RESUMEN
Suprachoroidal hemorrhage (SCH) is a rare and sight-threatening complication of various intraocular surgeries, including cataract surgery. Although the rate of SCH complicating cataract surgery has decreased in the era of phacoemulsification, most likely due to smaller self-sealing incisions and modern equipment, it remains a challenging complication to manage. The aim of this review is to summarize the current evidence of the pathophysiology and management of SCH complicating phaco surgery. A literature review was performed using the PubMed database searching for diagnosis, therapy, and management of SCH during phacoemulsification. The evidence available on the optimal management of this condition is low, and there is no consensus so far. An early diagnosis is thought to be essential to avoid progression to the devastating stage of expulsion of intraocular contents (expulsive hemorrhage). Sudden intraoperative anterior chamber shallowing, red reflex loss, and a significant increase in intraocular pressure are highly suspicious for this severe complication. A fundus examination and ocular ultrasound are crucial to confirm the diagnosis and, if it is confirmed, stabilize the globe immediately. The initial therapeutic approach includes aggressive topical and systemic medication focused on controlling ocular inflammation and intraocular pressure, whereas the timing and the indications of surgical intervention remain controversial.
Asunto(s)
Extracción de Catarata , Catarata , Hemorragia de la Coroides , Facoemulsificación , Humanos , Facoemulsificación/efectos adversos , Hemorragia de la Coroides/etiología , Hemorragia de la Coroides/terapia , Presión IntraocularRESUMEN
Objetivo: Publicar las características clínicas de la coriorretinopatía exudativa hemorrágica periférica (CEHP) en la población española. Métodos: Estudio retrospectivo y análisis de los resultados en pacientes con diagnóstico de CEHP. Fueron recogidas las características clínicas, por OCT, el tratamiento utilizado y la evolución posterior al tratamiento. Resultados: Se evaluaron 39 ojos de 23 pacientes con CEHP. La edad promedio al diagnóstico fue de 79 años (66-94 años). El síntoma ocular principal fue la disminución de visión en 26 ojos (66,6%), siendo 11 ojos (28,2%) asintomáticos. El diagnóstico de referencia más frecuente fue sangrado/exudación en 24 ojos (61,5%), le siguió melanoma coroideo con 9 (23,1%). Las hemorragias intra o subretinianas fueron el tipo de lesión periférica más frecuentemente encontrado, en 24 ojos (61,5%). Veinticinco ojos (58,9%) recibieron algún tipo de tratamiento: A 15 ojos (60%) se les realizó inyección intravítrea (IIV) de antioangiogénicos (anti-VEGF); se realizó fotocoagulación con láser en 2 casos (8%), terapia fotodinámica en 2 casos (8%) y 6 casos (18,2%) precisaron vitrectomía vía pars plana (VPP) por hemorragia vítrea. No hubo cambios en la agudeza visual (AV) en los pacientes seguidos con observación entre el inicio 0,66±0,80 (0,04-2,82) y el fin de seguimiento 0,75±0,96 (0,00-2,82) (p=0,352), ni para los que recibieron algún tipo de tratamiento entre inicio 0,78±0,79 (0,04-2,30) y fin 1,22±1,01 (0,04-2,82) (p=0,157), posiblemente debido al gran componente de degeneración macular asociada con la edad (DMAE) atrófica o exudativa presente en ambos grupos (29 ojos presentaron DMAE atrófica o exudativa). Conclusiones: La CEHP es una enfermedad poco frecuente, asociada frecuentemente con DMAE, que se presenta típicamente como una masa periférica que se confunde frecuentemente con melanoma...(AU)
Objective: To publish the clinical characteristics of peripheral exudative hemorrhagic chorioretinopathy (PHEC) in the Spanish population. Methods: Retrospective study and analysis of results in patients diagnosed with PHEC. The clinical characteristics, by OCT, the treatment used and the evolution after treatment were collected. Results: 39 eyes of 23 patients with PHEC were evaluated. The average age at diagnosis was 79 years (66-94 years). The main ocular symptom was low vision in 26 eyes (66.6%); only 11 eyes (28.2%) were asymptomatic. The most frequent referred diagnosis was bleeding/exudation in 24 eyes (61.5%), followed by choroidal melanoma in 9 (23.1%). Intra or subretinal hemorrhages were the type of peripheral lesion most frequently found, in 24 eyes (61.5%). Twenty-five eyes (58.9%) received some type of treatment: 15 eyes (60%) underwent intravitreal injection (IIV) of antiangiogenic agents (anti-VEGF); Laser photocoagulation was performed in 2 cases (8%), Photodynamic therapy in 2 cases (8%) and 6 cases (18.2%) required pars plana vitrectomy (PPV) due to vitreous hemorrhage. There were no changes in visual acuity (VA) in patients followed with observation between baseline 0.66±0.80 (0.04-2.82) and end of follow-up 0.75±0.96 (0.00-2.82) (P=.352), nor for those who received some type of treatment between the beginning 0.78±0.79 (0.04-2.30) and the end 1.22±1.01 (0.04-2.82) (P=.157), possibly due to the large component of atrophic or exudative age-related macular degeneration (AMD) presented in both groups. (29 eyes presented atrophic or exudative AMD). Conclusions: PHEC is a rare pathology, frequently associated with AMD, which typically presents as a peripheral mass that is frequently confused with choroidal melanoma and other intraocular tumors and hence the importance of learning to identify it, making the correct differential diagnosis and avoid unnecessary treatments. Antiangiogenic therapy is effective in most patients with...(AU)
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Enfermedades de la Retina/diagnóstico por imagen , Hemorragia de la Coroides/diagnóstico por imagen , Hemorragia Retiniana/diagnóstico por imagen , Enfermedades de la Retina/terapia , Hemorragia de la Coroides/terapia , Hemorragia Retiniana/terapia , Estudios Retrospectivos , EspañaRESUMEN
AIMS: To assess the incidence, risk factors and outcomes of management of delayed suprachoroidal haemorrhage (DSCH) in children who had undergone Ahmed glaucoma valve implantation. METHODS: A retrospective case-control study of eyes which developed DSCH in children <18 years of age who underwent surgery between January 2009 and December 2017 with a follow-up of at least 2 months was performed. Nine cases were compared with 27 age, gender and surgeon matched controls who had undergone surgery during this period. RESULTS: The incidence of DSCH was 4.7% (95% CL 1.5% to 7.7%, 9 eyes of 191 children). There were no significant differences between cases and controls in baseline details except for the number of intraocular pressure (IOP) lowering medications (p=0.01) and follow-up period (p=0.001). Risk factors identified on univariate analysis (p≤0.1) were axial length (p=0.02), diagnosis of primary congenital glaucoma (p=0.05), postoperative hypotony (p=0.07) and aphakia (p=0.1). None of them were found to be significant on multivariate analysis. Five eyes, three with retinal apposition and two with retinal detachment, underwent surgical drainage. There were no significant differences in the outcomes of eyes which underwent drainage compared with those which did not. Failures, defined as IOP>18 mm Hg despite use of medications, loss of light perception, phthisis or removal of the implant were more frequent in cases (three eyes, 33.3%) compared with controls (four eyes, 14.8%) (p=0.002). CONCLUSIONS: None of the risk factors analysed in our series proved to be significant. Failures were more common in eyes with choroidal haemorrhage, despite surgical intervention.
Asunto(s)
Hemorragia de la Coroides/etiología , Implantes de Drenaje de Glaucoma/efectos adversos , Glaucoma/cirugía , Hemorragia Posoperatoria/etiología , Implantación de Prótesis/efectos adversos , Adolescente , Estudios de Casos y Controles , Niño , Preescolar , Hemorragia de la Coroides/diagnóstico por imagen , Hemorragia de la Coroides/fisiopatología , Hemorragia de la Coroides/terapia , Femenino , Estudios de Seguimiento , Glaucoma/fisiopatología , Humanos , Lactante , Presión Intraocular , Masculino , Hemorragia Posoperatoria/diagnóstico por imagen , Hemorragia Posoperatoria/fisiopatología , Hemorragia Posoperatoria/terapia , Periodo Posoperatorio , Implantación de Prótesis/métodos , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , UltrasonografíaRESUMEN
A 78-year-old man with angle closure glaucoma and on treatment with oral anticoagulants, underwent phacoemulsification. An early acute suprachoroidal hemorrhage (SCH) occurred and the surgical wound was rapidly sutured without complete soft lens matter removal, nor insertion of intraocular lens. The SCH was managed conservatively and it resolved in 5 weeks; the intraocular pressure was 35 mm Hg despite maximal medical treatment. Secondary soft lens matter removal followed by intraocular lens implantation combined with XEN45 was then performed. After 7 days the patient developed a potentially "kissing" choroidal touch due to significant delayed SCH. This was treated with surgical drainage. Significant suprachoroidal bleeding can occur after minimally invasive glaucoma procedures. Patients on anticoagulant therapy may require careful monitoring while planning glaucoma surgery.
Asunto(s)
Hemorragia de la Coroides/terapia , Implantes de Drenaje de Glaucoma/efectos adversos , Glaucoma de Ángulo Cerrado/cirugía , Anciano , Antibacterianos/uso terapéutico , Antihipertensivos/uso terapéutico , Hemorragia de la Coroides/etiología , Terapia Combinada , Glaucoma de Ángulo Cerrado/fisiopatología , Glucocorticoides/uso terapéutico , Humanos , Presión Intraocular/fisiología , Implantación de Lentes Intraoculares , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos , Facoemulsificación/efectos adversos , Succión , Tonometría Ocular , Agudeza Visual/fisiologíaRESUMEN
New direct oral anticoagulants (DOAC) have been approved for treatment and prevention of some thromboembolic diseases: acute and chronic phase of thromboembolic disease, deep venous thrombosis prophylaxis in orthopedic surgery and prevention of stroke in patients with atrial fibrillation. These molecules are an alternative to heparins and vitamin K antagonists. Among these, rivaroxaban (Xarelto®, Bayer Schering Pharma) is a direct factor Xa inhibitor, and dabigatran etexilate (Pradaxa®, Boehringer Ingelheim) is a direct free thrombin inhibitor. These molecules are almost the ideal anticoagulant: oral administration, few drug and food interactions, wide therapeutic target, and especially no lab monitoring. However, their use remains associated with hemorrhagic complications such as gastrointestinal, intracranial or urinary hemorrhages. We describe two clinical cases of spontaneous choroidal hemorrhage in patients treated with direct oral anticoagulants (rivaroxaban and dabigatran etexilate) for atrial fibrillation. These cases show that an ocular hemorrhagic risk exists with these drugs. Patients treated with DOAC should have the therapeutic dose adjusted based on creatinine clearance. Special monitoring should be performed in patients with age-related macular degeneration or with hypertension even though meta-analysis shows that the risk of intraocular bleeding is reduced by 22% compared with warfarin.
Asunto(s)
Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Hemorragia de la Coroides/inducido químicamente , Administración Oral , Anciano , Anciano de 80 o más Años , Hemorragia de la Coroides/diagnóstico , Hemorragia de la Coroides/epidemiología , Hemorragia de la Coroides/terapia , Dabigatrán/administración & dosificación , Dabigatrán/efectos adversos , Drogas en Investigación/administración & dosificación , Drogas en Investigación/efectos adversos , Femenino , Humanos , Rivaroxabán/administración & dosificación , Rivaroxabán/efectos adversosRESUMEN
We present cases of blinding spontaneous suprachoroidal haemorrhage in anticoagulant taking wet-AMD patients. A retrospective study has been performed to present the clinical course, management and final outcome of spontaneous suprachoroidal haemorrhage in 7 eyes of six age-related macular degeneration patients seen in our clinic from January 2016 to April 2017. All patients were on chronic oral anticoagulant therapy because of cardiovascular disorder. In one patient, haematological disorder was also present modifying significantly the haemostasis. All eyes received prior anti-VEGF treatment for exsudative AMD. Acute angle closure glaucoma - with no response to topical and oral IOP lowering therapy - was the most frequent ocular complication in our cases. The final visual prognosis was usually very poor. The risk of spontaneous suprachoroidal haemorrhage is increased in wet-AMD patients who are on anticoagulant therapy. To prevent this blinding condition, a stronger communication between ophthalmologists and cardiologists would be beneficial, with an ophthalmological check-up in this group of patients before and during the use of anticoagulants. Orv Hetil. 2018, 159(24): 985-990.
Asunto(s)
Anticoagulantes/efectos adversos , Hemorragia de la Coroides/etiología , Degeneración Macular/complicaciones , Índice de Severidad de la Enfermedad , Anciano , Anciano de 80 o más Años , Hemorragia de la Coroides/terapia , Femenino , Humanos , Masculino , Hipotensión Ocular/etiología , Pronóstico , Agudeza VisualRESUMEN
PURPOSE: To review the most current treatment recommendations and outcomes for delayed suprachoroidal hemorrhages. METHODS: Article review of management and outcomes of suprachoroidal hemorrhages, with emphasis on delayed suprachoroidal hemorrhages in the setting of glaucoma surgery. CONCLUSION: Time of drainage of suprachoroidal hemorrhages remains controversial. Earlier drainage should be considered with high intraocular pressure, expulsion of intraocular content, or retinal detachment. In clinically stable eyes with suprachoroidal hemorrhage, recommendations range from observation to immediate drainage. Clot lysis occurs at roughly 14 days.
Asunto(s)
Hemorragia de la Coroides , Manejo de la Enfermedad , Cirugía Filtrante/efectos adversos , Glaucoma/cirugía , Complicaciones Posoperatorias , Agudeza Visual , Hemorragia de la Coroides/diagnóstico , Hemorragia de la Coroides/etiología , Hemorragia de la Coroides/terapia , Humanos , Presión IntraocularRESUMEN
BACKGROUND: [corrected] To indentify surgical risk factors for delayed suprachoroidal haemorrhage (DSCH) and to report the outcomes of an effective intervention in a consecutive of patients. METHODS: The clinical data of ten patients diagnosed with DSCH in our hospital between July 2007 and December 2012 were extracted from hospital records and analyzed, including ophthalmologic examination, ophthalmologic ultrasonography, surgical procedures, and outcome measures including visual acuity and intraocular pressure. RESULTS: Ten eyes of ten patients including six men and four women with mean age of 56.6 ± 17.67 years, with DSCH, were enrolled. After diagnosis, drainage or/and pars plana vitrectomy were performed for eight patients; another two received conservative treatment. All the patients were followed up for 15.2 ± 4.3 months. Intraocular pressure decreased significantly (p < 0.001); the mean final visual acuity improved significantly after intervention (p < 0.001). CONCLUSIONS: We emphasized other great risk factors such as intraoperative mitomycin-C use, systemic anticoagulation or thrombolysis, and chronic kidney disease. It seems that earlier surgical intervention after the diagnosis of DSCH will be beneficial to patients by improving their final visual acuity.
Asunto(s)
Hemorragia de la Coroides/terapia , Lesiones Oculares/complicaciones , Procedimientos Quirúrgicos Oftalmológicos/efectos adversos , Complicaciones Posoperatorias , Adulto , Anciano , Hemorragia de la Coroides/etiología , Dexametasona/uso terapéutico , Drenaje/métodos , Intervención Educativa Precoz , Femenino , Glucocorticoides/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , VitrectomíaAsunto(s)
Hemorragia de la Coroides/terapia , Fibrinolíticos/uso terapéutico , Succión/métodos , Activador de Tejido Plasminógeno/uso terapéutico , Anciano de 80 o más Años , Hemorragia de la Coroides/diagnóstico por imagen , Terapia Combinada , Humanos , Masculino , Esclerostomía , Tomografía Computarizada por Rayos XRESUMEN
The aim of our report is to present 2 cases of patients with suprachoroidal hemorrhage (SH). Suprachoroidal hemorrhage occur relatively infrequently and in our cases are not associated with the surgery or postoperative period. The first case was a patient with suprachoroidal hemorrhage following spontaneous corneal penetration after corneal ulcer. The second case was a patient with a suprachoroidal hemorrhage after severe contusion of the eye globe. The most important is rapid diagnosis of disease, differentiation from other eye diseases and initiation of therapy. We discuss clinical symptomatology, diagnostic and treatment of suprachoroidal hemorrhage.
Asunto(s)
Hemorragia de la Coroides/etiología , Contusiones/complicaciones , Perforación Corneal/complicaciones , Lesiones Oculares/complicaciones , Anciano , Hemorragia de la Coroides/diagnóstico , Hemorragia de la Coroides/terapia , Humanos , Masculino , Persona de Mediana EdadRESUMEN
AIMS: To evaluate the incidence, patient risk factors, diagnosis and management of suprachoroidal hemorrhage (SCH) after glaucoma filtering surgery. METHODS: Retrospective case series study comprised 1553 eyes having glaucoma filtering surgery during the last 15 years (between January 1993 and December 2007) at our department. Observations included incidence, patient risk factors, peri and postoperative diagnosis, management, and outcomes of SCH after this procedure. RESULTS: Two cases of SCH were revealed. In one eye SCH developed at the end of surgery, in the other eye in the postoperative period. Both patients had systemic and ocular risk factors (hypertension, high preoperative intraocular pressure, myopia, pseudoexfoliation, aphakia or pseudophakia). Visual functions improved in the case of intraoperative SCH over 2 months withouth surgical intervention, in the eye with delayed postoperative SCH visual outcome was poor despite multiple lavages of anterior chamber and vitreous cavity. CONCLUSION: Suprachoroidal hemorrhage, both expulsive and delayed, is a rare, but severely debilitating complication of glaucoma surgery.
Asunto(s)
Hemorragia de la Coroides/etiología , Cirugía Filtrante/efectos adversos , Glaucoma/cirugía , Anciano , Cámara Anterior , Hemorragia de la Coroides/fisiopatología , Hemorragia de la Coroides/terapia , Femenino , Humanos , Complicaciones Intraoperatorias , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Recuperación de la Función , Irrigación Terapéutica , Factores de Tiempo , Resultado del Tratamiento , Agudeza VisualRESUMEN
PURPOSE: This study aimed to evaluate the clinical features and visual outcomes of non-traumatic suprachoroidal haemorrhage (SH) in Taiwan. METHODS: We report a retrospective, non-comparative, interventional case series study carried out in an institutional setting. Thirty-nine eyes with non-traumatic SH were studied using a new system for grading the severity of SH. The aetiologies of SH were analysed. The correlations between grades and prognoses of SH were studied. Multiple logistic regression was used to assess factors associated with final visual outcome. RESULTS: Conditions causing SH in the eyes considered in this study included cataract surgery (43.59%), age-related macular degeneration (AMD) (17.95%), filtering operation and vitrectomy (both 10.26%), scleral buckling (5.13%) and others. Twelve eyes (12/39, 30.77%) had a final visual outcome of no light perception. Only 12 eyes (12/39, 30.77%) had final visual acuity (VA) > 4/200. Grade of SH correlated significantly with need for surgical drainage and with final visual outcome (Spearman rank correlations 0.313 and - 0.408, p = 0.010 and p = 0.00317, respectively). 'Good' and 'poor' final VA was significantly associated with VA at the time of SH (multiple logistic regression coefficients 2.132 and - 2.809, p = 0.015 and p = 0.008, respectively), as well as initial retinal detachment (multiple logistic regression coefficients - 2.267 and 2.223, p = 0.036 and p = 0.006, respectively). Higher grades of SH and increased age were associated with poor final visual outcome (multiple logistic regression coefficients - 1.332 and - 0.122, p = 0.013 and p = 0.022, respectively). CONCLUSIONS: Suprachoroidal haemorrhage is a devastating ocular problem. Complications of intraoperative surgery and AMD are common causes. The new SH grading system provides a simple method for evaluating the need for drainage and for predicting visual prognosis. Visual acuity and retinal detachment at the time of SH are major factors associated with good and poor final VA, respectively.
Asunto(s)
Hemorragia de la Coroides/etiología , Hemorragia de la Coroides/fisiopatología , Agudeza Visual , Hemorragia de la Coroides/complicaciones , Hemorragia de la Coroides/terapia , Evisceración del Ojo , Humanos , Modelos Logísticos , Degeneración Macular/complicaciones , Hipotensión Ocular/etiología , Procedimientos Quirúrgicos Oftalmológicos/efectos adversos , Dolor Intratable/etiología , Dolor Intratable/cirugía , Pronóstico , Desprendimiento de Retina/complicaciones , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , TaiwánRESUMEN
BACKGROUND: Choroidal hemorrhage is usually seen as expulsive hemorrhage related to surgical invasion and is rarely observed in the absence of surgery or trauma. In this report, we describe a case of choroidal hemorrhage caused by hypertension related to chronic renal failure. CASE: A 32-year-old man presented with sudden visual loss, eye pain and swelling in his left eye. He had a history of renal failure and hypertension. Eye examination demonstrated choroidal hemorrhage associated with ocular hypertension in his left eye and marked hypertensive retinopathy in his right eye. OBSERVATIONS: He was treated with hemodialysis and antihypertensive drugs. Upon repeat eye examinations, a gradual reabsorption of the choroidal hemorrhage was observed, although vitreous hemorrhage appeared in the left eye. The vitreous hemorrhage was treated with vitrectomy with the patient regaining good visual acuity post-surgery. CONCLUSIONS: This rare case suggests that patients with severe background disease need to be carefully observed.
Asunto(s)
Hemorragia de la Coroides/etiología , Hipertensión/complicaciones , Fallo Renal Crónico/complicaciones , Adulto , Antihipertensivos/uso terapéutico , Hemorragia de la Coroides/terapia , Humanos , Hipertensión/terapia , Fallo Renal Crónico/terapia , Masculino , Diálisis Renal , Resultado del Tratamiento , VitrectomíaAsunto(s)
Hemorragia de la Coroides/terapia , Anciano de 80 o más Años , Hemorragia de la Coroides/etiología , Terapia Combinada , Femenino , Glaucoma/tratamiento farmacológico , Glaucoma/cirugía , Humanos , Presión Intraocular , Mitomicina/administración & dosificación , Enfermedades del Nervio Óptico/tratamiento farmacológico , Enfermedades del Nervio Óptico/cirugía , Trabeculectomía/efectos adversos , Agudeza VisualRESUMEN
PURPOSE: To estimate retrospectively the incidence, predisposing factors, and possible mechanisms precipitating massive suprachoroidal hemorrhage (MSCH) development during cataract extraction surgery. METHODS: The study was conducted on 6639 consecutive cataract extractions performed between 1994 and 2002. All of the procedures were carried out using traditional nucleus expression methods. The study cases comprised 19 patients who developed intraoperative MSCH. The remaining 6620 patients served as the control group. Baseline systemic and ocular characteristics, as well as intraoperative factors, were analyzed. Categorical variables were analyzed using the chi-square test and the Fisher exact test. RESULTS: The incidence of MSCH during cataract surgery was 0.28%. Highly significant risk factors included high myopia, glaucoma, and diabetes (p<0.01). Atherosclerotic vascular diseases and/or hypertension were less significantly related to the condition (p<0.05). There was no significant relationship between MSCH formation and age, sex, side of the cataract, history of ocular trauma, or inflammation. The incidence of MSCH did not differ between patients operated on with extracapsular or intracapsular cataract extraction. CONCLUSIONS: Attention to multiple preoperative and intraoperative ocular and systemic variables may allow the identification of, and prophylaxis for, patients at greater risk for MSCH.
Asunto(s)
Extracción de Catarata , Hemorragia de la Coroides/epidemiología , Complicaciones Intraoperatorias , Adulto , Anciano , Anciano de 80 o más Años , Hemorragia de la Coroides/diagnóstico , Hemorragia de la Coroides/terapia , Femenino , Humanos , Incidencia , Presión Intraocular , Implantación de Lentes Intraoculares , Masculino , Persona de Mediana Edad , Polonia/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Agudeza VisualRESUMEN
AIMS: To study the incidence, management, and outcomes of suprachoroidal haemorrhage (SCH) complicating cataract surgery in the United Kingdom. METHODS: Cases were prospectively collected by active surveillance through the British Ophthalmological Surveillance Unit. Details were obtained using an incident questionnaire with follow up at 6 months. RESULTS: 118 cases were reported in 1 year. The estimated incidence of SCH was 0.04% (95% confidence interval 0.034% to 0.050%). Cataract extractions were by phacoemulsification in 76.2%, extracapsular cataract extraction (ECCE) in 11.0%, and phacoemulsification conversion in 12.8%. SCH was "limited" (1 to 2 quadrants) in 48.7%, "full blown" (3 to 4 quadrants) in 43.1%. SCH in phacoemulsification was more likely to be limited (63.2%), compared with ECCE (11.1%) and phacoemulsification conversion (23.1%) (p<0.001, chi(2) test). Visual acuity (VA) was better than 6/60 in 57 of 95 (60%) cases after a median follow up interval of 185 days. 33 of 34 cases (97.1%) with secondary anterior segment revision had VA better than 6/60. VA was worse than 6/60 in 7 of 8 (87.5%) cases that had intraoperative sclerostomy, and in all 6 (100%) cases that had secondary posterior segment intervention. CONCLUSION: SCH is a rare but serious complication of cataract surgery. Poor prognostic factors included full blown SCH, ECCE, phacoemulsification conversion, retinal apposition, and retinal detachment.
Asunto(s)
Extracción de Catarata/efectos adversos , Hemorragia de la Coroides/etiología , Complicaciones Intraoperatorias/etiología , Anciano , Anciano de 80 o más Años , Hemorragia de la Coroides/epidemiología , Hemorragia de la Coroides/terapia , Femenino , Humanos , Incidencia , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/terapia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Resultado del Tratamiento , Reino Unido/epidemiologíaRESUMEN
PURPOSE: To identify the risk factors, prognostic factors, and clinical outcomes of patients with perioperative appositional suprachoroidal hemorrhage (ASCH). DESIGN: Case-control study. SETTING: Tertiary referral center. METHODS: Subjects included all patients with perioperative ASCH documented by B-scan ultrasound between May 1990 and March 2001. Two or three control patients were selected for each case, matched by surgeon, procedure, and date of surgery within 1 month. Surgery was performed as necessary. main outcome measures. The odds of ASCH associated with clinical risk factors. secondary outcome measure: visual acuity. RESULTS: Thirty-seven cases with ASCH were identified. Ninety-two procedure- and surgeon-matched control subjects (2.48:1) were selected. Twenty-six cases (71%) of ASCH were related to a glaucoma operation. Risk factors for the development of ASCH included previous vitrectomy (P = .003, odds ratio of 12) and older age (P = .007, odds ratio 1.57/decade of increasing age). Hypertension was found to be protective (P = .02, odds ratio of 0.33). Factors associated with a poor visual outcome in patients with ASCH included apposition >30 days (P = .01), history of uveitis (P = .04), history of dry age-related macular degeneration (P = .05), and history of extracapsular cataract extraction (P = .05). Median pre-ASCH visual acuity was 20/100, and final median visual acuity was 20/1600. CONCLUSIONS: Risk factors for the development of ASCH include previous vitrectomy and older age. Patients with these risk factors should be informed of their greater chance of poor visual acuity and anatomic outcomes secondary to the development of ASCH.