Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2018; 6(15): 1059-1066
Published online Dec 6, 2018. doi: 10.12998/wjcc.v6.i15.1059
Sub-Tenon’s urokinase injection-assisted vitrectomy in early treatment of suprachoroidal hemorrhage: Four cases report
Fang Chai, Hua Ai, Jin Deng, Xi-Quan Zhao
Fang Chai, Hua Ai, Jin Deng, Xi-Quan Zhao, Xi’an No. 4 Hospital, Shaanxi Ophthalmic Medical Center, Affiliated Guangren Hospital, School of Medicine, Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Author contributions: Zhao XQ and Chai F designed the study; Zhao XQ, Chai F, and Ai H performed the experiments; Deng J performed statistical analyses; Chai F wrote the manuscript; Zhao XQ revised the manuscript; all authors read and approved the final manuscript.
Supported by the Project of Science and Technology of Social Development Fund of Shaanxi Province, No. 2016SF-100 and No. 2016SF-133; and Xi’an No. 4 Hospital Research Incubation Fund, No. 2018LH-2.
Informed consent statement: Consent was obtained from relatives of the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xi-Quan Zhao, MD, Chief Doctor, Director, Xi’an No. 4 Hospital, Shaanxi Ophthalmic Medical Center, Affiliated Guangren Hospital, School of Medicine, Xi’an Jiaotong University, 21 Jiefang Road, Xi’an 710004, Shaanxi Province, China. zhaoxiquan1972@163.com
Telephone: +86-29-87480848 Fax: +86-29-87480858
Received: July 11, 2018
Peer-review started: July 12, 2018
First decision: October 11, 2018
Revised: November 21, 2018
Accepted: November 23, 2018
Article in press: November 24, 2018
Published online: December 6, 2018
Abstract
BACKGROUND

Suprachoroidal hemorrhage (SCH) is a rare but potentially catastrophic ocular event. Surgery for SCH is often challenging because of the difficulty in resolving the retinal and choroidal detachment. Here, we describe a novel surgical technique in which urokinase is administered by sub-Tenon’s injection to target an organized clot in SCH prior to drainage.

CASE SUMMARY

A consecutive case series of four eyes with serous and hemorrhagic choroidal detachments secondary to cataract surgery or trauma was documented to evaluate the feasibility of using a sub-Tenon’s urokinase injection-assisted 23-gauge and 20-gauge incision to drain choroidal detachments. Urokinase (2000 IU) was given by sub-Tenon’s injection one day before surgery for clot liquefaction. A 23-gauge infusion line was placed in the anterior chamber. A 20-gauge incision was created in the suprachoroidal space 3.5 mm from the limbus. After drainage, pars plana vitrectomy was performed because of concomitant pathology that demanded this additional procedure. Visual acuity, ocular findings, the timing of surgical interventions, surgical procedures, and outcomes were retrospectively reviewed in four patients. Postoperative follow-up of the patients ranged from 6 to 24 mo (mean, 13 mo). After the treatment, all patients achieved excellent anatomical recovery.

CONCLUSION

Sub-Tenon’s urokinase injection-assisted vitrectomy makes clot liquefaction happen in the early treatment stage, resulting in marked stability during the procedure.

Keywords: Urokinase, Suprachoroidal hemorrhage, Choroidal detachments, Vitrectomy, Case report

Core tip: We report a consecutive case series of four eyes with serous and hemorrhagic choroidal detachments secondary to cataract surgery or trauma to evaluate the feasibility of using a sub-Tenon’s urokinase injection-assisted 23-gauge and 20-gauge incision to drain choroidal detachments. The primary advantage of this technique is that it makes clot liquefaction happen in the early treatment stage and allows a slower and semiautomated controlled mechanism to be achieved, resulting in marked stability during the procedure.