Stepwise Approach to Surgical Management of Hemorrhagic Choroidal Detachments

The established scleral cut-down approach to draining hemorrhagic choroidal detachments is effective but invasive involving large conjunctival cutdown, manipulation of the rectus muscle and elevated risk of hypotony, perforation or retinal damage. This video demonstrates a stepwise surgical approach to draining choroidal detachments. The first step involves drainage via a transconjunctival trocar cannula. In the second step, drainage is enhanced by removal of the trocar to expose the sclerotomy. Drainage is further enhanced in the third step by the creation of a focal peritomy around the prior sclerotomy and enlargement of the prior sclerotomy into a radial sclerotomy. Progression between steps only occurs if prior steps did not provide adequate drainage. This approach minimizes incision size, which reduces tissue disruption and damage compared to the traditional scleral cut-down approach.