July 12, 2018
First decision: October 11, 2018
Revised: November 21, 2018
Accepted: November 23, 2018
Article in press: November 24, 2018
Published online: December 6, 2018
Processing time: 148 Days and 8 Hours
Suprachoroidal hemorrhage (SCH) is a rare but potentially catastrophic ocular event. Surgery for SCH is often challenging because of the difficulty in resolving the retinal and choroidal detachment. Here, we describe a novel surgical technique in which urokinase is administered by sub-Tenon’s injection to target an organized clot in SCH prior to drainage.
A consecutive case series of four eyes with serous and hemorrhagic choroidal detachments secondary to cataract surgery or trauma was documented to evaluate the feasibility of using a sub-Tenon’s urokinase injection-assisted 23-gauge and 20-gauge incision to drain choroidal detachments. Urokinase (2000 IU) was given by sub-Tenon’s injection one day before surgery for clot liquefaction. A 23-gauge infusion line was placed in the anterior chamber. A 20-gauge incision was created in the suprachoroidal space 3.5 mm from the limbus. After drainage, pars plana vitrectomy was performed because of concomitant pathology that demanded this additional procedure. Visual acuity, ocular findings, the timing of surgical interventions, surgical procedures, and outcomes were retrospectively reviewed in four patients. Postoperative follow-up of the patients ranged from 6 to 24 mo (mean, 13 mo). After the treatment, all patients achieved excellent anatomical recovery.
Sub-Tenon’s urokinase injection-assisted vitrectomy makes clot liquefaction happen in the early treatment stage, resulting in marked stability during the procedure.
Core tip: We report a consecutive case series of four eyes with serous and hemorrhagic choroidal detachments secondary to cataract surgery or trauma to evaluate the feasibility of using a sub-Tenon’s urokinase injection-assisted 23-gauge and 20-gauge incision to drain choroidal detachments. The primary advantage of this technique is that it makes clot liquefaction happen in the early treatment stage and allows a slower and semiautomated controlled mechanism to be achieved, resulting in marked stability during the procedure.