Influence of Surgical Procedures and Instruments on the Incidence of Suprachoroidal Hemorrhage during 25-gauge Pars Plana Vitrectomy.

ABSTRACT

PURPOSE: To evaluate the influence of surgical procedures and instruments that are associated with intraocular pressure (IOP) fluctuations on the incidence of suprachoroidal hemorrhage (SCH) during 25-gauge pars plana vitrectomy (25G-PPV), and to investigate the clinical features of SCH during 25G-PPV. DESIGN: Retrospective, comparative case series. PARTICIPANTS: A total of 3034 cases that underwent initial 25G-PPV at a single surgical center. METHODS: Univariate analysis was performed to evaluate the relationships between the incidence of SCH during 25G-PPV and the surgical procedures and instruments that were associated with IOP fluctuations. The participants were divided into 4 groups that underwent the following procedures neither fluid-air exchange nor vitreous shaving under scleral depression (group 1, n = 1144); fluid-air exchange alone (group 2, n = 463); vitreous shaving under scleral depression alone (group 3, n = 639); and both procedures (group 4, n = 788). The incidence of SCH in each group was compared. The clinical features and surgical outcomes of SCH during 25G-PPV were also investigated. MAIN OUTCOME MEASURES: The incidence of SCH during 25G-PPV and the clinical features and surgical outcomes of SCH during 25G-PPV. RESULTS: The incidence of SCH was significantly higher in cases that underwent fluid-air exchange (P = 0.0047) or vitreous shaving under scleral depression (P = 0.0157). There were no significant relationships between the incidence of SCH and the use of surgical instruments. The incidence of SCH in group 4 (8/788, 1.02%) was significantly higher than that in groups 1 (1/1144, 0.09%), 2 (0/463, 0%), and 3 (0/639, 0%) (P = 0.01). Almost all SCH cases were localized, and there were no cases of SCH involving the posterior pole. Of all the SCH cases, only one case required reoperation for retinal redetachment. No cases required secondary surgical management for SCH. CONCLUSIONS: There remains a slight risk of SCH during 25G-PPV in cases that require both fluid-air exchange and vitreous shaving under scleral depression. Even if SCH occurs during 25G-PPV, the surgical outcomes after SCH may not be substantially worse.