A Novel Surgical Strategy for Choroidal Avulsion in Complex Ocular Trauma: Choroidal Suturing Technique Using 9-0 Double-Armed Polypropylene Sutures.

PURPOSE: To describe a novel choroidal refixation technique using 9-0 double-armed polypropylene sutures combined with vitreoretinal surgery for severe ocular trauma complicated by choroidal avulsion, and to evaluate its anatomical and functional outcomes.

METHODS

This retrospective case series included eight consecutive patients with severe zone III open-globe injuries complicated by choroidal avulsion who were treated at the Ocular Trauma Center of the Eye and ENT Hospital of Fudan University between January and July 2025. All patients underwent vitreoretinal surgery within two weeks after primary globe repair. Choroidal avulsion was confirmed intraoperatively, and refixation was performed using 9-0 double-armed polypropylene sutures. Demographic characteristics, injury features, surgical details, and follow-up outcomes were reviewed. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), axial length, and globe survival were evaluated.

RESULTS

All eight cases involved open-globe injuries, including three eyes with 360° choroidal avulsion. The mean age was 52.87 ± 17.81 years, and 88.5% of patients were male. The baseline BCVA was 2.93 ± 0.21 logMAR, and the mean Ocular Trauma Score was 27.25 ± 3.53, indicating severe ocular injury. After a mean follow-up of 7.37 ± 1.51 months, the mean BCVA demonstrated a mild improvement, reaching 2.46 ± 0.74 logMAR. Mean IOP showed a mild increase from 9.56 ± 4.63 mmHg preoperatively to 11.48 ± 6.19 mmHg at final follow-up, while axial length remained stable Globe preservation was achieved in all cases, with no progression to phthisis bulbi. Four eyes underwent silicone oil tamponade, while the remaining four received implantation of a foldable capsular vitreous body.

CONCLUSION

This novel choroidal refixation technique 9-0 double-armed polypropylene sutures appears to be a feasible surgical approach for severe ocular trauma with choroidal avulsion, enabling successful globe preservation in eyes with a poor initial prognosis.