"Caution with choroidals" - choose the right one at right time.

Area of Science:

• Ophthalmology
• Surgical Techniques
• Retinal Surgery

Background:

• Choroidal detachment (CD) can complicate rhegmatogenous retinal detachment (RRD) repair.
• Pre-existing or intraoperative CDs negatively impact surgical outcomes and visual prognosis.

Purpose of the Study:

• To present video-guided surgical approaches for managing pre-existing and sudden intraoperative CDs during RRD repair.
• To educate surgeons on specific techniques for these challenging scenarios.

Main Methods:

• Video demonstration of specific surgical maneuvers.
• Description of cannula-guided choroidal drainage for pre-existing CDs.
• Management strategies for sudden intraoperative CDs, including hypotony and air entry complications.

Main Results:

• Cannula-guided drainage effectively reduces the severity of pre-existing CDs.
• Sudden intraoperative CDs can arise from hypotony or accidental suprachoroidal air entry.
• Accidental air entry can lead to life-threatening Venous Air Embolism (VAE), termed PRESUMED AIR BY VITRECTOMY EMBOLISATION (PAVE).

Conclusions:

• Cannula-guided drainage is essential for managing significant pre-existing CDs in RRD repair.
• Prompt recognition and management of sudden intraoperative CDs, especially those involving air, are crucial for patient safety.
• Specific techniques are presented to prevent PAVE during minimally invasive vitrectomy surgery (MIVS).