Efficacy of combined vitreous surgery and choroidal suture fixation on choroidal avulsion

Purpose:To evaluate the feasibility and efficacy of combined vitreous surgery and choroidal suture fixation on choroidal avulsion.Methods:A total of 21 patients (21 eyes) with choroidal avulsion,secondary to open eye trauma and a history of onestage eyeball wall closure were retrospectively evaluated in the present study.Preoperative findings included 3 to 7.5 mmHg (averagely 5.1±1.1mmHg) of intraocular pressure and presence/suspicion of visual light perception.Vitreo-retinal surgery in combination with choroidal suture fixation was conducted for these patients at 4 to 21 days (averagely 9.41±2.7 days) after the trauma.The postoperative follow-up lasted for 3 to 9 months (averagely 5.5±1.5 months).Results:The intraoperative findings indicated several choroid residuals with different densities attached on the sclera at the choroidal detachment area.Retinal proliferation/detachment,incarceration and/or partial retinal loss were also observed.Intraoperatively,the retina was separated and released,and the suture fixation outside the sclera in combination with intraocular photocoagulation and silicone oil filling were performed at the avulsed choroidal area.The suture fixation on the ciliary body was also introduced in some of the patients.At one month posteoperatively,a complete choroidal reattachment was achieved in 16 eyes (16/21,76.19％) and partial reattachment in the remaining 5 eyes. At the end of follow-up,partial choroidal redetachment was observed in 4 of 16 eyes(25％ ),resulting in complete reattachment in 12 eyes (12/21,57.1％) and partial reattachment in 9 eyes (9/21,33.34％).The complete choroidal reattachment rate at the end of follow-up was not significantly different from that observed at one month after the surgery (Chi-square test,P＜0.05),while the complete retinal reattachment rate at this time point was significantly lower than that at one month postoperatively ( Chi-square test,P＞0.05).Conclusion:Transscleral suture fixation serves as a reliable technique,particularly improving the choroidal reattachment rate in the choroidal avulsion.