Optical coherence tomography in the verification of choroidal detachment diagnosis

PURPOSE. To identify signs of choroidal detachment (CD) in the late postoperative period using optical coherence tomography (OCT).

METHODS. Patient L. was admitted with the diagnosis «advanced open-angle glaucoma with elevated intraocular pressure, complicated cataract, and epiretinal fibrosis OD. Anophthalmos on the left». Visual acuity in the right eye was 0.5 sc; IOP (P₀) was 30 mm Hg. The patient underwent sinus trabeculectomy with implantation of a Repergel A1 drainage device and prophylactic posterior scleral trephination in the right eye. A hyphema occupying approximately onehalf of the anterior chamber volume was observed during the first postoperative week. Subsequently, hyphema washout was performed, followed by phacoemulsification with intraocular lens implantation.

RESULTS. Four months after surgery, the patient presented with decreased vision in the right eye (visual acuity 0.2 sph +1.5 = 0.3); P₀ 7 mm Hg. OCT of the retinal periphery revealed flat CD with a height of 390 µm, accompanied by folds of the retinal pigment epithelium and neuroepithelium at the base of the detachment. OCT of the macular region showed deformation of the macular interface, cystoid spaces, folding of the pigment epithelium and neuroepithelium, and localized neurosensory detachment. Three days later, posterior scleral trephination was performed. One week postoperatively, OCT of the retinal periphery demonstrated complete reattachment of the choroid. Persistent macular edema was an indication for intravitreal implantation of dexamethasone 0.7 mg implant. Two weeks after the treatment, visual acuity improved to 0.7 sc, and IOP increased to 16 mm Hg.

CONCLUSION. OCT enables identification of signs of flat CD and its complications. OCT of the retinal periphery visualizes a slit-like cavity of ciliochoroidal detachment with hyporeflective content, allows measurement of detachment height, and facilitates dynamic monitoring of choroidal effusion resorption and treatment outcomes. OCT of the macular region reveals secondary signs of hypotony-related CD, including folds of the retinal pigment epithelium and neuroepithelium, neurosensory detachment, and cystoid macular edema.

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