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      Immediate Choroidal Expansion after Bleb Needling

      case-report

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          Abstract

          The purpose was to report a case of immediate choroidal expansion after a needling procedure. This is a retrospective case report of an 80-year-old male with pseudoexfoliative glaucoma who underwent Xen 45 Gel stent implantation and then trabeculectomy in the right eye. During follow-up, several bleb needling procedures were required to treat bleb fibrosis. Before and after the last bleb needling, spectral-domain optical coherence tomography (SD-OCT) was performed to investigate choroidal changes. SD-OCT was also repeated 1 week later. SD-OCT showed instant choroidal expansion (both in the macular and peripapillary area) that was quite sustained throughout the 1 week-follow-up and after 5 months. Bleb needling can cause immediate choroidal expansion that can be quite sustained throughout several months of follow-up. SD-OCT is essential for detecting choroidal changes.

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          The multifunctional choroid.

          Debora Nickla, Josh Wallman (2010)
          The choroid of the eye is primarily a vascular structure supplying the outer retina. It has several unusual features: It contains large membrane-lined lacunae, which, at least in birds, function as part of the lymphatic drainage of the eye and which can change their volume dramatically, thereby changing the thickness of the choroid as much as four-fold over a few days (much less in primates). It contains non-vascular smooth muscle cells, especially behind the fovea, the contraction of which may thin the choroid, thereby opposing the thickening caused by expansion of the lacunae. It has intrinsic choroidal neurons, also mostly behind the central retina, which may control these muscles and may modulate choroidal blood flow as well. These neurons receive sympathetic, parasympathetic and nitrergic innervation. The choroid has several functions: Its vasculature is the major supply for the outer retina; impairment of the flow of oxygen from choroid to retina may cause Age-Related Macular Degeneration. The choroidal blood flow, which is as great as in any other organ, may also cool and warm the retina. In addition to its vascular functions, the choroid contains secretory cells, probably involved in modulation of vascularization and in growth of the sclera. Finally, the dramatic changes in choroidal thickness move the retina forward and back, bringing the photoreceptors into the plane of focus, a function demonstrated by the thinning of the choroid that occurs when the focal plane is moved back by the wearing of negative lenses, and, conversely, by the thickening that occurs when positive lenses are worn. In addition to focusing the eye, more slowly than accommodation and more quickly than emmetropization, we argue that the choroidal thickness changes also are correlated with changes in the growth of the sclera, and hence of the eye. Because transient increases in choroidal thickness are followed by a prolonged decrease in synthesis of extracellular matrix molecules and a slowing of ocular elongation, and attempts to decouple the choroidal and scleral changes have largely failed, it seems that the thickening of the choroid may be mechanistically linked to the scleral synthesis of macromolecules, and thus may play an important role in the homeostatic control of eye growth, and, consequently, in the etiology of myopia and hyperopia. Copyright 2009 Elsevier Ltd. All rights reserved.
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            The advanced glaucoma intervention study (AGIS): 7. the relationship between control of intraocular pressure and visual field deterioration

            (2000)
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              Visual field progression in the Collaborative Initial Glaucoma Treatment Study the impact of treatment and other baseline factors.

              David Musch, Brenda W. Gillespie, Paul Lichter … (2009)
              To evaluate factors associated with visual field (VF) progression, using all available follow-up through 9 years after treatment initiation, in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Longitudinal follow-up of participants enrolled in a randomized clinical trial. Six hundred seven newly diagnosed glaucoma patients. In a randomized clinical trial, 607 subjects with newly diagnosed open-angle glaucoma initially were treated with either medication or trabeculectomy. After treatment initiation and early follow-up, subjects were evaluated clinically at 6-month intervals. Study participants in both arms of the CIGTS were treated aggressively in an effort to reduce intraocular pressure (IOP) to a level at or below a predetermined, eye-specific target pressure. Visual field progression was analyzed using repeated measures models. Visual field progression, measured by Humphrey 24-2 full-threshold testing and assessed by the change in the mean deviation (MD), and an indicator of substantial worsening of the VF (MD decrease of > or =3 dB from baseline), assessed at each follow-up visit. Follow-up indicated minimal change from baseline in each initial treatment group's average MD. However, at the 8-year follow-up examination, substantial worsening (> or =3 dB) of MD from baseline was found in 21.3% and 25.5% of the initial surgery and initial medicine groups, respectively. The effect of initial treatment on subsequent VF loss was modified by time (P<0.0001), baseline MD (P = 0.03), and diabetes (P = 0.01). Initial surgery led to less VF progression than initial medicine in subjects with advanced VF loss at baseline, whereas subjects with diabetes had more VF loss over time if treated initially with surgery. The CIGTS intervention protocol led to a lowering of IOP that persisted over time in both treatment groups. Progression in VF loss was seen in a subset, increasing to more than 20% of the subjects. The findings regarding initial surgery being beneficial for subjects with more advanced VF loss at presentation, but detrimental for patients with diabetes, are noteworthy and warrant independent confirmation. The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Ophthalmol
                Journal ID (iso-abbrev): Case Rep Ophthalmol
                Journal ID (publisher-id): COP
                Title: Case Reports in Ophthalmology
                Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                ISSN (Electronic): 1663-2699
                Publication date Collection: Sep-Dec 2020
                Publication date (Electronic): 16 December 2020
                Publication date PMC-release: 16 December 2020
                Volume: 11
                Issue: 3
                Pages: 658-667
                Affiliations
                [1] aClinica Oculistica, DiNOGMI, University of Genoa, Genoa, Italy
                [2] bIRCCS Ospedale Policlinico San Martino, Genoa, Italy
                Author notes
                *Michele Iester, University Eye Clinic, Viale Benedetto XV, 7, IT–16132 Genoa (Italy), iester@ 123456unige.it
                Article
                Publisher ID: cop-0011-0658
                DOI: 10.1159/000508253
                PMC ID: 7841747
                SO-VID: 61f5a627-1342-48e7-8ffb-3624e6e8bdcc
                Copyright © Copyright © 2020 by S. Karger AG, Basel
                License:

                This article is licensed under the Creative Commons Attribution-NonCommercial-4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                History
                Date received : 6 March 2020
                Date accepted : 19 April 2020
                Date: 2020
                Page count
                Figures: 3, Tables: 1, References: 23, Pages: 10
                Categories
                Subject: Case Report

                Keywords: choroidal expansion,bleb needling,spectral-domain optical coherence tomography
                Data availability:
                Keywords: choroidal expansion, bleb needling, spectral-domain optical coherence tomography

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