Role of choroidal drainage in therapeutic keratoplasty

To discuss the role of choroidal drainage in the management of positive vitreous pressure during therapeutic keratoplasty for patients with perforated corneal ulcers.

Over a 2-year period, 8 of 36 (22%) consecutive patients with therapeutic grafts presented with a shallow anterior chamber during or immediately after surgery. These patients underwent choroidal drainage for formation of the anterior chamber. In 5 of them choroidal drainage was done intraoperatively when there was significant positive vitreous pressure and the anterior chamber could not be formed. Three patients had drainage within a week postoperatively for persistent shallow anterior chamber when ultrasonogram showed choroidal detachment.

Of the eight cases, seven drained fluid and the chamber could be reformed well. One was a dry tap and the chamber did not reform completely.

Choroidal detachment (CD) is a previously unpublished cause for positive vitreous pressure in therapeutic keratoplasty for perforated corneal ulcers. In these situations suprachoroidal drainage can be considered as an option for the reformation of the anterior chamber. We recommend that a preoperative B-scan ultrasound be included in the workup of all corneal perforations and that intraoperative drainage of the fluid is considered in cases with significant positive vitreous pressure and confirmed CD.